Behavioral Disorders are not "All in Your Head"

The serenity prayer: 

God grant me the serenity to accept the things I cannot change, the courage to change the things I can, and the wisdom to know the difference.

 

When I read psychotherapy journals and posts on psychotherapy list-serves, it often sounds to me like the field has lost its collective mind. Some authors seem to think that every behavioral syndrome results entirely from some deficiency within a person, rather than being mostly a reaction to their social environment (the fundamental attribution error). If their patients are upset or anxious, they ask them things such as what is wrong with your thoughts or why they don’t know how to calm yourself down (cognitive behaviorists). Or what might be their deep-seated desires that they won’t face (psychodynamic therapists). 

(To be clear I’m not talking about major psychiatric disorders that are most likely real brain diseases such as schizophrenia).  

While these types of questions can be helpful for people who are not very disturbed about their lives and relationships, sometimes their use has been comical. As a psychiatrist named Jim Dillon put it:

“As a psychiatrist, I cringe upon hearing recommendations for psychotherapeutic methods employed to resolve ongoing social conflicts. It is like suggesting labor unions obtain group counseling when the threat of a strike is the only strategy that will improve their economic circumstances.”

Or teaching clients “mindfulness” when they are being invalidated, criticized or abused by their family and spouses - instead of helping them learn how to put a stop to the dysfunctional interactions.

 

As I described in a previous post, more systemic or social types of therapy that involve family members (family systems therapy), while still out there and being employed by masters’ level therapists, have fallen out of favor with psychologists. And they were never taught to psychiatry trainees at all (except in a residency program that I ran). This has occurred because of a number of social issues. Examples: Feminists thought systems people were blaming just women, who are still the primary caretakers for children;  some folks believed that there were people using the “abuse excuse” for criminal behavior and to avoid taking any personal responsibility for their problems; unscrupulous therapists were uncovering “false memories” of abuse through suggestions to the highly suggestible, as well as through hypnosis.

 

That last one also points to another issue that shows the field’s current state is more political than scientific. Just because some of the ideas therapists' used for problematic behavior were being misused in some contexts does not automatically make them invalid. Furthermore, if some of aspects of complex theories are wrong, that hardly means that all of them are wrong.

 

These phony arguments are also used to further the financial interests of  pharmaceutical companies, who want to sell more pills. If everything is a disease, drugs should be all you need. They are also used by the medical insurance companies. These insurers refuse to pay for any longer-term psychotherapy treatments in order to better cash in. They only cover symptomatic treatment. Bogus “medical necessity” criteria are used to drastically cut down the number of sessions therapists can administer. In other words, the current models help the greedy. The federal parity law that says psychiatric disorders must be paid for by insurers just like physical disorders has been a complete joke.

 

Science has clearly shown beyond a reasonable doubt that the structure of the “plastic” human brain is in part shaped by interpersonal interactions. Most of what we do in social situations is learned (or intuited as I believe some are),  and is then done automatically in response to environmental clues. The brain has about 6 Billion neurons with up to a thousand connections each, and the circuits change in response to what is learned. And learning also includes how to best react to literally thousands of environmental factors operating at different times, strengths and combinations.

 

An article published by Harvard University Center for the Developing Child says that 700 new connections per second are made in the brains of newborns within the context of care-giving relationships  Another recent study showed that small differences in a mom's behavior early on in interactions with infants may possibly show up in child's epigenome (epigenetics is the study of how genes are turned off and on in response to such things as social interactions).

 

It is time for therapists to learn, not how to change their clients’ “internal” family system (another recent therapy fad), but how to help them react better to their external one.