Cognition & Reality

Saturday, 30 April 2011

The Dog Whisperer & Biological Determinism

Through his program, “The Dog Whisperer,” Cesar Millan has made himself into the most famous dog trainer in America, if not the world. His approach features his intuitions about dogs’ motivations. In explaining those motivations, he frequently refers to the descendence of domestic dogs from wolves, and only occasionally refers to the relationship between breed characteristics and a dog’s problem behavior. I have never heard him blame bad behavior on a dog’s genetics. In fact, he is a strong defender of pit bulls and other breeds that have been seen as dangerous because they are bred to be aggressive. Because he almost always sees the roots of a problem in confusion about dominance, he trains owners to reinforce positive, submissive behavior by becoming better “pack leaders.” When it comes to dogs, as the success of Millan’s program demonstrates, the public is willing to believe that behavioral pathology is mostly a product of learning.

It is therefore interesting that, in the popular imagination, human psychoemotional difficulties, not so different from the fearfulness and aggressiveness the Dog Whisperer often addresses, represent underlying physiological anomalies. Although people readily accept that dog psychopathology reflects bad “parenting,” they reject the idea that the same can be true of humans. To explain humans’ dysfunction, the public prefers explanations that seem to be at a remove from the direct experience of learning and developing, such as “chemical imbalance” or physical inheritance.

Cesar Millan’s treatments are invariably behavioral. Although I believe he doesn’t explicitly disapprove of using antidepressants with dogs, he never presents chemical or even dietary interventions on his show. Instead, through careful titration, he focuses on changing behavior, replacing dysfunctional behaviors with functional behaviors. He not only employs himself and other humans to do this, but also the dogs in his own pack, particularly his pit bull Daddy and a few other canine co-therapists.

Right now, I’m watching a touching installment of “The Dog Whisperer,” in which Cesar is rehabilitating a fearful Doberman mix named Baby Girl. When he discovers that Baby Girl refuses to eat, Cesar brings in a vet to examine the dog for physiological problems, but there is nothing physically wrong with her. Cesar concludes that Baby Girl’s eating disorder is “psychological.”

Admittedly, the psychological disorders of dogs do not track exactly the psychological disorders of humans. In addition, the cases that make it on to Cesar’s show, more often than not, involve violent dogs. Not only is an aggressive dog likely to drive owners to seek help, but a violent dog also makes better TV. On the other hand, Baby Girl was not violent. She had symptoms more similar to clinical depression or a personality disorder, and Cesar used a mixture of behavioral approaches to treat her. The point here is not so much that Cesar Millan believes in the efficacy of psychological treatment, but that the audience believes in the efficacy of psychological treatment, when the “patient” is a dog.

When the patient is a human, however, the public has been conditioned to accept the use of pharmaceuticals to treat psychoemotional problems, and they have accepted the notion that much psychopathology is “genetic.” Contrast this set of ideas with the way Cesar Millan operates. Although he does, under some circumstances, take into account a dog’s genetics, he almost always attributes behavioral problems to what we would call “upbringing” in the human context: The problem is really with the owners, an attribution most of the owners on the show readily accept.

One can see how much more difficult a similar conclusion about human parenting is to accept . Parents don’t want to believe that they contributed to the psychopathology of a child. In addition, physicians presently enjoy enormous power in treating psychopathology. It is therefore in their interest to promote a relationship between physiology and behavior that Cesar Millan implicitly rejects in the way he treats the psychological problems of canines.

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Sunday, 24 April 2011

Disease, Disorder, Distraction

Responsible scientists who are familiar with the research but want to preserve the disease concept of alcoholism have had to redefine their terms. They define “disease” as whatever doctors choose to call a disease (Jellinek, 1960)! The point of using the word, they acknowledge, is “social” rather than medical. There is a lack of consistent self-control that leads to harmful consequences (Vaillant, 1990). Of course such sweeping uses of the term make almost every human and social problem into a “disease.”

In the above passage, from a book chapter published over 20 years ago, Herbert Fingarette prefigured the current obsession with attributing any troubling behavior to an underlying disease. The extension of medicine into areas where it does not belong, because its methods do not apply, is an insidious ongoing process. We have not only given doctors great power within the legal domain, but we have also permitted the ideology called “medical science” to dominate the cultural definition of many types of behavior.

Sadness and worry are now perceived as symptoms of an underlying disease, although they could result from a wide range of potential causes. To be in a down mood is the natural response to various circumstances, such as a bad marriage or financial difficulties; and events, such as the loss of a job or loved one. As the beginning of this piece from The Guardian suggests, however, the medical community and the pharmaceutical industry have succeeded in redefining a psychiatric condition called “depression” as a common disorder. Because it is presumed to have an underlying physiological cause, a critical feature of this newly redefined disorder is that it can be addressed with certain expensive medications.

Accordingly, the official numbers indicate that 9% of the US population count as “depressed,” with 3.4% meeting the criteria for Major Depressive Disorder, while doctors write millions of prescriptions for antidepressants yearly, at a rate that continues to accelerate. From one perspective, these figures raise questions about a society with a tenth of its members bummed out, some seriously bummed out, many of them dependent on daily doses of drugs having limited efficacy and unknown long-term effects. From another perspective, the same figures raise questions about what counts as a mental disease or disorder such that so many people suffer from such conditions.

Our society had become addicted to medicalizing social, moral and spiritual problems. As Fingarette predicted, many troubling behaviors have been reconceived as disease states. Doing so puts money in the pockets of pharmaceutical companies and physicians, while it reassures members of both the medical profession and the general public. Insurance companies and government agencies like it, too, because the treatment of medical disorders usually involves medication and other courses of treatment that are much less expensive than traditional psychotherapy, with its emphasis on developmental issues.

First of all, there are “food addiction,” and “sex addiction,” new names for otherwise normal activities that have reached an unacceptable level of excess. Although eating too much can be injurious to one’s health,and reckless promiscuity can wreak havoc, putting these problems into a category with dependence on intoxicants places them within the same disease-oriented framework. As discussed in a previous post, conceptualizing substance abuse as resulting from “disease” is misleading as a guide to treatment and unjustified by empirical evidence, and the same is true, of course, for destructive patterns of behavior to which the addiction metaphor has been extended. Nevertheless, there are many intensive, expensive treatment programs, modeled on programs for substance abuse, dedicated to treating overeating and promiscuity.

The emergence of Asperger syndrome as a diagnosis shows that the redefinition of human behavior as disease does not stop with sadness, overeating, and fucking too much (however much that is). Most people realize that this “syndrome” is nothing more or less than “nerdiness,” as it was called before it became a disease. A look at the diagnostic criteria for Asperger’s illuminates its shaky foundation. A child need only meet two diagnostic criteria by exhibiting “impaired social interaction,” and “repetitive and stereotyped patterns of behavior”; other criteria, such as having “inadequate relationships,” or “impaired nonverbal communication,”among others, belong in the “Maybe” category. Treatment for this “syndrome” is a joke, consisting mainly of medications insurance companies will pay for, and therapeutic modalities that, by their nature, are limited in duration: physical therapy, occupational therapy, cognitive behavioral therapy, social skills training, and parenting classes. It need hardly be said that none of these has yielded reliable improvement of the identified problems. Nerdy children may suffer some pain as a result of their behavior, although the very nature of the “syndrome” presupposes that they don’t notice the inadequacy of their relationships. For sure, children who fit the criteria for Asperger’s are annoying, and they can grow into adults with horrible manners, which may explain the amount of attention this “disorder” has received from physicians and psychologists.

Attention deficit hyperactivity disorder (ADHD) is another instance of the “diseasing” of behavior that is deemed to be troubling and disruptive. The controversy over ADHD is so old and so fraught with emotion that there is no point in revisiting it here. Suffice it to say that a recent study, conducted under the auspices of the National Institutes of Health, found that, despite initial improvement, children treated for ADHD through a variety of different recognized modalities, either singly or in combination, fare far worse than children who have not been diagnosed with ADHD. The children received the best treatment the medical establishment can offer, including advanced medications, for at least 14 months, and some were still receiving treatment years later, when they were assessed for their school performance and many other variables relevant to social  and psychological adjustment. Nevertheless, as the results summarized in this table show, they compared unfavorably with comparison subjects on almost every measure chosen by the investigators, who undoubtedly believed in the efficacy of treatment. If ADHD is a disorder with physiological substrates that reflect a genetic disposition, as has long been claimed, “medical science” has not succeeded in discovering how to treat it.

Much the same can be said about the medical approach to the other problems surveyed here. Recidivism by alcoholics and drug addicts who have gone through draconian rehabilitation regimes is notorious. Depression remains a significant problem, as one can tell from the number of commercials one sees for antidepressants. No one is suggesting that there is a reliable treatment for Asperger’s or ADHD. In spite of this abysmal record, physicians continue to operate under the questionable assumption that these conditions represent underlying, circumscribed causes, and continue to treat these conditions as if they know how to ameliorate their effects.

Friday, 1 April 2011

Changing The Past

Filed under: Attachment,Emotion,Film,Psychotherapy — drtone @ 1:50 pm

In previous posts, I have discussed the non-existence of past and future. They are projections consisting of nothing but complex thoughts, and are therefore not real. In its many guises, the past can be particularly problematic. From a “psychotherapeutic” standpoint, the past, as we conceive it to be, is the source of many difficulties in the present. We trace the defensive adaptations that seem to get in our way to the distorted family dynamics of childhood. Our memories of the past, constructed though they are, can appear to us with great clarity. Although they refer to the “past,” our memories happen to us in the present.

You can’t change what doesn’t exist. In movies, sometimes, a character journeys into the past, where he or she has no power and can’t even talk to those he or she sees, perhaps to warn them of an impending disaster. Our experience of the past is much more like those movies than we usually recognize. Memories, especially when they are very clear, seem to be as subject to the rules that govern reality, such as the laws of physics, as are events that actually occur in the present. So we try to solve the problems that come to us from the past as if they were happening now. The problem is that we walk around in our memories much like a character in a movie who wanders wraithlike through scene after scene in which he or she can touch nothing nor be heard.

Saturday, 19 March 2011

“Getting Better”

Non-attachment means recognizing the basic goodness of our situation. I give up my goals, my notions about improving, because trying to “get better” implies moving away from WHO I AM NOW. Whatever I do, win or lose, come or go, I experience reality as it happens, unadorned by my stories about it. By the same token, as long as I focus on where I want to be in the conjectural future, I reduce the psychic space available in the present. If I am not attached to results, not only am I free from the suffering I might engage in, but also my mind and senses are clear. Paradoxically, once I renounce my attachment to going anywhere in particular, I become more effective at going where I want to go.

We can’t open selectively, however. Because pain and turmoil are part of life, we must accept them if we are to remain open to love and joy. I have told clients who have come to me as a result of ruptured relationship or financial crisis to welcome the opportunity the seeming disaster presents. Although these events are painful, to say the best, they also can illuminate pathways that would have been impossible to see under the prior, apparently more comfortable, circumstances. Notoriously, for example, a secure marriage, once gone, reveals itself as having been a hindrance to growth. Non-attachment from the immediate consequences of separation and divorce can therefore lead directly into previously foreclosed possibilities.

Thursday, 17 February 2011

If Not “Psychotherapy”

Filed under: Psychotherapy — drtone @ 10:45 am

A couple of daze ago, I commented on the implications of using the term “therapy” or “psychotherapy.” I’ve tried to come up with some alternatives, if only to demonstrate the difficulties inherent in labeling the work we do.

Although it is a term used colloquially in a broad sense for various forms of (let us call it) counseling, it’s unfortunate that “psychoanalysis” already has an established meaning too specialized to allow it to refer accurately to the process under description.  In spite of being devised by a physician, “psychoanalysis” doesn’t carry with it the metaphor of disorder and repair that we have identified as infecting the broader term “psychotherapy.” It literally means something like “dissolving the soul,” or “loosening the soul.” Pretty much perfect.

There are a number of candidate terms that I’ve rejected. “Self-examination” and “self-investigation” seem to come from the criminal justice system. “Self-exploration” and “self-discovery” come too close to the dismissive navel-gazing, masturbatory metaphors used by critics and those who do not wish to engage. I thought about “psycho-spelunking,” but it does not have the right ring.

Tuesday, 15 February 2011

If It Ain’t Broke…

Filed under: Emotion,Psychotherapy,Radical Constructivism — drtone @ 9:09 am

Because the process of psychotherapy also depends on a story, one about receiving “treatment” for a “problem,” it consists in a self-contradictory story. In that story, I am damaged and someone else, a “therapist,” comes along and fixes whatever is wrong with me. Not only does such a story depend on a static medical model, with a doctor ministering to a passive recipient, but it also involves the false portrayal of the entire situation as a transit from illness to health. When we renounce attachment to our narrative about repairing the Self, we discover that there was nothing broken in the first place.

“If it ain’t broke, don’t fix it” is a maxim to live by. Once we recognize that the true self manifests constantly, we can begin to examine why that is not apparent to the conscious mind. Suffering does occur. Under no circumstances can arrangements in the world meet every need. Life outside is not like life in the womb. It can be uncomfortable and unsafe, a discovery an infant continues to make from birth onward. In response, we develop defenses against the elements of experience that do not comport with feelings of comfort and safety. Psychotherapy is somehow about reaching behind those defenses without disrespecting them.

A client suggested to me, when we discussed psychotherapy and the question of “fixing,” to consider the meaning of the word “fix,” which is about preserving the status quo. In photography, for example, the “fixer” bath prevents the newly developed photo from changing. Fixing, thought of that way, is against change. Therefore, the client suggested, psychotherapy, at its best, is about “un-fixing.”

Thursday, 13 January 2011

Medicine & Law: The Psychiatric “Hold”

Filed under: Diagnosis,Medical Morality,Psychotherapy — drtone @ 1:54 pm

Many are familiar with the meaning of the term “5150,” It refers to a provision of California law, Section 5150 of the Welfare & Institutions Code, pertaining to the involuntary commitment of an individual designated as “a danger to self or others” or “gravely disabled.” The law is administered at the county level, usually involving county sheriffs as the main agents of commitment, although others, principally psychiatrists so designated by the county, can place a person in an involuntary “hold” at a psychiatric facility. Naturally, such a law is a constant matter of debate among civil libertarians, but let us stipulate, for the moment, that there are circumstances in which it is necessary to confine someone who is acting out in a potentially dangerous manner or is manifestly and severely suffering from self-neglect.

From my perspective, the interesting thing about this kind of “hold” is the legal power it places in the hands of physicians, not so much in admitting the individual in question, but in ending the hold and allowing him or her to leave the facility. According to a subsection of the law, WIC Section 5152, not only is it up to a psychiatrist to continue or end a hold, but the final decision to end a hold in disputed cases resides with the head of the medical facility where the person is being held, or if that doctor is not a psychiatrist, by a psychiatrist appointed by him or her. Think about that: A segment of the medical profession, psychiatrists, have legally defined powers over a person’s freedom. This is surely not the only instance where doctors are written into the law. We take it for granted, however, that members of a given profession who are usually not public officials deserve a level of trust far in excess that accorded other citizens. I’m not suggesting it’s wrong that we do this, but only that we consider what it means.

Friday, 24 December 2010

Spiritual Bypassing In Spades

Filed under: Attachment,Perennial Philosophy,Psychotherapy — drtone @ 1:43 pm

While thinking about writing an entry about the relationship of psychotherapy and spirituality, I noticed that some Googling I had previously done on “object relations” had turned up a conference of New York psychoanalysts on “psychoanalysis and spirituality.” As I looked further, and linked to one of the participants, Jeffrey Rubin, a Buddhist psychoanalyst of whom I had heard, I saw that he had a link on his website to a story in the New York Times Magazine about his treatment of a “Zen master.” I’m not sure if it’s precisely relevant to the topic I began with, but it’s an interesting study in how spiritual practice, mystical practice, or whatever you want to call it, can paradoxically act against the process of self-discovery that is presumably at its center.

Thursday, 23 December 2010

Soul Without Shame: Book Recommendation

As background for writing a book on the Inner Bully, I’m reading Soul Without Shame by Byron Brown, written from the perspective of the Diamond Approach of A.H. Almaas, with quotes from Almaas. The format is good, using vignettes to illustrate the different forms the “inner judge” or superego takes, and delving precisely into the origins of self-criticism and self-doubt. The Diamond Approach, although based in Sufism and other mystical traditions, draws heavily on object relations theory, making the book of interest to anyone interested in the relationship of depth psychology and spirituality.

Wednesday, 22 December 2010

Weird News

Knowing that my therapist, Michael Sieck, was involved with the Diamond Approach, I have reluctantly concluded that all roads lead to Ken Wilber.

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