In a recent comment on my last post Jeanne raised some important questions concerning homosexuality.  These are issues where considerations of political correctness and religious dogma have stifled genuine discussion and dialogue.  I will try to address these questions openly and straightforwardly.

The sex or gender of a person expresses itself in five general ways.

1.  Every cell of the body is recognizable under a microscope as male or female.

2.  Anatomically:  The male develops testicles; the female develops ovaries.  These differences are discernible in the embryo within a few weeks of fertilization.

3.  Secondary sex characteristics:  The male develops a penis and the seminal ducts.  The female develops a uterus, fallopian tubes, vagina, and clitoris.  Additional gender characteristics become evident at puberty.  Male:  facial and pubic hair, deepening voice.  Female:  breasts and pubic hair.

4.  Endocrine system:  The pituitary gland releases gonad-stimulating hormones into the bloodstream – constantly in males; on a 28-day cycle in females.

5.  Behavior.  In animals these gender-specific behaviors tend to be stereotyped and rigid.  In humans there are some uniformities, but there is also a very substantial influence from environmental factors (especially the social environment).

In most people these five factors all show the same direction – all five factors indicating male; or all five indicating female.  Individuals in which all five factors don’t agree are called hermaphrodites.  There are five sub-groups.

1.  True hermaphrodites have ambiguous gonads; or a testicle on one side and an ovary on the other.  This condition is very rare.

2.  Pseudomales have female cells but male sex organs.  These individuals are usually sterile.  Sometimes at adolescence the breasts enlarge.  Incidence is approximately 1 in 2000.

3.  Pseudofemales have male cells but female external sex organs.  Ovaries are missing.  At puberty breasts do not develop and menstruation does not occur.  Incidence is approximately 1 in 2000.

4.  Male pseudohermaphrodites have male cells and have testicles, but gonaducts and external sex organs are female (to a greater or lesser extent).  Testicles are often undescended.  Incidence is about 1 in 2000.

5.  Female pseudohermaphrodites have female cells and ovaries, but during fetal development male hormones are produced, which results in various degrees of maleness in appearance at birth and throughout life.  Incidence, again, is about 1 in 2000.

There is a sixth group, in which the first four factors all show the same direction, but the individual desires to live and function like the opposite sex.  Sometimes the person acts on these desires.  These individuals are called homosexuals, or in modern terminology, gays.  The condition admits of degrees with regards to the kind of behavior involved and the frequency of these behaviors.  Some individuals are bisexual – i.e. they engage in both heterosexual and homosexual behavior.  As to why homosexuality occurs, there are four theories:  genetic; endocrine; psychosocial; and a mixture of two or more of the above.

With regards to which theory is correct, I think there are two general points.  Firstly, a great deal of research is being done in this area, and secondly, people have taken deeply entrenched positions for reasons that have nothing to do with genuine scientific understanding.  There is also a school of thought that says it is wrong to even enquire as to the cause(s) of homosexuality – that focusing on homosexuality is inherently stigmatizing, and presupposes that the condition is somehow wrong or aberrant.  In my view, there is nothing stigmatizing about the desire to understand.  A botanist studying the phenomenon of blooming in no way detracts from the beauty of the flower.  And, in any case, the human quest for knowledge and understanding won’t be stifled by dictatorial fiats.

Human existence, although laden with the potential for great happiness and fulfillment, is not always easy.  As children we learn that toys break and vacations come to an end.  And throughout life we experience incidents of loss, grief, and heartache.  Pain, bereavement, and disappointment are an intrinsic part of the human condition, and often there isn’t the familial/social support to carry us through these difficulties.  Some of our difficulties are of our own making, but this is difficult to admit.

All of this results, in some cases, in a kind of smoldering resentment or anger, but with no legitimate target for these feelings.  So we invent targets: blacks, Jews, Mexicans, and of course, homosexuals.  The latter group has had a particularly rough road, ostracized as they were by church and state alike.  Why do people express such negative feelings towards homosexuals?  Here again, there are lots of exotic theories.  My view is simply that they were taught to express these kinds of feelings by their role models, and were rewarded in both tangible and subtle ways for these expressions of hatred and disapproval.  Sometimes these feelings of hatred are expressed as violence and even murder.  Both secular and religious leaders have contributed to this violence through the ages.

The genetic theory of homosexuality is attracting a good deal of support at the present time, largely because it is seen as relieving the homosexual individual of guilt.  The reasoning (often unspoken) seems to be that either he was “born that way” (and therefore can’t help it) or he is a wicked, immoral person. Now for me, “immoral” has only one meaning – harming others.  Whether two men (or two women) engage in sexual behavior simply is not a moral issue.  We may find it difficult to understand or identify with, but that’s immaterial.  I find sky-diving more-or-less incomprehensible, but that doesn’t make it wrong, and certainly doesn’t give me the right to direct my anger or violence towards people who engage in the sport.  A man who engages in consensual sexual activity with another man has no more onus to defend his behavior than a person taking a walk on a summer evening, or playing ball with his children.  Perhaps the most fundamental principle of behaviorism is that behavior is behavior is behavior.

So for the behaviorist, the idea of letting the homosexual “off the hook” by asserting the genetic theory is irrelevant.  He (or she) is not on the hook to begin with.

The determinants of behavior are well-known and well-understood in general terms.  How these determinants work out in individual cases, however, is almost impossible to establish.  You can stand at the mouth of the Mississippi and know with 100% certainty that some of the water running past you comes from the Little Bighorn River.  But it is impossible to identify the actual molecules of water that came from this source.  Similarly, we can talk authoritatively about how parents influence their children’s behavior through reinforcement, punishment, modeling, etc., but we can’t pick out one specific behavior and reliably relate it back to a specific parental practice.

Although a good deal of research is being done on the genetic theory at the present time, the results are often difficult to interpret.  It is widely reported, for instance, that having an older brother increases the probability of a man being gay, and that each additional older brother increases these odds.  By way of explanation, it has been proposed that the male fetus provokes a maternal immune reaction (an antigen) that becomes stronger with each successive male fetus.  Subsequent male fetuses are attacked by this antigen, resulting in less masculinization in utero.  However, the phenomenon can be equally well explained in psychosocial terms.  A mother who has had two, three, or even four boys desperately wants a daughter, and raises the youngest boy in a feminine sort of way (through the usual methods of reinforcement, encouragement, etc.).  It’s not being suggested that she sets out deliberately to feminize her son, but rather that her deeply felt desires express themselves in ways that lead to this outcome.  Some researchers maintain that you can’t become homosexual in this way.  But I think this is more a doctrinaire issue than an established fact.  I have worked with many homosexual individuals over the years, and a number of them have expressed the belief that these kinds of psychosocial influences did have a formative effect on their sexuality.  In the late ‘60’s I was doing a research internship at a juvenile offender facility.  One of the clients was openly homosexual.  At one point I asked him if he had any idea why he was homosexual.  “I was raised in a house full of women,” he replied.  “They dressed me in silk gowns; they did my hair and my fingernails.”  And he shrugged.

Genes determine structure.  Structure, of course, in turn, has an influence on behavior, but it is by no means the only such influence.  Genes, for instance, determine that we have legs, but it is our early experience that determines largely whether those legs will be used for ballet dancing or soccer or for kicking people in the head!

And so the debate continues.  Here’s my position.  Genes determine whether we have male or female cells and male or female anatomy.  I also believe that genes determine whether we have sexual yearnings towards male or female partners.  These yearnings are wired or programmed into the brain in the form of arousal at the sight of certain anatomical features.  Cleavages, for instance, have an arousing effect on men; strong well-developed muscles have an arousing effect on women.  The precise nature of this “wiring” is not known.  Various researchers have identified small differences in brain structure between homosexual and heterosexual individuals.  And, of course, there has been a great deal of interest in X928 – the “gay gene.”

But this is where the plot thickens.  The wiring, although genetically determined, does not manifest itself until several years after birth.  This is not unique in nature.  Babies, for instance, are endowed genetically with the ability to walk upright, but this ability doesn’t emerge for about a year.  So between birth and puberty there is a relatively long period in which basic drives can be modified by psychosocial influences.

What seems evident to me is that for a male individual to reach puberty with clear heterosexual yearnings he needs to:

-          have male cells;

-          develop testicles, a penis, and seminal ducts in utero;

-          have a pituitary gland that secretes testicular androgens;

-          have the appropriate neural “wiring,”

and to have been raised in an environment that fostered (or at the very least didn’t stifle) these yearnings.

It is likely that the “wiring” admits of degrees with regards to strength and direction.  In other words, a person who is born male, cellularly and anatomically, may be “wired” strongly male or weakly male.  Similarly for babies who are born female – they may be wired strongly female or weakly female.  Admittedly all this is speculative, because I don’t know the nature of the “wiring,” but almost every human characteristic admits of degrees, so it seems a reasonable assumption.  It is also reasonable to believe that the pituitary secretions can vary in strength from person to person.

The rest of the story I think is clear.  People “wired” strongly will experience exclusively heterosexual yearnings at the onset of puberty; people “wired” weakly will also experience heterosexual yearnings unless their psychosocial environment has been such as to nudge them otherwise.  Or perhaps we have to distinguish between wiring and programming?  My knowledge of neurology is very limited, and I don’t have any precise or definite information in this area.

It will be argued by some that the wiring is rigid and cannot be modified by environmental factors.  But consider this.  The only drive in man stronger than the sexual drive is self-preservation.  This drive prompts us to flee overwhelming danger.  Soldiers, however, because of their training and other environmental influences, routinely behave in ways directly contrary to this drive.  Similarly, people on hunger strike suppress their desire to eat.  Neural wiring and/or programming, like almost everything else in the human body, is modified and sculpted by experience.  We are what our histories have made us.  This includes, but is not limited to, our genetic histories.

Some of the psychosocial factors that could conceivably nudge an individual towards a homosexual orientation are:

-  having a parent who wanted very much to have a child of the opposite gender and who treats one as if he or she were of the opposite gender;

-  having a same gender parent who was particularly ineffective or particularly obnoxious

-  being severely ostracized during childhood and adolescence by same-gender peers

-  (for girls) being sexually abused by one’s father (or other males)

-  disappointment in heterosexual relationships pushing a person back to the safety of same sex friendships.  (Culturally there is an expectation that we will form a heterosexual significant-other bond as adults.  People who don’t do this successfully in a heterosexual way can of course stay single. Or, if their heterosexuality was marginal anyway, they can reach out towards a homosexual relationship.)

The central point here is that what we think of as the male role (or the female role) is actually an extensive collection of specific behaviors that are developed and maintained through modeling on others and by being reinforced.  If the reinforcement doesn’t occur (for whatever reason), or if in fact punishment occurs, then the behaviors in question will tend towards extinction.  But humans are very adaptable, and if opposite-gender role behaviors are reinforced instead, then they will be emitted, and may become habitual. That’s the kind of organism we are.  We adapt.  We go with the flow.  During childhood we do the things that bring us good feelings and positive attention, and we learn to avoid the behaviors that bring us pain or disapproval.

The major need in this area is for clear thinking.  The various doctrinaire stances are unhelpful.  Sin is a contentless concept.  As long as people are not harming one another, blame is an irrelevance.

Although the APA formally demedicalized homosexuality in 1974, there is still a widespread belief in the mental health community, and in society generally, that homosexual individuals are not quite ok – that they are “messed up” – that they have more emotional problems than heterosexual people.  But I’m not aware of any research that supports this position (except for the side-effects of systematic persecution, which has fortunately abated considerably in recent years).  Homosexual individuals are as varied in their presentation as heterosexuals.  Some have their stuff together; others less so; others not as all.  But first and foremost, they are people, with the absolute right to be respected and treated as such.

Now obviously this is contentious stuff.  I’m not claiming that I’ve got everything right.  As I stated in the text, some of my ideas are speculative, but I believe that the position sketched out above is consistent with the facts.

According to the American Psychiatric Association, until 1974 homosexuality was a mental illness.  Freud had alluded to homosexuality numerous times in his writings, and had concluded that paranoia and homosexuality were inseparable.  Other psychiatrists wrote copiously on the subject, and homosexuality was “treated” on a wide basis.  There was little or no suggestion within the psychiatric community that homosexuality might be conceptualized as anything other than a mental illness that needed to be treated.  And, of course, homosexuality was listed as a mental illness in DSM-II.

Then in 1970 gay activists protested against the APA convention in San Francisco.  These scenes were repeated in 1971, and as people came out of the “closet” and felt empowered politically and socially, the APA directorate became increasingly uncomfortable with their stance.  In 1973 the APA’s nomenclature task force recommended that homosexuality be declared normal.  The trustees were not prepared to go that far, but they did vote to remove homosexuality from the list of mental illnesses by a vote of 13 to 0, with 2 abstentions.  This decision was confirmed by a vote of the APA membership, and homosexuality was no longer listed in the seventh edition of DSM-II, which was issued in 1974.

What’s noteworthy about this is that the removal of homosexuality from the list of mental illnesses was not triggered by some scientific breakthrough.  There was no new fact or set of facts that stimulated this major change.  Rather, it was the simple reality that gay people started to kick up a fuss.  They gained a voice and began to make themselves heard.  And the APA reacted with truly astonishing speed.  And with good reason.  They realized intuitively that a protracted battle would have drawn increasing attention to the spurious nature of their entire taxonomy.  So they quickly “cut loose” the gay community and forestalled any radical scrutiny of the DSM system generally.

Also noteworthy is the fact that the vote of the membership was by no means unanimous.  Only about 55% of the members who voted favored the change.

Of course, the APA put the best spin they could on these events.  The fact is that they altered their taxonomy because of intense pressure from the gay community, but they claimed that the change was prompted by research findings.

So all the people who had this terrible “illness” were “cured” overnight – by a vote!  I remember as a boy reading of the United Nations World Health Organization’s decision to eradicate smallpox.  This was in 1967, and by 1977, after a truly staggering amount of work, the disease was a thing of the past.  Why didn’t they just take a vote?  Because smallpox is a real illness.  The human problems listed in DSM are not.  It’s that simple.  You can say that geese are swans – but in reality they’re still geese.

An interesting aspect of this is that homosexuality actually does meet the APA’s present criterion for a mental illness!  The criterion is:  “… a clinically significant behavioral or psychological syndrome or pattern that occurs in an individual and that is associated with present distress…or disability…or with a significantly increased risk of suffering death, pain, disability or an important loss of freedom.”  (DSM-IV-TR, p xxxi)  Although conditions for gay people have improved considerably since 1974, they are still subject to ridicule, discrimination, and violence.  What’s also ironic in this regard is that if the gay community had stayed within the protective embrace of the APA, they might by now have managed to have homosexuality declared a disability, with benefits payable by the Social Security Administration!

The overall point being that the APA’s taxonomy is nothing more than self-serving nonsense.  Real illnesses are not banished by voting or by fiat, but by valid science and hard work.  There are no mental illnesses.  Rather, there are people.  We have problems; we have orientations; we have habits; we have perspectives.  Sometimes we do well, other times we make a mess of things.  We are complicated.  Our feelings fluctuate with our circumstances, from the depths of despondency to the pinnacles of bliss.  And perhaps, most of all, we are individuals.  DSM’s facile and self-serving attempt to medicalize human problems is an institutionalized insult to human dignity.

Psychiatry likes to present itself as a helping profession, but even a cursory look at its history suggests otherwise.  Here are some of the “treatments” that this pseudo-science has promoted for its pseudo-illnesses.

STERILIZATION

It is estimated that 65,000 people were sterilized in America under various eugenic statutes.  This practice, which was used between the 1920’s and 1970’s, was aimed at “undesirables” which included the so-called mentally ill.

HYDROTHERAPY

This involved suspending the client in a cold bath for hours and even days at a time.  It was widely practiced in the early decades of the twentieth century.

HYSTERECTOMY, OVARIECTOMY, AND CLITORIDECTOMY 

These “treatments” were also used in the early decades of the 20^th century.  The theory was that insanity was caused by pelvic irritation which was “cured” by these methods.  Robert Whitaker (Mad in America) reports that Clitoridectomy “did not disappear altogether from American asylums until at least 1950.”

SURGICAL REMOVAL OF OTHER BODY PARTS

Removal of teeth, colon, appendix, fallopian tubes, cervix, and other parts were all used as “treatments” for the hapless residents of American asylums.

INJECTION OF ANIMAL HORMONES

Extract of sheep thyroid was popular.

DEEP SLEEP THERAPY

This involved putting patients into a deep drug-induced coma and leaving them in this state for days on end.  Mortality rates of 6% were reported.

FEVER THERAPY

Fevers were induced by hot baths, electric heaters, and even deliberate infection with malaria.

EXTREME COLD THERAPY

Patients were refrigerated for two or three days at a time at temperatures as low as 20° F below normal body temperature.

INCARCERATION

Between 1900 and 1950 discharge rates from the asylums were extremely low, reflecting a belief that containment was the “treatment” of choice.  Conditions were often brutal and degrading.

INSULIN COMA THERAPY

Administration of insulin to a non-diabetic person results in a reduction in blood glucose. If enough insulin is given, the individual goes into a coma.  During the 1930’s and 1940’s, psychiatrists in Europe and America promoted the preposterous idea that coma induction of this sort, when repeated often enough, was an effective “treatment” for residents of the asylums.  The procedure caused severe and permanent brain damage.  This “treatment” was common even up to the early 1950’s, even though the apparent efficacy of the “treatment” was nothing more than the docile child-like state that resulted from the extensive brain damage.

METRAZOL CONVULSIVE THERAPY

This “treatment” consisted of injecting the patient with Metrazol (a synthetic camphor).  Metrazol is toxic, and the injection produced an epileptic-like seizure.  The effect on the patient was extremely unpleasant and terrifying.  Patients were usually exposed to multiple “treatments,” resulting in permanent brain damage.

ELECTRO-SHOCK THERAPY

Here electric shock was used to induce the brain-damaging seizure.  Psychiatrists hailed this “treatment” as a great therapeutic breakthrough, even though it was widely recognized that the “therapeutic” agent was the destruction of brain cells in the cerebral cortex, with consequent loss of higher cognitive functioning.  This “treatment’ was used extensively even in recent times.  In 1955 Lauretta Bender, a renowned psychiatrist, reported that she had administered a twenty-shock “treatment” program to a two-year-old infant!

PRE-FRONTAL LOBOTOMY

This involved drilling holes in the side of the head, inserting a scalpel, and then moving the scalpel up and down, severing the front part of the brain from the rest.

All of the practices outlined above were barbaric, and most involved permanent damage to the victim.  Yet psychiatry embraced them whole-heartedly.  The misgivings of objectors were treated with cavalier dismissal.

It is particularly interesting that each of these “treatments” was backed up by spurious and simplistic theories, and these theories were promoted as vigorously as the brain illness nonsense of today.

The widespread and destructive “treatment” of ordinary problems of living with dangerous drugs, and the wanton disregard of the collateral damage, is just the latest page in psychiatry’s legacy of shame and abuse.  The pushing of drugs is not as overtly barbaric as the “treatments” of former years, but as the number of people involved is so much higher today, the total damage inflicted is probably greater.

Many authors have written extensively on this facet of psychiatry’s history – but Robert Whitaker’s treatment of this subject in Mad in America is especially worth reading.

In a comment on my post on Natural Correction, Nanu Grewal raised a question concerning the addressing of behavioral problems.  This is a huge topic, and I feel the reply warrants a post.  There are others who could do a better job than me, but here’s my take on it.

Traditional behavior therapy starts with assessment.  Take nail-biting as a fairly simple example. Observations are made for a week or so, and the frequency of the problem behavior is measured as accurately as possible.  Next step is remediation.  In this case, say, application of a foul-tasting preparation to the subject’s nails.  Then more monitoring.  Essentially what has occurred is that the problem behavior has been punished by the foul taste, and one expects to see the problem diminish in frequency to the point of extinction.  Further monitoring would occur about a month later to ensure no return of the problem.

Nail-biting is a trivial example, but that’s the paradigm.

The fundamental principles are:

1.  When an action is followed by reinforcement, the probability that the action will recur in that (or similar) context is increased.  (Reinforcement has a rather technical meaning but essentially it means something pleasant.)

2.  When an action is followed by punishment, the probability that the action will recur in that context is decreased.

These principles seem like basic common sense, and indeed they are, but they have also been verified empirically in a wide range of situations.  From a behaviorist point of view, whenever we see habitual behavior, we conclude that this behavior is being reinforced in some way.  For people the primary source of rewards and punishments is other people.

Sometimes we reinforce maladaptive behaviors in our children.  Sometimes the process is obvious.  (“Stop making noise and I’ll give you a cookie.”).  But often the behavioral dynamics can be subtle.  A father, for instance, may derive a certain “macho” satisfaction from seeing his young son misbehave, and may communicate this to the child in almost subliminal ways.  Or even:  the father may have some hostility towards the mother (such a cad!) and subtly encourages the boy to give her trouble.  Etc., etc..

Behavior therapy is firmly based on science, but the application of these principles to the subtleties and intricacies of life involves a good measure of art.  The best text on this subject that I’ve ever come across is A Psychological Approach to Abnormal Behavior by Leonard P. Ullmann and Leonard Krasner (Second Edition 1975).

Behavior therapy was popular in the 60’s in a wide range of contexts, and its efficacy was undisputed.  Then, fairly suddenly, it was gone, replaced by Rogerian-type counseling, or reality therapy, etc., or, more usually, by drugs.  Today, of course, we have cognitive-behavioral therapy, which is not behavior therapy.

Behaviorists focus on specific behaviors.  Many years ago a young woman came to see me.  She was beset with problems:  single mother; alienated from her own mother; no job; depressed; anxious, etc..  She mentioned in passing that she was the “sort of person who never finishes anything,” and that she had seven unfinished knitted sweaters in her closet.  At the end of the hour she was clearly feeling better just for having had a chance to “unload,” and she asked for my advice as to what she should do about her various problems.

“Get rid of the sweaters,” I replied.

“But I paid good money for the yarn and the patterns.”

“Yes,” I agreed, “but they’re causing you nothing but grief.  They sit in the closet ‘leering’ at you, making you feel guilty.”

“I can’t just throw them away.”

“Keep one and finish it this week; give the others away.”

She agreed with this suggestion, and next week returned wearing the completed sweater, looking much more relaxed and functional.

Now I’m not suggesting that this resolved all her problems – but by identifying one specific problem, she was able to tackle this and find some feelings of success and control in her life.  Then we used this paradigm to tackle other problems.

Often with depressed individuals I would suggest that they make the effort to smile at people they encountered in stores and other public places.  Here again, the emphasis is on identifying a specific response that is incompatible with the problem behavior.  (Note that to a behaviorist, depression is always depressed behavior.  We focus on things like the downward cast of the eyes; the slow speech; the slumped shoulders, etc..  Walk the walk; the good feelings will follow).

In my view this entire area is overshadowed by a simple, much-denied fact:  that the vast majority of people who come to a mental health/counseling/therapy setting do NOT come with a view to making changes in their behavior.  This is not a criticism – just a statement of fact.  But it is a problem, because all the major paradigms (including behaviorism) assume that behavioral change is the objective.  So various games are played.

Usually – in my experience – clients just want to have someone to talk to; someone to validate their views and their relationships; sometimes just someone who’ll play “ain’t it awful.”  Now of course we try to  nudge even the most entrenched individuals towards more functionality, but most therapists that I have known (including myself) spend a good portion of their day holding hands (not literally), soothing frazzled nerves; making encouraging noises, etc., as opposed to pursuing behaviorally specific objectives in a purposeful and objective fashion.

But – having said all that – there are still some behavioral principles that can guide our work.  First and foremost, of course:  focus on specific behavior; encourage functional behavior and discourage dysfunctional.  This can sometimes be subtle.  Craziness is a good example.  If a client tells his therapist that he is convinced that the power company is monitoring his thoughts through the electricity meter and reporting their findings to the government, the therapist is likely to “prick up his ears,” so to speak and perhaps even take notes.  Now this is reinforcing, and what this therapist has done has actually contributed (albeit slightly) to the client’s craziness.  What I do (well, used to do, since I’m now retired) is studiously ignore this kind of comment, let my gaze slip to the middle distance, and wait for the client to say something sensible.  The reality is that the client knows that his assertion is not true; that it is nonsense.  He is saying this because it has been reinforced in the past – by family, police, medics, psychologists, etc., etc..

Now I’m not suggesting that my policy of ignoring nonsense will turn things around, but – and this is noteworthy – I heard remarkably little psychotic speech in my office, even though I routinely worked with individuals who carried various psychosis-type “diagnoses.”  I believe – I hope – that I conveyed to these individuals that for an hour a week they could be completely cogent, lucid, articulate people.

Unfortunately, of course, there were a great many other forces in their lives nudging them in opposing directions.  In my experience crazy people never really get cogent until they develop the skills necessary to start experiencing some success in their lives.  Some of the rehabilitation programs are good in this area, but many are just baby-sitting/daycare services, where the staff have thoroughly absorbed the spurious notion that crazy behavior is the result of an incurable disease called schizophrenia.

From a behaviorist point of view the therapist above who “pricks up his ears” is literally teaching the client to be crazy.  Psychotic speech is a skill that has to be learned (i.e. acquired).  Its primary payoff is that it relieves one of virtually all responsibilities and, in developed countries, attracts a regular, if meager, government pension.

Similar considerations apply to problems like depression and anxiety.  Sometimes I would give direct advice based on behavioral principles, but always I encouraged functional behavior and discouraged dysfunctional.  So if a depressed person indicated that he thought perhaps he should get out and about more, I would enthuse appropriately; if he was just wallowing in the sadness of it all, I would be more neutral, etc., though not to the point of callousness or indifference.  Sometimes it’s a fine line.

With painful memories (currently known as PTSD), I would encourage the client to talk about the precipitating incident over and over from different aspects until the memory of the event ceased to be a fear-provoking stimulus.

I realize that this is a bit fragmented (a bit?!).   Behaviorism is really a mind-set – a way of looking at human existence.  It’s a perspective in which human behavior is a natural phenomenon, and the therapist is someone who tries to elicit functional, successful behavior and discourage the opposite.

The central theme of this blog is that there are no mental illnesses and that the spurious medicalization of problems of living represents a tragic wrong turn in human history.

In a comment on my last post, Nanu Grewal raised the question of a natural correction.  In other words, does there come a point where the nonsense is so outrageous that some corrective force emerges which would undermine and even supplant the present illogical system.  In my view this is an excellent question.

I used to think that the insurance companies might provide such a correction, by simply refusing to pay for this so-called treatment (as they did with inpatient substance abuse treatment in the early 1990’s.)

But this simply hasn’t happened.  Indeed here in the U.S. we’ve recently enacted a parity law whereby insurance companies are required to cover the so-called mental illnesses on an equal footing with real illnesses.  This makes it virtually impossible for insurance companies to start clamping down now.

I have sometimes wondered if the cost of the mental health system would become too great a burden on the public purse, and that some corrective measures would be undertaken.  Most public support of healthcare in the U.S. is through Medicare and Medicaid, and it is widely reported that these programs are under a good deal of financial strain.  Most of the suggestions in this regard, however, have been on the lines of requiring individuals to pay more than they already do, rather than eliminating, or even reducing, the mental illness services.  So I see no great ray of hope in that area.

And of course over and above all of this is the fact that a great many people simply like to take drugs, and this is a powerful drive which tends to maintain the status quo.

Through the years there have been a number of individual writers who have seen through the nonsense and who have spoken out fearlessly.  In recent years perhaps we’ve seen a little more of this, but it certainly hasn’t become a groundswell of protest.  But perhaps that is the best natural correction that we can hope for – more and more individuals speaking out, exposing the spurious nature of the so-called mental illnesses and the tragic consequences of the drugs-for-every-problem philosophy.

Anyway, I can think of nothing else on the horizon.  I’d be interested if any readers had any thoughts.  Can you see any natural corrections in the works?  Are there things we could be doing to promote natural corrections?

On June 23, the New York Review of Books, one of the most prestigious literary magazines in the country, published a piece by Marcia Angell.  I’ve mentioned Dr. Angell before.  She had been editor-in-chief of the New England Journal of Medicine  and had come out strongly against the extent to which drug companies are controlling and directing medical research.

Well in this recent article she reviews three books:

The Emperor’s New Drugs:  Exploding the Antidepressant Myth, by Irving Kirsch, PhD

Anatomy of an Epidemic: Magic Bullets, Psychiatric Drugs, and the Astonishing Rise of Mental Illness in America, by Robert Whitaker

Unhinged: The Trouble with Psychiatry – A Doctor’s Revelations About a Profession in Crisis, by Daniel Carlat, MD

Marcia does a very nice job of drawing the various threads from these three authors together into a coherent, stand-alone two-part article (which you will find here and here) that is well worth the read,.  She has also written a book of her own:

The Truth About the Drug Companies: How They Deceive Us and What to Do About It. (Random, 2004)

It’s encouraging that this kind of material is appearing in mainstream publications.  Disenchantment with psychiatry can no longer be dismissed as the crackpot ravings of a few disgruntled eccentrics.

Although I am encouraged by the work of Angell, Kirsch, Whitaker, and Carlat, in my view they all baulk at the final fundamental conclusion:  that there are no mental illnesses. The concept of mental illness is intrinsically spurious.  It’s not just that the concept is applied too liberally, or that drugs are misused, etc..   The critical point is that the APA defines mental illness as, essentially, any human problem – and then, voila! – discovers that lots and lots of people have these so-called mental illnesses.

Until this simple logical fallacy is recognized, progress is inevitably going to be slow and sporadic.  But we’ll keep trying!