Schizophrenia Is Not An Illness (Part 1) « Behaviorism and Mental Health

Schizophrenia Is Not An Illness (Part 1)

The APA defines schizophrenia by the presence of two or more of the following, each present for a significant portion of time during a one-month period:

(1) delusions

(2) hallucinations

(3) disorganized speech

(4) grossly disorganized or catatonic behavior

(5) negative symptoms i.e. affective flattening, alogia or avolition

Signs of the disturbance must have been present for at least six months and there must be significant deficits in one or more areas of functioning such as work, interpersonal relations or self-care.

The “two or more” concept constitutes a substantial flaw in the so-called diagnosis. An individual who is displaying hallucinations and delusions (criteria 1 and 2) will be assigned a diagnosis of schizophrenia. But a person whose behavior is grossly disorganized and whose affect is flat (criteria 4 and 5) can be assigned the same diagnosis. Superficially these presentations are very different, and the only reason for assigning the same diagnosis is that the APA say so. This state of affairs is found throughout DSM. Elliot S. Valenstein, Professor Emeritus of Psychology and Neuroscience at University of Michigan has this to say:

“Although those who directed the DSM-IV project claim that “there has been a stronger emphasis on research data than with previous revisions,” scientific considerations do not play a significant role in the manual. Instead, the psychiatric tradition and sociopolitical considerations seem to have played the major roles in shaping this document. Dr. Allen Frances, who directed the DSM-IV project, stated that “we didn’t want to disrupt clinical practice by eliminating diagnoses in wide use.” Very different symptoms are included under the rubric of “schizophrenia” mainly because they have always been grouped together, rather than because of any new scientific evidence that they share a common etiology.” (Blaming the Brain, 1998, p 161)

This contrasts markedly with general medicine. For instance, there is a disease called Wegener’s granulomatosis which is caused by inflammation of the blood vessels. In the large vessels the inflammation does relatively little harm, but the small vessels can become completely occluded, leading to significant damage in kidneys, lungs, nerve endings, etc.. People with this disease may present very different clinical pictures, but the underlying disease process is essentially the same and the same antibody will be found in their blood stream.

It is widely assumed among the general public that some kind of similar commonality is present in schizophrenia, and that psychiatrists and other mental health professionals are aware of this pathological link. This is simply not the case. Selecting two “symptoms” out of five leads to ten different presentations. Selecting two or more out of five yields 25 different permutations. Whilst one can acknowledge that a measure of overlap and commonality might exist in these various presentations, there is no evidence that all of these people have the same underlying pathology. They are assigned the same diagnosis and deemed to have the same “mental illness,” simply because the APA says so.

The central point of this blog is that the concept of mental illness is essentially spurious, and that the vast majority of the problems set out in DSM are problems of daily living and learned behavior. The so-called diagnoses are routinely presented as explanations of abnormal or unusual behavior, when in fact they are nothing more than labels.

Let’s examine the schizophrenia “symptoms” one by one.

Delusions

A delusion is a false belief. Now the only way you can discern a person’s belief is through his speech, writing, or other overt indication. All of these indicators are behaviors. Speech is behavior, and our patterns of speech are subject to the same behavioral influences as any other behaviors. So when people express nonsensical ideas (or more accurately, when they speak nonsense) we need to ask why. Under the DSM system, we don’t ask why. The delusional speech is simply a “symptom” of the “illness” called schizophrenia, and nothing remains except the prescription of major tranquilizers. In fact, it is widely believed, and promulgated to students, that nothing can be done to ameliorate delusional speech.

The reality is quite different. For decades numerous researchers have demonstrated that delusional speech can be reduced and eliminated through appropriately designed behavioral interventions. Ayllon and Haughton (Modification of symptomatic verbal behavior of mental patients in Behavior Research and Therapy, 1964, 2, 87-97), for instance, achieved a 60% reduction in a hospital patient’s delusional speech by training the staff to ignore these kinds of remarks over a period of 6 months. The individual in question routinely referred to herself as “the Queen,” and would question staff as to why she was not being afforded treatment befitting this exalted position. This had been going on for fourteen years. The staff were trained to simply not respond, to look away, to appear bored, to shift their attention elsewhere, etc., whenever she made these kinds of delusional statements, but to respond normally to non-delusional speech.

The essential point is that delusional speech is behavior and follows the same general principles as any other behavior. In particular, speech which attracts positive attention and approval is more likely to increase in frequency, while speech which attracts no attention or disapproval tends to be eliminated. This is as true of everyday conversations as it is of the delusional speech of mental health clients.

In the same article mentioned above, Ayllon and Haughton describe two mental hospital clients, one with a diagnosis of schizophrenia, the other depression. Both were females and both spent a good deal of time complaining about their health, even though no physical problems had been detected. This had been going on for years. Here again, the hospital staff were trained to ignore the somatic complaints, and to respond positively and attentively to normal speech. The incidence of delusional speech declined rapidly, and by 18 months had been reduced to virtually zero. This research was done 45 years ago! More recent examples can be found at Wilder et al (Journal of Applied Behavior Analysis, 2001, V 34, No 1, 65-68) and Mace and Lalli (Journal of Applied Behavior Analysis, 1991, V 24, No 3, 553-562)

What’s particularly noteworthy here is that mental health staff unwittingly but routinely reinforce delusional speech. Under the DSM system, this kind of behavior is considered a symptom, and the staff tend to “prick up their ears,” so to speak, when clients emit this kind of speech. The staff member may even take notes. Mental health clients are as adroit as anybody else at reading signs of attention and approval, and staff become the unwitting coaches for delusional behavior. This kind of interaction is a direct consequence of the DSM system, under which schizophrenia is conceptualized as an incurable disease, one of whose symptoms is the presence of delusions. If one focuses instead on delusional speech as a dysfunctional behavior which is learned, then the appropriate response becomes clear: ignore the delusional speech and encourage normal speech. Note that this is not the same as trying to talk the individual out of his delusions – trying to persuade him that he is mistaken. These kinds of attempts are generally unsuccessful, because they provide attention and therefore reinforcement.

In Western culture the three great challenges of early adulthood are: emancipation from parents; launching a career; and finding a life partner. At the risk of stating the obvious, some individuals are more successful in these endeavors than others. Most young people, however, manage to stumble through these difficult times and to emerge into adulthood with a reasonable measure of success in these three areas.

Some hapless individuals, however, fail miserably in one or more of these challenges, and a small number of people fail in all three. Whenever we fail – whenever we don’t succeed in meeting an objective – whether the matter is large or small – we always have two options. We can recognize the failure and take corrective action, or we can reorganize our thinking so that the failure gets relabeled as something else. This fundamental truth is expressed nicely in the old adage: A bad carpenter blames his tools. If I decide, for example, to make a window box and the project is a disaster, I can acknowledge that I need to improve my carpentry skills, perhaps even attend some classes, or I can complain that the tools were no good or the lumber was defective, or that my wife is a nag for asking me to do the project in the first place, etc.. In other words, I can change my behavior (in this case my carpentry skills) or I can change my thinking. In general the latter is usually easier than the former.

In the case of the window box, the outcome is relatively trivial. In the case of major failures, however, the outcome is very significant, and the cognitive distortion can be considerable.

Consider the example of a young man who leaves home after graduating from high school, and finds a job in another town. He is filled with hope and a sense of independence, but after a couple of months he is fired. He is so dispirited that he doesn’t seek another job, and a month of two later is evicted from his apartment. Finally, in desperation, he calls “home” and his parents wire him the bus fare and pick him up at the bus station. For good measure, let’s also say that his girl friend has dumped him

Now if he’s an exceptional young man, he might say something like this:

“Thank you mother and father for rescuing me. I really didn’t have the discipline, stamina, or interpersonal skills necessary to succeed in the adult world. If it’s all right with you, I’d like to stay here with you for another year and work on my skill deficits. I’ll get a job and pay you rent, and I’ll join Toastmasters to help me develop some confidence in my dealings with other people, and I would greatly appreciate any feedback or coaching that you could give me.”

Unfortunately a more likely scenario is that he sulks in his room, neglects his personal hygiene, and persuades himself that he would have been ok if people hadn’t had it in for him. In a context of significant failure, these kinds of paranoid thoughts feed on themselves, and in extreme cases reach a level that would be described as delusional. A good measure of family tension usually ensues. Sometimes this degenerates into overt hostility, which further feeds and confirms the young person’s paranoia.

At this stage, he (or she) discovers that delusional speech has a significant pay-off. It reduces expectations. He is no longer expected to find a job, set up home for himself, or find a life partner. He is referred to the mental health system, where he is given a diagnosis and a prescription for a major tranquilizer. He may also be awarded disability status with financial and medical benefits. By this stage the chances of emancipation and functional independence are slim. (The major tranquilizer, of course, dampens down the problem behavior. But real improvements in functioning are rare, and the side effects of the drugs can be truly devastating.) If the parents ask why their son is so paranoid and withdrawn and unmotivated, they will receive the reply: “because he has schizophrenia.” This looks like an explanation, but if the parents were to press the matter and ask: “how do you know he has schizophrenia?” the only possible reply is: “because he is so paranoid, withdrawn, and unmotivated.” The “diagnosis” of schizophrenia is nothing more than a label describing the very behaviors it purports to explain. And a destructive label at that, in that it stifles and suppresses genuine exploration into the true cause(s) of the problem, and genuine remediation of the original skill deficits.

It needs to be stressed that I’m not suggesting that our hypothetical individual is deliberately and consciously faking his “craziness.” It is simply the case that behavior that is reinforced tends to increase in frequency whilst behavior that is not reinforced or which attracts negative consequences becomes less frequent. In the case in question, the behavior of launching out on one’s own, finding a job, and a partner, etc., all ended disastrously. But the behavior of sulking in his room expressing angry paranoid thoughts was rewarded with attention, solicitous concern, home-cooked meals, and an extraordinary measure of power and control over his parents. The outcome is not surprising. An essential point here is that delusional speech and normal speech are on a continuum. People express mildly delusional ideas all the time. Listen to any talk radio show. Listen to politicians railing against their opponents. Listen to religious zealots. Listen to racial stereotypes. Listen to people who insist that the Earth is only 6000 years old. Listen to golfers after they’ve played a bad stroke. Listen to people who get passed over for promotion, etc., etc., etc.. The processes that promote this kind of mildly delusional speech can lead to severe delusions if the conditions are ripe.

It is noteworthy that our young person’s real problem – i.e. a marked lack of general coping skills – never gets addressed. The skills we’re talking about here include:

- critical self-appraisal

- bringing tasks to completion

- not procrastinating

- making good dietary decisions

- managing money; budgeting

- interacting appropriately with supervisors and other authority figures

- interacting with peers; resisting negative peer pressure

- managing a checking account

- getting to bed at a reasonable hour

- “chatting up” prospective sexual/relational partners

- dating

- personal hygiene

- buying and maintaining a car

- house-cleaning and general management of personal space

- choosing friends

- cooking

- good management of time

- etc., etc., etc.

Our culture is generally unsympathetic to individuals who are in trouble because of basic skill deficits. We have helpful programs for vocational skill deficits, but not for the more fundamental skills, such as those listed in the previous paragraph. Individuals with these kinds of deficits are usually subjected to censure and negative labeling (e.g. lazy, dirty, slovenly, prodigal, brash, stupid, klutzy, etc.)

The point here is that the three great challenges: emancipation from parents, launching a career, and finding a life partner – are just that: great challenges. They are not easy. But this fact is seldom acknowledged. The cultural expectation is that young people should be able to do all this without difficulty. And the fact is that most of us do manage to muddle through these years with at least some measure of competency. Others, however, don’t, and some of this latter group crash disastrously and become mental health clients for life. In this regard it is noteworthy that the majority of people who are assigned a “diagnosis” of schizophrenia are “diagnosed” in their late teens and early adulthood – precisely when the basic skills demands are greatest.

Of course the bio-psychiatric school would contend that these individuals were already “sick” before they started their emancipation endeavors – that they had a brain disease which impacted their ability to function effectively. This position may be correct. But the APA’s definition of schizophrenia includes the criterion that “(the disturbance is not due to … a general medical condition.” So delusional behavior that is caused by a brain malfunction is not (by definition) schizophrenia. If indeed it could be established that there are individuals with compromised brains and that this neurological damage was truly the cause of problems in living, then the disease needs to be recognized as such, given an appropriate name (e.g. Smith’s neuropathy or whatever), diagnosed neurologically, and treated appropriately. Meanwhile, assuming a neurological deficit on the basis of unusual or abnormal behavior is intrinsically unsafe. When we are considering people’s behavior, there are always multiple paths to the same place. Consider eleven people on a soccer team playing a game on a Saturday afternoon. They are all engaged in the same activity (playing soccer), but the sequence of events that led them to this point will be extremely diverse. One player, for instance, might be motivated largely by a desire to please his father, while another might be there primarily to annoy his father. A third might be simply trying to lose weight. A fourth is showing off for his girlfriend. A fifth may be trying to dissipate feelings of anxiety and tension, etc., etc., etc..

Similarly, it is clear that genes and physiology have an impact on people’s actions, and it is possible that one person’s delusional speech is the direct result of a brain malfunction. Another person, however, could be emitting very similar behavior without any neurological problem; the delusional speech in the latter case being the outcome of the kind of failure-ridden psychosocial history described earlier. The brain is a pattern-seeking apparatus. It looks for regularities and patterns in the data it receives and stores these patterns for later use. When it can’t discern a pattern (for whatever reason), it makes one up. In the case of our hypothetical young person mentioned above, the correct pattern was his significant lack of skills in a wide range of areas. This is a difficult thing to accept, so his brain invented the notion that other people were out to get him – were sabotaging his efforts. From his point of view this is a perfectly valid explanation for his failures. Of course, it’s not the true reason, and other people see him as paranoid and delusional, and if he is referred to the mental health system, he is given a diagnosis of schizophrenia.

The problem areas which the APA label as schizophrenia constitute an extremely complex topic, and inevitably this blog post has become very lengthy. I have more to say on this matter, but I thought I’d post this and continue with more thoughts on schizophrenia in the next post. Meanwhile, your comments – as always – are welcome.

Next post: Schizophrenia is not an illness (Part 2)

delusional speech, schizophrenia

This entry was posted on January 21, 2010, 7:35 pm and is filed under A Behavioral Approach to Mental Disorders. You can follow any responses to this entry through RSS 2.0. You can leave a response, or trackback from your own site.

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The purpose of this website is to provide a forum where current practices and ideas in the mental health field can be critically examined and discussed. It is not possible in this kind of context to provide psychological help or advice to individuals who may read this site, and nothing written here should be construed in this manner. Readers seeking psychological help should consult a qualified practitioner in their own local area. They should explain their concerns to this person and develop a trusting working relationship. It is only in a one-to-one relationship of this kind that specific advice should be given or taken.

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Nightingale

I stumbled across your article about schizophrenia and it struck a chord with me, so I thought I’d tell you about my personal experience.

I do know that schizophrenia is genetically inherited, as it has been shown to be passed down from generation to generation. They believe my birth father had schizophrenia and so do I (though I don’t take medication, I’ve grown to accept and have learned to live with it in harmony and see it more as personality disorder now in my social awkwardness). However, I believe that those with schizophrenia may have a genetic predisposition towards feeling the need to develop these perceptions as a sort of defense mechanism to an offensive outside world created by an equally dysfunctional society.

I developed mild to moderate schizophrenia at the age of 2 years old (or even earlier). My memory is impeccable in that I can remember that far back, including details of my childhood home, and have had my memories confirmed by my parents.

My parents adopted my sister around the time I developed schizophrenia, which (considering the circumstances) may have been the trigger for it. My sister is a troubled child from Romania who suffers from Fetal Alcohol Syndrome and severe behavioural problems. Even as a baby, she would scream and scream for hours on end at night for seemingly no reason at all.

This put horrible stress on me and even more so when my parents started to neglect giving me attention over my sister’s constant need for it. So, I developed what I call “characters” in a world I originally called “Character Land” and which separated into “the Carousel” and “the Wasteland” within the last 3 years.

This land is literally filled with cartoon characters (like Mickey Mouse, Bugs Bunny, Batman, Superman, etc). I began spending more time alone as a result, so I now believe my schizophrenic tendencies to have resulted from a defense mechanism designed to combat childhood loneliness and abandonment (the imaginary friends who never went away because they were always needed).

This torment with my sister continued on until I left home at age 19 and still occurs on a much less impacting scale today. My sister (along with the death of my grandmother) eventually drove my mother to severe alcoholism and a mental breakdown. My father preoccupied himself with work as a distraction and sometimes disassociated himself with family life.

I drove myself into an introverted lifestyle, developed decent but awkward social tendencies (that get more and more awkward the longer I’ve gone without regular human interaction) and gained a sense of distorted love and distrust for my own family due to our daily blow-up arguments and a fatigued, verbally abusive mother.

I’m unclear if the stress my sister caused our family hurt me or my mother more. Certainly we were both affected in our own painful ways. My mother was certainly not the kind of woman who could handle a challenge like my sister. She became an angry, petulant and bitter person, with a child-like approach to her emotions, as a result and even today still takes her frustration out on either my sister, me or herself often in the form of emotional degradation.

It was perhaps all three of us who truly damaged each other. My sister acted up and that stressed out my mom, who would sideline or even snap at me as a result while giving attention (no matter how negative) to my sister. My pain at feeling rejected would result in my snapping back (to hurt her) while retreating even deeper into myself in the process, which only confused and irritated my mother, who took it out on both my sister and I. My sister began taking even the negative attention as positive, so she’d lash out even more. A vicious cycle that was sure to eventually implode…and it did.

Eventually, I snapped and left home because of the hostile environment and aggravated thoughts of suicide as a result. My sister snapped a year later in a very violent way towards my mother (she threatened to attack her with a kitchen knife one day), so she was sent to prison before being sent to a foster home. My mother’s mental breakdown occurred shortly after the incident, which led her to lock herself in her room for 5-6 months and drink heavily. Yes, I’m aware I have a fucked up family. LOL! But who doesn’t these days? The funny part is that I seem to be the only one who can see the reality of it clearly (so much for schizophrenics losing touch of reality, huh).

So, as you were saying, schizophrenia is perhaps a behavioural problem not because its behavioural tendencies are genetic but because the genetic code causes those with the illness to perceive others’ interactions, their environment or social situations differently, which causes them to dig deeper into the behavioural disorder as a form of comfort.

Not everyone finds comfort in their schizophrenia, though. Mainly, I think, due to being told that it isn’t normal which already eats away at a fragile ego, but I believe that’s what its there for. As a natural neurological defense set up in a person simply programed to perceive the world differently, to help protect that person from whatever emotional harm is vexing them. I believe that occasionally schizophrenia can BECOME the emotional harm if the individual does not address the situation, allows their thoughts to embody their negativity or masks the pain using improper medication.

Schizophrenia, I believe, is quite simply a series of vivid involuntary jumps into one’s subjectively sensitive psyche that is relayed back as an artificially interactive stimulus. It is from my experience with Character Land and my own schizophrenia that this experience is built out of components or concepts that the mind has found simple and repetitive to comprehend and relay to itself (frequently heard words, frequently seen people, constantly occurring feelings, etc). So, a schizophrenic who is suicidal might have developed that through the frequent negativity in his own life that is agitating his thought patterns to such a degree that it eventually consumes him.

Problem is that some don’t like what they see and hear when they experience their mind. They fear their difference based on personal insecurities, negative environmental influences or pressure from the medical community to heavily medicate. Those with schizophrenia sometimes can hear their thoughts as if they were commentated, so it’d be safe to theorize that the suicidal tendencies and negative thoughts that schizophrenics are prone to hearing may be brought upon as a sort of visual and audio conceptualization of their own poor emotional health brought to light by behavioural ineptness, self-esteem issues or a negative childhood.

In other words, people with schizophrenia aren’t sick. We’ve been given a strange anomaly that allows us to literally experience ourselves in both mental and physical realities. That being said, schizophrenics might just be individuals who are very sensitive to their physical and social environments and are subject to suggestive sensitivity. If I’m correct, then that means that, if their emotional life is in negative turmoil, then their schizophrenic experience might be more negative than a schizophrenic who has a more optimistic approach to life. Also, that social withdrawal may be one way schizophrenics attempt to reduce some emotional negativity in their life brought upon by awkwardness. This only worsens their social abilities. Considering our world is so very negative today, is it any wonder that so many people with schizophrenia feel the negativity and stress in their thought pattern too?

It’s interesting to note that my parents still don’t know I’m schizophrenic. Regardless of my constant admittance of hearing voices or having “characters” that I talked to, my parents refused to accept that BOTH their children had “problems” and, thus, they refused to let me get tested. Audible noises were brushed off as a “hyperactive imagination”. Talking to my “characters” was a cute, childhood game turned “bad habit” to them that they believed I was simply left not dealt with due to me just not being dedicated enough in stopping the behaviour.

Furthermore, I had been alone for so long that I developed a fear of public humiliation and built the belief in my mind that I was only going to hurt the family more by making my issues another problem for my parents to deal with. I also have a strange ability to separate my reality from the Carousel, so I know what is real and what isn’t. I hear the voices but I understand where they’re coming from, so I’ll only ever have out-loud conversations with myself or show such ticks when I’m alone. Otherwise, the only visible oddity in me is my social withdrawal and awkwardness in face-to-face interactions.

That combination resulted in my parents never noticing or not believing my issues were a problem to be addressed. It wasn’t until very recently that I was diagnosed.

This is getting quite long, but I’ll finish off by saying that my schizophrenia helped me in so many ways because I looked upon it as a good thing that helped enrich my childhood during a time when I needed someone to talk to most (but didn’t click with other kids). I never went through the phase of feeling that my voices were “bad” or “wrong” because nobody cared enough about my condition during my childhood to tell me it was. I see my characters (who are a part of my daily life and are constantly present, if not always acknowledged in public) as loving, loyal, caring, protective companions or guardians who helped guide me with the wisdom of their real cartoon counterparts towards a better future. In some ways, many of my characters even became parental figures and embodied what I believed the perfect parents would be like.

So, for people to say that schizophrenia is a negative thing that requires “fixing” isn’t always correct in all cases. It’s hilarious and ironic, but I truly think I would have gone mad if it weren’t for my schizophrenia.

Thought I’d share my situation with you. Hope you found it interesting!

Cheers,
Nightingale
http://behaviorismandmentalhealth.com Phil

Nightingale: Thank you for your very detailed and insightful comments. You’ve covered such a range of topics, that I hardly know where to start!

Let’s start with the notion of genetic inheritance. The first thing that needs to be recognized is that behavior, as such, is not directly inherited. What is passed on in DNA is structure – not behavior. So, for instance, a snake looks like a snake because his parents looked like snakes. And snakes move along the ground in the way that they do because their structure promotes that kind of locomotion. No amount of training or experience will induce a snake to walk as a human. He, quite literally, doesn’t have the equipment.

Structure determines behavior – but not precisely. Rather, structure establishes limits, and within these limits, experience and training operate to “shape” our habits, etc..

You use the term “genetic predisposition.” The problem with this term is that it is very difficult to define. Most people think of it as a “nudge.” In other words, our genes are nudging us in certain directions. And I suppose this has certain validity, in that our genes do indeed set limits on our behaviors as mentioned above. You could say that we have a genetic predisposition towards walking, in that we have legs. Or a genetic predisposition towards speaking because we have mouths, vocal cords, etc.. But I don’t think a person could be said to have a genetic predisposition towards speaking English. I speak English because that’s the language that my parents taught me – not because I inherited it from my parents or even because I inherited a genetic predisposition to speak it.

Now, it is an obvious fact that people differ in almost any number of areas. These differences are clear to see with regards to externals, but less obvious concerning the inside. But in fact, there are certainly lots of subtle differences in the way our brains, glands, muscles, etc., are structured, and it is very likely that our perceptions, feelings, etc., are different – as a consequence of these structural differences. I know a woman who perceives colors differently with her left eye than her right. These variations are part of what it means to be biological, and should be no more considered illnesses than being a little tall or a little short should be so considered.

You write: “…I believe that those with schizophrenia may have a genetic predisposition towards feeling the need to develop these perceptions as a sort of defense mechanism to an offensive outside world created by an equally dysfunctional society.” Now I don’t believe that genes nudge us that hard, but in every other respect I agree with your statement. I feel that you have expressed that particular reality very well.

There is so much in your comment that I want to respond to, but constraints of time and energy force me to pick up just a few of the more salient points.

You mention social awkwardness, and here again is a clear indication of your honesty and your critical self-appraisal. Most of the individuals who acquire a diagnosis of schizophrenia are socially awkward – but most do not articulate or acknowledge this as you have done. Given the history that you’ve outlined, it would be remarkable if you did not have some social awkwardness. Social skills have to be taught. This is part of what we call parenting. Parents usually don’t even think about this – they just shape their children’s behavior through the time-honored methods of reward, punishment, modeling, encouragement, etc.. When parents say: “Say hello to Aunt Jane,” or say “Please,” they are teaching social skills. Obviously, some parents do a better job of this than others – this is not a value judgment – just a statement of fact. But the question for you and individuals in similar situations is: What can I do about the social awkwardness? And that question is a huge turning point – because learning continues until death, and you can acquire polished social skills – if you want to. And I’m not saying you should – just if you want to. It’s the kind of help that should be available within the mental health system, but rarely is.

There is a philosophical question implicit in your writing: Is it better to live in the real world (with all its tragic and destructive properties) or a fantasy world of my own making? And it sounds almost like you make that choice on a daily basis and that your choice is to vacillate. Certainly the world is replete with hate, exploitation, and destructiveness – but there can also be found love, companionship, and creativity. I suppose the answer to the question for me is to try to keep my life and the lives of my loved ones as joyful and successful as possible, and to spread help and comfort where I can. When I say “successful” I don’t necessarily mean that in the conventional sense. But I believe we all need to experience feelings of success in something.

I encourage you to read my post on Posttraumatic Stress Disorder.

You seem very comfortable with what you call your “characters.” You describe them as “…loving, loyal, caring, protective companions or guardians, who helped guide me with the wisdom of their real cartoon counterparts towards a better future.” Richard Bentall in his book Madness Explained mentions a Dutch survey which reported that one third of the individuals who reported “voices” indicated that they were happy with them.

Finally, never lose sight of the fact that the wisdom of your characters is actually your own wisdom.

Once again, thanks for your comment. My career as a psychologist and my experience in writing this blog have brought me in contact with so many thoughtful and insightful individuals such as yourself, that the bio-pharma-psychiatric efforts to impose spurious medical categories on the richness and individuality of human existence seem all the more tawdry and obscene.

Best wishes, Nightingale, in all your endeavors. Don’t hesitate to come back if there’s anything you would like to discuss further.
Susan

Hi Dr. Hickey,

I came across your website behaviourismandmentalhealth.com while researching different perspectives on mental health/illness, in particular schizophrenia. I began researching schizophrenia constantly last month- not for academic purposes- but out of fear. It started when I came across the statistic that “1 in 100 people will get schizophrenia”. I later came across another source (the World Health Organization) that said that 7 in a 1000 will develop schizophrenia-which sounded much more realistic and eased my fear a bit. However by the time I came across the WHO statistic, I had already developed an intense and unrelenting fear that I may develop schizophrenia or slip into psychosis sometime during the future. The conflicting and sometimes disturbing information I came across before finding the more realistic “7 out of 1000″ statistic complicated the issue. Most of what anti- biological psychiatry advocates say makes sense- but I have trouble reconciling the information with other conflicting information. The conflicting information in mainly this: A case of a girl in the United States name Jani Schofeild who has apparently been born with schizophrenia. Of course- they cannot find any brain abnormalities but her symptoms seem rather severe and I am wondering how a child could be compliant in this. I also came across a disturbing story of a man who killed himself by sticking knives in his eyes until they reached his brain. His mother lives in my province in Canada, and campaigns for family members to be able to have another family member institutionalized without personal consent. I also hear of many people violently killing others and that they had no choice because the were delusional and psychotic. As you can imagine- this is extremely disturbing to me. I would never- ever- want to hurt or traumatize a loved one, or an innocent person directly- or indirectly-through violence or suicide. The idea that these people are at the “mercy of their minds” is horrifying to me but I cannot imagine any other reason someone would commit heinous acts if they were not.

Any thoughts you have about this would be greatly appreciated and thank you so much for reading.

Susan
http://behaviorismandmentalhealth.com Phil

Susan: Thanks for your comment.

Firstly, I need to say that because I don’t know you directly, it would not be right for me to give you advice or counseling. What I can do is respond to the general topics that you raise and allow you to draw your own conclusions.

There is a widespread belief in the mental health system that schizophrenia is a real illness – like diabetes – and that this “illness” is inherited in the same way as, say, red hair or blue eyes. This is simply not the case. There is no such thing as schizophrenia. Schizophrenia is a concept – an idea – that was introduced about the year 1900 to explain “craziness.” Prior to that time “craziness” was often considered to have been caused by sin – either of the individual or of the parents, or by evil spirits. But psychiatrists working in the 1890’s and the early 1900’s thought that it was caused by an illness – an illness that they called schizophrenia.

Readers of this blog will recognize the spurious nature of this so-called explanation. If you had asked one of these early psychiatrists why an individual was acting so crazy, he would have replied: “because he has schizophrenia.” But if you’d pushed the matter and asked: “How do you know he has schizophrenia?” the only possible answer would have been: “because he is acting so crazy.” In other words, the only evidence for the illness is the very behavior that it purports to explain. I know that I’ve repeated this argument many times, but it is so fundamental to an understanding of the spurious nature of concepts like schizophrenia.

“Schizophrenic” is simply another word for “crazy.” It tells us nothing useful about human existence. In fact, it is extremely unhelpful because it gives the impression that we understand something, when in fact true understanding involves so much more than assigning a label. For more information on this topic, please read all three Schizophrenia posts in this blog.

So when you read statistics that say one person in a hundred will “get schizophrenia” – what this means is that one person in a hundred will start to behave in a certain way. And if we want to understand behavior (i.e. why do people behave in this way), then we need to study and learn about the dynamics of behavior acquisition, and (and this is crucial) we need to study in detail the history of the individual concerned. All behavior is understandable – if one has the time and the resources to explore the history.

In my experience, craziness is always a result of profound feelings of failure. I talked about this in Schizophrenia Part 1.

Crazy behavior, in other words, is a way of opting out of the responsibilities of the real world. And, of course, at a mundane level this sort of thing happens all the time. Whenever we make an error – even minor errors – we have two options: we can acknowledge the error; or we can cast around for an excuse. The excuse often represents a distortion of reality – a little slice of craziness. An example of this after a tail-end collision would be to say: “He braked too suddenly.” We all know that you should leave enough space so that you can stop safely if the car in front brakes. So saying: “he braked too suddenly” is simply nonsensical – but comments like this are often elicited from us when we experience failure.

Now imagine what it’s like for individuals who experience failure in almost everything they touch. It is no coincidence that the behavior labeled schizophrenia emerges almost always in late teens and early adulthood. This is the time in life when we are most severely taxed, when our coping skills are not yet developed, and when we are least likely to ask for help.

This brings us to the “childhood schizophrenia” issue mentioned in your comment. I do not know the individual you mention – Jani Schofield – but I have read “An edited version of Jani’s story as told by her father, Michael Schofield.” Here are some quotes:

“She moved constantly [in utero], so much so that when on Memorial Day 2002 Susan [Jani’s mother] did not feel her move for 90 minutes, she panicked and broke down, terrified that Jani had died inside.”

Now “breaking down” because she hadn’t felt the baby move for 90 minutes suggests that Jani’s mother may have been an extremely tense and anxious individual.

“By four and a half, Jani was so lonely and getting into so much trouble everywhere she went she asked for a sibling, which is how Bodhi came into existence.”

Now over the years I’ve heard lots of dysfunctional reasons for conceiving a child. But to conceive a child because a four- year-old child wants a sibling is about as dysfunctional as it gets.

It is also clear from Michael’s writings that Jani was completely in charge of the Schofield household, and that the Schofields are not shy about publicity. They even allowed their child to appear on the Oprah show!

Children are born self-centered and demanding. Parents usually indulge their newborns, but sooner or later all parents have to begin the process of “introducing” the child to the real world and teaching the child that he/she is not the center of the universe. This is an extremely difficult task for parents, but most of us muddle through in a reasonably successful way. From my reading of Michael Schofield’s account, it seems to me that the Schofields’ efforts in this regard were truly disastrous, and that Jani Schofield ran the household pretty much from the day she was born.

The past twenty-five years have seen a marked increase in the practice of assigning psychiatric “diagnoses” to children. In my experience this is always a function of indifference or ineptness on the part of the parents. This is a very unpopular notion because it is seen as blaming the parents. But in my view, distorting the reality serves no one’s best interest. It is easier to accept the palliative “Your child has schizophrenia,” than face the reality that one’s parenting skills are inadequate. The drugging of children to render them more tranquil and compliant is an age-old practice. Incompetent parents in former times would feed their babies alcohol. Today powerful pharmaceutical products are used essentially for the same purpose, under the guise of “medication” and with the endorsement of psychiatrists. These products are not medicines, they are drugs.

But to get back to your specific concerns. You mention that “Jani… has apparently been born with schizophrenia.” This is a convoluted issue. If “schizophrenia” means disconnected from reality – then of course Jani was born schizophrenic – all children are born disconnected from reality. The newborn has no notion of the distinction between self and other. The world just is – all sensations seem to the newborn to be one all-embracing, colorful, cacophonous pageant. The distinction between self and other emerges as the months pass, and the need to respect others is instilled by parental intervention over a period of years.

So the notion of being “born with schizophrenia” simply makes no sense. Incidentally, from my reading of Michael Schofield’s account, it is my view that Jani is very much in touch with reality – the reality that she can get whatever she wants simply by pushing the right parental buttons. Never underestimate the ability of a young child to exploit parental weakness.

You express a concern that you yourself might go “crazy” and even hurt someone. Susan, in this regard I believe that you are a victim of a great marketing ploy that has been perpetrated by the American bio-pharma-psychiatric system. The ploy is based on the false premise that there are these diseases out there that somehow take over people’s lives, in the same way that physical illnesses such as cancer, smallpox, diabetes, etc. can attack our bodies. We’re talking billion – perhaps trillion – dollar industries here, and the stakes are huge. What the industry wants is for you to feel sufficiently anxious about this, that you will go to a psychiatrist and get some anti-anxiety pills. Nothing more. Once you are eating the pills, on a regular basis – hopefully hooked for life – then as far as the system goes, you are a success. The psychiatric system uses essentially the same techniques to “hook” you as other businesses use to persuade you that you need their products. (Please read my post on the so-called anxiety disorders.)

In your letter you mention heinous acts and acts of self-destruction. And certainly these kinds of occurrences are difficult to understand. I can tell you this. In my experience, suicide and suicide attempts are almost always forms of dysfunctional communication, (“Look what you made me do”) or dysfunctional attempts to control a situation (“Now you must be nice to me”). Many years ago, I worked in the British Prison System. At that time it was reasonably common for female prisoners to stick pins into the whites of their eyes! This had the effect of freaking out the guards. I never heard of anyone shoving the pins all the way back into the brain. But there are no pain receptors in the whites of the eye, and I suppose it could be seen as an extreme example of manipulative behavior. It certainly “freaked out” the guards. “Freaking out” parents and other authority figures is a popular pastime in our culture. (Many young people get tattoos to “freak out” their parents.) But as the ante is raised and the stakes get higher, it can become quite dangerous.

Acts of violence are harder to understand, but I think similar dynamics are usually involved. Often it’s just a callous disregard for the feelings of others coupled with a strong desire for the spotlight – a desire to feel important. Sometimes it’s just drugs and alcohol! But it’s never because they were “at the mercy of their minds.” Ultimately all behavior is understandable, though usually we can’t get at this understanding because it is lost in the individual’s history. A true understanding of behavior comes from a knowledge of the dynamics of behavioral acquisition and as detailed a knowledge of the individual’s history as we can get.

Susan, it would be nice if I could say to you: go see a professional counselor and share your concerns. But I am reluctant to do this because I can be almost certain what you will get: a “diagnosis” and a bottle of pills – not because there is anything necessarily wrong with you – but because that’s what everyone gets! (Of course, if you choose to pursue the pharmaceutical avenue, I certainly wouldn’t argue with you. That’s your choice.) There are counselors out there who operate outside the bio-pharma-psychiatric system and would provide you genuine help in thinking through and resolving these kinds of issues. You might be able to find someone like this if you feel the need to talk these things through. We all need at least one good friend – someone we can talk to honestly and openly about anything – including the kinds of concerns you voice in your letter. We also need feelings of success – little things that we do, that we get right – every day.

Finally, the tone and form of your comment is intelligent, cogent, coherent, and articulate. Just based on your letter, you seem to me to be a person who is solidly connected with the real world and has genuine concern for other people. Your concern that you might hurt someone is difficult for me to evaluate because I don’t know you, but my general advice to anyone with these kinds of concerns is to share them with someone you trust.

Once again, thanks for your interest and for your enquiry. These are complex topics, and if there is any aspect you would like to discuss further, feel free to come back. Best wishes.
Susan

Thank you again for your informative and thoughtful response.

I find behaviorism fascinating and cannot believe it has become such an overlooked and underutilized perspective.

Your response cleared up a lot of questions I had. However, I am still struggling with one aspect.

http://www.humanehealthcare.com/Article.asp?art_id=220

The people described in the article above say that their family members did not kill themselves- but were killed by their ‘illness’. I am not trying to be excessively “morbid” but for some reason I dwell on the question “Why would someone do this?” For example: “Twenty-year-old Matthew plunged two ordinary dinner knives into his eyes and pounded his head on the floor until they pierced his brain. ”

Because I cannot think of any reason why, if given the choice, someone would choose that, the conclusion I come to is mainly this: “They must not have had a choice.”

I know this is faulty reasoning but I am still curious as to how a behaviorist might reconcile their perspective with such information.

Any thoughts or opinions you have about this would be greatly appreciated! Hope you’re well.
Empires

I appreciate this article, but I have to add something to Susan’s comment with a little personal insight.

I had never been formally diagnosed with any mental “illness” and I have firmly believed for years that a person’s mental state of mind is a creation of their own, through physical stimuli, stress and reasoning (or lack of). Etc. Then Susan says “They must not have had a choice” and that rings a bell. See, about two weeks ago my boyfriend noticed personality changes in me (I was much more sexual than usual, more agitated). One night I “snapped”, I turned on all of the lights in the house, went outside, got in my car and decided to go grocery shopping. I came back and decided to go walking late at night, so we both went for a walk. When we both got back to the apartment I felt that I had lost all control of my body. Apparently, and I have a very vague memory of this, I snapped his phone in half after he deleted text messages telling people I was acting strange (I had a fear he was going to call the cops or send me to a hospital), and then I took a knife to the bed, and complained about loud noises that wouldn’t stop. I was clearly hallucinating but now, over a week later, the only thing I can describe this “episode” as is a remote experience. I can’t remember all I did, it wasn’t brought on by drugs or alcohol, but I can remember the feeling of being away from my body. It felt like I had lost all control and my actions were being controlled by someone else. Despite wanting to stop it, I couldn’t.

Luckily I didn’t end up in a hospital or jail. I lost 3 days of work, and was forced to buy my boyfriend a new cell phone. I feel much better now. But I still can’t get the feeling out of my head of that “losing control.” How do you explain the experience of being controlled by another entity or losing control?
http://behaviorismandmentalhealth.com Phil

Susan: Thanks for your comment/query.

I am glad to hear that you find behaviorism helpful. For me it is not only a professional perspective, but a life philosophy as well. I consider the words psychology and behaviorism essentially synonymous. Psychology is the science of behavior. Behaviorism is the scientific study of behavior. I see no essential difference

So why is it so overlooked and underutilized?

Well in one respect, it isn’t. Human activity proceeds in accordance with the principles of behaviorism, whether people verbally acknowledge this or not. But you are correct in that people do seem to resist behaviorism more vigorously than they do other formulations. I think there are a number of reasons for this. Firstly, the notion that human life plays itself out in accordance with fundamental laws and regularities is repugnant to many for religious and other sentimental reasons. Secondly, the complexity of human life seems incompatible with the notion that it can be embraced within a relatively circumscribed framework. Thirdly, I believe that behaviorism and behavior therapy posed a particular threat to the bio-pharma-psychiatric bloc and were systematically marginalized.

In 1994 I wrote an article called “Resistance to Behaviorism” for the Behavior Therapist. It is too long to include here, so I will email a copy directly to you.

I read the article you mentioned: “Schizophrenia: a Family Perspective,” by June Beeby. I have a number of comments. Firstly, the author is not an objective observer – she is a member of a “family support” group. These groups (many affiliated with NAMI) are advocacy groups, and they almost always subscribe to, and avidly promote, illness-type explanations of the behavior labeled mental illness. Many of these groups receive generous financial support from pharmaceutical groups. At the time the article was written, June Beeby was a member of the Ontario Friends of Schizophrenics. This group is now called Schizophrenia Society of Ontario. Their 2010 balance sheet shows contributions in the $10,000-$50,000 range from AstraZeneca, Eli Lilly, Janssen-Ortho, Novartis Pharma, and Pfizer. A donation from Mylan Pharmaceuticals is in the $5,000 to $10,000 group. Secondly, families of individuals who are assigned these so-called diagnoses have an affinity for “illness” explanations, presumably because it is seen as letting them off the hook somehow for the anomalous behavior of their family member. The pharmaceutical companies have exploited this tendency, and routinely deploy these family members as front-line troops in their ideological crusade.

But all that aside – I agree that shoving dinner knives into one’s brain through one’s eyeballs is an extreme way to commit suicide.

So – why would someone do this?

You say that this couldn’t be by choice, presumably because no one would choose to inflict on themselves such pain. However, there are well-documented cases of people inflicting terrible pain on themselves. For instance, in the 60’s and early 70’s several Buddhist monks set themselves on fire in Saigon to protest America’s role in the Vietnam War. They would sit down in the street, pour gasoline on themselves, and set themselves on fire. And these individuals certainly seemed to be making a choice. So while I agree that the degree of pain some individuals can inflict on themselves is indeed horrifying, I don’t think it necessarily requires us to abandon our perspective.

But let’s examine the notion of choice. Suppose I decide to go for a walk. I put on my coat and go to my front gate and step out onto the street. I can go either left or right. So I pause for a moment, looking both ways, and then turn left. If you were observing me, you might say that I chose to go left. And this is correct. You might say that I hesitated briefly at the point of turning, or that I vacillated. And words like hesitate and vacillate can be challenging to define behaviorally – but they could be defined.

Now from a behaviorist point of view, there is no problem – I paused briefly and then turned left. And the explanation is: because of the stimulus properties of the situation and my reinforcement history.

But…there’s more to the story. Implicit in the notion of choice as it is embedded in our culture is the element that one could have taken the other road – the road not taken in fact. That in some way I was free to turn right. But the act of turning right on the occasion in question (although within my behavioral repertoire) did not actually occur. It is therefore impossible to observe. What we are always left with when we observe someone making a choice is a description of what he actually did. The fact is that people choose because they have brains that are capable of examining alternatives, weighing options, etc… And we can do all this in our heads – we don’t have to physically go through each option to check it out. We have apparatus in our heads that enables us to run through the options virtually – and then we choose. We select – and the other options available at that instant in time are precluded. The real world is the world where we did what we did. These other worlds – the worlds where we might have done something else – simply don’t exist. You will sometimes hear people say: “I wish I’d bought such and such stock in 1972. I’d be a billionaire now.” But the reason they didn’t buy the stock was because of the stimulus properties of the situation in 1972 and their reinforcement history.

The fundamental problem with the notion of choice is this: people think of choice as explanatory of behavior, when in fact it is merely descriptive. In the example given earlier of my choosing to turn left, many people, if asked why I turned left, would reply: “because that was his choice.” And because of our linguistic and cultural heritage, that is widely seen as a valid explanation. But the acid test of explanatory validity is to push the next question: “How do you know he chose to turn left?” And the only possible answer is: “Because he turned left.” In other words, the only evidence for the explanation is the very behavior it purports to explain. Saying: “He chose to turn left” adds nothing to our knowledge. This reasoning will be familiar to regular readers of this blog because it is essentially the same logical fallacy as the mental illness type explanations of unusual or disturbing behavior. Choice is a descriptive, not an explanatory term.

So back to the question of horrific suicide. Your conclusion that: “They must not have had a choice” contains the implication of choice as an explanation. If you accept the notion that choice is merely descriptive, then of course they did make a choice. But the question remains – why did they choose something so painful? And the honest answer is: “I don’t know” – because I don’t know anything about the individual’s reinforcement history or the stimulus properties of the situation. I don’t know why widows in some parts of India throw themselves on their husbands’ funeral pyres. (Although this has been outlawed since 1829, there have been cases recorded as recently as 2008.) I don’t know why some religious ascetics routinely inflict severe pain on themselves.

I can speculate as to why these people behave in these ways, and my speculations would be based on established principles of behavior acquisition. Let’s consider the case of a young couple with a one-year-old child. If the child hurts himself, he will almost invariably withdraw from the offending stimulus and howl. One of the parents (or both) comes running and provides cosseting and comfort. Now you can see how there is potential here for the child to become an habitual self-injurer. Most parents avoid this, of course, by requiring an age-appropriate response as the child matures and by mildly punishing responses that are considered “babyish.” Nevertheless, it is easy to imagine the occasional parent becoming “trapped” in the practice of reinforcing self-injurious behavior on the part of the child. One can also readily imagine the parents’ misgivings on the matter and their uncertainty and vacillation. And the response from the child when reinforcement is withdrawn would be to escalate the problem behavior, whereupon the parents relent and the cycle continues. Certainly these sorts of dynamics have been documented in institutional settings, where typically nurses and other staff rush to aid and comfort individuals who are banging their heads or injuring themselves in other ways. Perhaps you can think of other ways in which a person’s environment might encourage him/her to engage in self-mutilative activity despite considerable pain?

And of course there is always the possibility that an individual’s brain is damaged – from trauma, disease, or drugs. The brain is the apparatus that enables choosing behavior to occur and which generally ensures that the choices made are in the best interests of the organism. Every day, however, we see cases of individuals whose brain activity is impaired by alcohol making disastrous choices. But disastrous choices can be made in the absence of any kind of neural pathology. Deeply ingrained habits and beliefs can be as constraining as the heaviest chains.

Once again, thanks for your interest. I hope this is helpful. Feel free to come back. Best wishes.
http://behaviorismandmentalhealth.com Phil

Empires: Thanks for your comment/query. Because I do not know you directly, it would not be appropriate for me to advise or counsel you on these issues. What I can do is offer some general thoughts from which you can draw your own conclusions.

If you were to go to a psychiatrist and recount this incident, I think it is likely that you would be assigned a “diagnosis.” He/she would question you further to determine which “diagnosis” best fits your presentation. There are several possible candidates: brief psychotic disorder, depersonalization disorder, etc.. What needs to be stressed, however, is that these are not real illnesses like diabetes and pneumonia. They are simply labels that the APA has codified and presents as diagnoses in order to justify the administration of drugs. So you would probably exit the psychiatrist’s office with a prescription and an appointment to come back in two weeks. And you would have entered the rolls of the “mentally ill.”

If I were still practicing and someone came to me and recounted an episode of this sort, here are some of the questions/issues that I would raise.

• What was going on generally in your life around the time of this incident?
• How are things at work?
• How are things with your family of origin?
• How are things with your boyfriend?
• Etc., etc..

I would also try to gain an understanding of you – who you are as a person – where have you come from – where are you going. What are your dreams, goals, etc.? Are you a highly motivated person or happy-go-lucky? Do you use drugs/alcohol? Your age would also be a consideration. The reality is that time proceeds at its own steady pace – but our perception of the passage of time is colored by various psycho-social considerations. Our 30th, 40th and 50th birthdays are considered particular milestones, and often arouse strong feelings – usually regrets, opportunities lost, etc… So I’d be asking you about things like that.

Also, of course, it’s the holiday season – which is often a trying time as individuals struggle to live up to the commercially driven expectations. So I would ask if you had any particular concerns in this regard.

You mention the issue of choice. In this regard, please see my most recent response to Susan. The essential point here is that choice is a descriptive term – not an explanatory one. When people experience the kinds of sudden changes that you describe, they often say that the changes just happened – there was nothing that brought the changes on. In my experience this is seldom the case. Usually something has changed – a relationship, a loss, a gain, a promotion, etc..

With regards to specifics:

• Turning on all the lights in the house suggests some kind of fear/concern about the dark
• Breaking your boyfriend’s phone suggests a realistic concern on your part that he was going to “call the cops.”
• Replacing the cell phone suggests a realistic taking of responsibility
• Taking a knife to bed suggests a concern about danger, possibly rape?
• Feelings of depersonalization (i.e. that the normal sense of connectedness to the various parts of one’s body is absent) are quite common, and in themselves are not a cause for concern.

Another factor to look at is outcome. What was the end result of the incident? Perhaps you had been feeling that your boyfriend was “slipping away” and this brought him back closer. Or perhaps you were looking for an excuse to break up? I’m not suggesting these are realistic possibilities (because I’m not sufficiently familiar with the situation), but simply as the kind of context that might have had a bearing.

And finally, I would talk to you about feelings of success – are you feeling competent and successful – in work – at home – in little things – in big things. “Crazy” thoughts (e.g. that my actions are being controlled by another) almost always derive from feelings that we are not functioning as well as we think we should.

So there is it. That’s the best I can give you from a distance. Should you seek help? Should you go to a psychiatrist for a prescription? I can’t answer those questions – but perhaps my comments/thoughts will be helpful to you in making those decisions.

Best wishes.
cathryn

Phil,

Wow, I know some schizophrenics.. and this article rings very true to their family environment. One of them I knew was repetitively kicked out of his house since he was four years old, his parents were mentally unstable people. He used to tell me he would wander out in the woods for days before his parents decided to go ‘fetch’ their kid. Your website/blog is really starting to change my mind about things. You make a LOT more since then the APA, thats for sure.

Cathryn
Martin

Cathryn,

I knew a schizophrenic once as well. He was part of my extended family and was in his late 50′s. My family thought it was scary not only because they believed it came out of nowhere but also because they believed it was genetic and that his son and grandchildren needed to be on the lookout for it as well.

My immediate question was did this man abuse drugs in his life? And my Aunt explained how he grew up during the 60′s and had experimented with a variety of drugs. My response saying that the drugs may have caused this supposed “unexpected change” in him was quickly shot down by saying that rather the drugs UNCOVERED the schizophrenia that already existed. I think this is truly a fallacy in logic and goes back to what Phil has been saying about explanatory and descriptive behavior. No one else in his family had ever been diagnosed, just him. And even though he was a smart man, being a Math teacher for many years, the idea that drugs may have damaged the brain was not considered an option. Rather this guy just HAPPENED to be genetically hot wired to have a supposed illness uncovered from years of recreational drug use.

On top of that, he never had any deviant behavior associated with his “mental illness,” maintaining a 40 hour a week job as a grounds keeper after his retirement. His diagnosis came when his family demanded he see a psychiatrist when he decided to up and leave the family after retirement and go to live further out in the country by himself. Obviously, just getting up and leaving the family must mean he has a mental illness as conceptualized by today’s standards.

And lastly, my Aunt added that he was always a “weird” guy and that she could see how he had schizophrenia.

It really strikes me at how vague such concepts really are in explaining behavior because I know a lot of WEIRD people and have been told myself more than once that I am weird as well. I see this more so as a compliment because such comments result from the creative ideas I express about traditionally held norms in society. Does this mean I have schizophrenia? The fact that my mind thinks in ways I feel like very few people can understand? No, not at all. People are different and express themselves in a variety of different ways which make up their personalities. These personalities come in many different types but in no way can be defined in the typical 30 minute psychiatric session. I do not adhere to the belief that there are personality disorders, but rather there are problems in living expressed through the misbehavior of such people. Mental illness is generally regarded as the source of human disharmony, but then this is a view that says all human interactions are inherently harmonious, which is not true.

Glad to see people coming around to varying view points on behavior that are not from the traditional norms. I read so much information concerning mainstream psychiatry throughout high school that I thought I knew it all. It was not until I came to college that I reevaluated what I believed in mental illness.

Keep up the good work Phil!

Martin
http://behaviorismandmentalhealth.com Phil

Cathryn,

Thanks for your comment. Ultimately all human behavior – even that which appears “crazy” – is understandable if we could know all the facts. But genuine understanding involves so much more than assigning a label.

Best wishes.
http://behaviorismandmentalhealth.com Phil

Martin,

Thanks for your insightful comment. The DSM system has gone unchallenged for too long.

Best wishes.
http://www.acrimeagainsthumanity-13.blogspot.com Thomas Murphy

It is not an illness at all. Those who have it are demonized by dependent minds.
Nightingale

Susan, as a person with Schizophrenia, I can tell you what it feels like for me. I was suicidal for a while and, on particularly bad days, I would consider killing myself. The effect was like a debate with myself in which my positive outweighed the negative every time.

It wasn’t a struggle between two halves. It was a struggle between my drive for life and the tipping point for my stress tolerance. Right now, I am a very calm, happy and positive individual. I’ve found peace in my life, but I used to be a very angry individual when I was a teen!

These individuals do not black out. They know what they’re doing. I knew what I was doing, but it’s like a debate raging on in your head on the pros and cons of ending your life.

I believe that was caused by stress, but my schizophrenia did no more than audibly debate in those situations. I suppose that if someone was stressed out and depressed enough, then someday the cons just outweigh the pros. I happen to believe that most health problems today are caused by stress.

As for why they choose such extreme ways. I couldn’t say. I can tell you my hypothesis, though. I believe violent, aggressive or outlandish things are a shocking way to feel like they’ll be noticed or remembered. Perhaps they felt ignored? I know that, if I had felt ignored my whole life and felt less and less important, then doing something memorable and shocking might be a way to feel remembered in a life where they didn’t feel they did anything else to be remembered for.

The cases of masochistic self-infliction might indicate the need to punish oneself. Finding one of the most painful ways they can think of to die might mean they feel like a failure and feel the need to punish themselves.

Violence towards others is usually just an act of aggression towards an individual who is perceived to be a source of negativity (ex: a verbally abusive mother; an alcoholic father who beats them; bullies at school).

It’s quite literally the moment you just stop giving a fuck. Where you can’t think of a single reason to care anymore. I’ve nearly gone that far a couple of times, but I’m lucky that my characters are positive. They’ve always given me reason to believe that the world was a better place because I’m alive.

Schizophrenia might seem complicated and that would be right. However, the primary cause is stress and behavioral problems.

My cousin and aunt both had/have schizophrenia, too. He killed himself. She tried to drown herself in a river, but failed.

Do I think they weren’t in control? I think they were. I’ve been there and I can tell you that suicide is a choice and a matter of taking the action. As is the way in which you do it. My aunt told me that she knew exactly what she was doing. She just didn’t see a reason to care anymore.

So, from my experience, people do not become victims of their mind. They are still in control, but I believe it’s the stress level they have and why they have it that stress that will determine how they commit suicide.

Some just want to get it over-with and some want to feel like they’ve made a point. Either way, suicide and murder takes conscious thought to do. It’s the fight between the thought that you shouldn’t and the thought that is telling you all the reasons why you should. It’s poor coping capabilities with stress piled on top, but (from my experience) it’s always been a choice.

Anyways, take what you will out of this. That’s just my view on it. Cheers!

Susan :
Thank you again for your informative and thoughtful response.
I find behaviorism fascinating and cannot believe it has become such an overlooked and underutilized perspective.
Your response cleared up a lot of questions I had. However, I am still struggling with one aspect.
http://www.humanehealthcare.com/Article.asp?art_id=220
The people described in the article above say that their family members did not kill themselves- but were killed by their ‘illness’. I am not trying to be excessively “morbid” but for some reason I dwell on the question “Why would someone do this?” For example: “Twenty-year-old Matthew plunged two ordinary dinner knives into his eyes and pounded his head on the floor until they pierced his brain. ”
Because I cannot think of any reason why, if given the choice, someone would choose that, the conclusion I come to is mainly this: “They must not have had a choice.”
I know this is faulty reasoning but I am still curious as to how a behaviorist might reconcile their perspective with such information.
Any thoughts or opinions you have about this would be greatly appreciated! Hope you’re well.
http://behaviorismandmentalhealth.com Phil

Thomas,

Thank you for your comment. I’m not sure what you mean by demonized by dependent minds. It sounds like you have something to say. Please come back with more detail.
http://behaviorismandmentalhealth.com Phil

Nightingale,

Thank you for this very detailed reply to Susan’s question. I think you are right in the importance you ascribe to stress. Sometimes the world seems overwhelming, and many people entering adulthood are simply unprepared for this.

With regards to suicide, my position is that suicide and suicide attempts are usually more a matter of communication style than a reflection of depression as such. This is in line with some of the things you say – e.g. “…a shocking way to feel like they’ll be noticed or remembered.” It’s almost like: “Now do you hear me?”

I think the mental health system often ignores people’s concerns. For instance, when a person is angry, they simply prescribe pills instead of trying to inquire into the sources of the anger and allowing people an opportunity to talk about these kinds of matters.

I’m extremely grateful to you for writing this comment, and I hope you’ll come back with further insights.
june conway beeby

Throughout history,there have been false ideas about all physical diseases until the confusion is sent packing by scientific research.

It’s wise to look at all claims, and any scientific evidence for them and then decide which one has the scientific validity..

Otherwise, you are merely the empty chalice of other people’s, hare-brained ideas, speculations, and assumptions usually based on history when science was still an infant.

For knowledge is the only antidote to ignorance.
Bindi

Hmmm…. looking forward to reading how you explain away hallucinations in schizophrenic patients.

While on the topic of suicide and schizophrenia – perhaps the topic of command auditory hallucinations could be discussed.
http://behaviorismandmentalhealth.com Phil

June,

Thanks for your comment.

I agree with you that science eventually trumps nonsense. It’s the “eventually” part that troubles me. Spurious ideas are often backed by enormous resources, and are often promoted with great vigor. The result is that genuine understanding is postponed for years – even centuries. And in many cases this involves the prolongation of human suffering.

Science does not exist in the abstract, but only in and through people – people who put aside their preconceived notions, observe reality, generate testable hypotheses, etc.. When we create an atmosphere in which these individuals are encouraged, then science (and humanity) flourishes. But the opposite is also true, and the present mental health atmosphere, with its pseudo-science and spurious explanations, is damaging large numbers of people.

So, yes, I agree, the nonsense will eventually fade away – but psychiatry has been damaging people systematically for more than a hundred years. I have discussed this topic in my latest post, Legacy of Abuse.

Once again, thanks for the comment and for raising such an important point. Best wishes.
http://behaviorismandmentalhealth.com Phil

Bindi,

Thanks for your interesting comment/question.

First, a note on terminology. Webster defines the term “explain away” as follows:

“to get rid of by or as if by explanation; to minimize the significance of by or as if by explanation.”

The phrase “explain away” contains, in my view, an inherent connotation of chicanery or even outright dishonesty. So, for the record, I feel the need to state emphatically that I do not explain things away. My objective in this blog is to provide genuine and valid explanations of unusual or disturbing behavior. In deed, one of the points that I make repeatedly is that the DSM explanations are spurious and invalid. In a very real sense I believe that the APA could be charged with explaining away. When psychiatrists say that hallucinations are caused by schizophrenia, they are using words in a way that looks like and purports to be an explanation, but in fact is nothing of the kind.

Now if you believe that I have engaged in this kind of practice, please cite the passage or passages concerned, and we can have some dialogue.

With regards to hallucinatory behavior, I wrote what I think is a fairly clear explanation of this in the post Schizophrenia is Not an Illness, Part 3, which you can see here. I have now re-read this piece, and it contains all of the main points I would wish to make on this topic. I would be very happy to elaborate further if there is some specific facet with which you disagree or on which you would like more information.

The phenomenon that you describe as “command auditory hallucinations” can be adequately conceptualized in essentially the same way as “ordinary” hallucinatory behavior, with the additional reinforcement that inevitably attends suicidal talk. When a person tells a mental health worker that there is a voice in his head telling him to kill himself, he inevitably becomes the focus of concerted and solicitous attention. Sadly, in our present medicalized, drug-pushing mental health business, this attention is seldom directed towards helping the individual acquire the skills necessary for functional living.

My general position on suicidal talk and behavior (whether successful or not) is that it is much more often a matter of dysfunctional, manipulative communication, than an expression of genuine despondency.

Once again, thanks for your interest. Please feel free to come back on any point if you would like clarification or if you think I’m missing something.
Cathryn

Phil
Why do you think suicide ideation is manipulative and dysfunctional communication? Haven’t you ever truely wanted to die? Doesn’t it give the idea less power when you talk about it and realize how absurd the feeling is once sOmeone outside your head tells you so? Or am I being optimistic?
http://behaviorismandmentalhealth.com Phil

Cathryn,

Thanks for your comment. You make a very good point: one of the best things we can do with our troubles is to share them with someone we trust. And I would certainly agree that one of the critical steps in coping with despondency is this kind of communication.

In my experience, however, the great majority of suicidal talk/behavior is not of this nature. It usually takes the form: “If you people aren’t nice to me, I will punish you by killing myself.” It’s not expressed in these words, of course, but that’s the substance.

As with everything else, however, there is an abundance of individual variation.

I like the idea you expressed of getting something “outside your head.” A great many human problems are amenable to improvement in this way.

Once again, thanks for coming in. It’s always nice to hear from you.

Best wishes.
june conway beeby

Real science, like chemistry,math and biology, base their findings on verifiable facts; social sciences base their findings on assumptions.

Which of these would you prefer to be the basis of your diagnosis and treatment for any serious disease?
http://behaviorismandmentalhealth.com Phil

June,

Thanks for your comment.

I actually have a number of very serious diseases, and I can tell you categorically that I prefer my treatment to be based on science than on anything else.

Schizophrenia, however, is not an illness; it is a behavioral problem, but here again, a “solution” based on sound scientific principles will yield better results than a “solution” based on the spurious DSM system.
June conway beeby

If you read current scientific brain research findings you might agree with me. Google The Treatment Advocacy Center to see more evidence of this.

You might change your mind on this.
Anonymous

June,

Thanks for coming back.

You say that if I were to read current scientific brain research findings, I might agree with you. Well, June, send me the references. I have browsed through a great deal of scientific brain research, and I’m still profoundly skeptical with regards to the “broken brain” theory of schizophrenia. In my view, a behavioral formulation is more explanatory, more informative, and more helpful with regards to remediation. But I keep an open mind. Send me the references that in your view provide the best support for the “broken brain” theory. I will review them as objectively and fairly as possible and will post my response here.

But I would also like to hear your perspective. Your comments tend to be very brief. So it’s difficult for me to know exactly what points you are making. It is only through dialogue and discussion that we move forward.

The essential point of this blog is that modern psychiatry is unhelpful, and sometimes even harmful, to its clients. And I say this after a lengthy career in prisons, addiction units, and mental health centers. I’ve seen the damage and the waste of human lives at close quarters. I’ve also seen people find real help when they are afforded proper respect and dignity – when they are treated like people and not like “chemical errors” that need to be corrected.

I’m not the bad guy here, June. I may be in error – if so, show me. Quote me the references. Tell me where you disagree with me. Tell me what you think and why you think it.

I did look at Treatment Advocacy Center’s website, but I didn’t find anything there to support the “broken brain” theory. Did I miss something?

Looking forward to hearing from you.
June conway beeby

Thanks for your thoughts on schizophrenia. I hope you will visit The Treatment Advocacy Center’s website to read current scientific findings on schizophrenia, manic depression and related psychoses.

It is actually dangerous for citizens suffering from these biological diseases of the brain to live in a world of misinformation about their illnesses. Society does not even question the validity of the unproved, out-dated Freudian based hypotheses (not theories) about serious mental illnesses (SMI). What other disease is treated without the benefit of scientific research, but by using only social/psychological theories?

This is why current planning and care for the SMI is akin to being cared for by Medicine Men.
Anonymous

June,

Thanks for coming back.

I have visited the Treatment Advocacy Center’s website, but I found nothing there on “current scientific findings on schizophrenia, manic depression, and related psychoses.” Perhaps I’m not getting into the right section. Please give me directions. I am always receptive to valid information.

The fundamental difference between our positions is this: you say that the people who meet the DSM criteria for schizophrenia are suffering from a biological disease of the brain. You also imply that people who don’t go along with your perspective constitute a danger to the individuals concerned.

I say: OK, this may be true – but prove it. Take delusions, for instance. Let’s say that a person says that the CIA has bugged his house with invisible transmitters. My position is that this piece of verbal behavior should be seen for what it is: a piece of verbal behavior. Now it could be that the individual is saying things like this because his brain is broken. But it’s more plausible that he is saying things like this because in some convoluted way this kind of statement is providing him with a payoff. It is an established fact that behavior that receives a payoff tends to be repeated; and that behavior that receives regular payoff becomes habitual. When I hear someone making crazy statements like the one above, I ask myself one question: what’s maintaining this behavior? In most cases the answer lies in the fact that the individual lacks the skills necessary for independent survival in the adult world, and craziness provides him with an acceptable way out.

With regards to “…out-dated Freudian-based hypotheses…,” all I can say is that you’ve got the wrong website. I disagree with the fundamentals of Freudian theory, and in fact I believe I would be hard-pressed to find a single Freudian tenet that I do agree with.

My stance is behaviorism (hence the title Behaviorism and Mental Health). Behaviorism is the scientific study of behavior – pure and simple. We observe what people do. We take detailed measurements; we count; we time; etc., and we draw (or try to draw) conclusions based on concepts like stimulus, response, reinforcement, response generalization, etc..

Finally, you say: “…current planning and care for the SMI is akin to being cared for by Medicine Men.” Well I wholeheartedly agree – but for different reasons. Most of the so-called treatment that I am aware of is based on the broken brain theory – eat your pills and go to the clubhouse or sheltered workshop every day. And so it goes until the onset of tardive dyskinesia, neuroleptic malignant syndrome; impaired liver function; acute renal failure; impotence; cataracts; retinopathy, etc.. Literally the fruits of the medicine men (your words).

So what I say is: 1) prove to me that the criteria listed in the DSM are caused by a brain malfunction. 2) show me a clear-cut test that tells who has that brain malfunction and who doesn’t. Until then, it’s just pharmaceutical straitjacketing. We’re not really helping these people – we’re destroying them for the sake of drug profits.

If I’m wrong – cite me the references!

Behaviorism and Mental Health

An alternative perspective on mental disorders.

Philip Hickey, Ph.D.