Behavior Analysis of Psychotic Disorders: Scientific Dead End or Casualty of the Mental Health Political Economy?
Wong, Stephen E., Behavior and Social Issues
Behavior analysis, once a promising approach to understanding and treating severe mental disorders, has been obscured by the biomédical model of mental illness and its ubiquitous psychotropic drugs. The present paper gives a brief overview of behavioral research on psychotic disorders followed by a critical review of the prevailing biomedical model including psychiatric diagnoses, anti-psychotic medications, clinical outcomes, and adverse effects of drug treatment. This paper also examines ideological, political, and economic mechanisms of control that have blocked the application of behavior analysis with severe mental disorders.
KEYWORDS: behavioral treatment, chronic mental patients, schizophrenia, history of behavior analysis, biomedical model, professional competition, pharmaceutical industry
Behavior analysis once offered a bright promise for advancing the understanding and treatment of severe mental disorders. Half a century ago, landmark studies in the experimental and the applied analyses of behavior were being conducted with psychotic patients in the ill-fated state mental hospitals. B. F. Skinner and Ogden Lindsley first replicated the free-operant paradigm with humans using chronic mental patients as subjects (Rutherford, 2003). They constructed an apparatus in which patients could pull a lever to obtain candy, cigarettes, projected slide images, and other stimuli dispensed on variable-interval and fixed-ratio schedules of reinforcement. Cumulative recorders showed the variable-interval schedules produced stable response rates that varied across individual patients, and the fixed-ratio schedules produced the characteristic postreinforcement pauses commonly seen with infrahuman organisms maintained on this schedule (Lindsley & Skinner, 1954; Skinner, Solomon, & Lindsley, 1954). These response patterns served as stable baselines against which patients' "psychotic episodes," brief periods of hallucinatory, destructive, or other disturbed behavior (lasting 20 minutes to several hours), and "psychotic phases," longer periods of psychotic behavior (lasting weeks or months), could be studied (Lindsley, 1960). This groundbreaking research, conducted at the Harvard Medical School Behavior Research Laboratory, in the Metropolitan State Hospital in Waltham, Massachusetts, both broadened the generality of behavioral principles to humans and demonstrated the feasibility of opérant conditioning with psychotic patients.
Another behavior analyst, Kurt Salzinger, was among the first to quantify and analyze the verbal behavior of schizophrenic patients in clinical interviews. Despite the seeming tangentiality of schizophrenic speech, Salzinger and Pisoni (1958, 1961) demonstrated that it was partially controlled by interviewer's questions operating as discriminative stimuli, and interviewer's attending responses (utterances such as "mmhmm," "uhha," or "I see") operating as positive reinforcement. Salzinger and Pisoni (1960) also found that schizophrenic patients' verbal behavior was less resistant to extinction than that of normal subjects. Based partly on this finding, Salzinger and his colleagues posited a theory in which persons with schizophrenia respond primarily to immediate spatial and temporal stimuli, as compared to normal persons that respond to more remote stimuli (Salzinger, 1973; Salzinger, Portnoy, & Feldman, 1966; Salzinger, Portnoy, Pisoni, & Feldman, 1970).
Behavioral programs for psychotic mental patients were among the first successful clinical applications of operant conditioning. These early programs demonstrated that, contrary to common belief, environmental events could have a substantial influence on the behavior of persons with psychotic disorders. By systematically presenting antecedent and consequent stimuli for specific responses, caretakers could change the rate of a patient's existing behavior or give rise to behavior not currently exhibited by the patient. …