IS BEHAVIORISM BECOMING A PSEUDO-SCIENCE?: POWER VERSUS SCIENTIFIC RATIONALITY IN THE ECLIPSE OF TOKEN ECONOMIES BY BIOLOGICAL PSYCHIATRY IN THE TREATMENT OF SCHIZOPHRENIA

Behavior and Social Issues, Fall 2006 by Wakefield, Jerome C

Behavioral definitions of "disorder" underscore the political dangers of an environmental approach. Such definitions generally scoff at medical models, thus implicitly ejecting themselves from the domain of the health professions and calling medical reimbursement into question (Wakefield, 1998, 1999b). As a replacement for an objective biological dysfunction as the criterion for what is considered a disorder (Wakefield, 1992, 1999), these definitions generally refer to social values or the undesirability of behavior. While I would argue that anyone who is suffering should be granted support in the form of mental health intervention, one must admit that it is indeed conceptually unclear why all the sorts of problems described in behavioral definitions of disorder inherently fit within the mandate of the mental health system. The behaviorist attack on the medical model seems at odds with the relentless striving by behaviorists along with other psychologists to be considered legitimate mental health professionals qualifying for medical reimbursement.

WONG'S CRITIQUE OF BIOLOGICAL PSYCHIATRY

I now turn to Wong's article. Again, I can only address a sampling of his arguments, although I consider selected issues in more detail in subsequent sections.

Wong begins with the statement: "Behavior analysis once offered a bright promise for advancing the understanding and treatment of severe mental disorders." I address treatment later. Regarding the understanding of psychosis, Wong's statement is without foundation. It remains of interest that operant procedures can influence the manifestation of psychotic behaviors. But never did the literature on conditioning or token economies with psychotic patients suggest any serious understanding of the etiology of psychosis, any more than shaping the behavior of developmentally disabled children or head trauma patients offers a cogent etiological explanation of these conditions. (Ayllon and colleagues' success in getting a psychotic woman under controlled institutional conditions and with prompting by staff to hold a broom when inappropriate so that it appeared to psychiatrists to be a symptom is not serious evidence of general psychotic symptom etiology, in my view.)

The token economy literature, by showing that even bizarre psychotic behaviors are influenced by learning to some extent, did offer a corrective to ideological claims of rigid biological determination of psychotic symptoms. But Wong would be the first to point out that the fact that chlorpromazine reduces psychotic symptoms does not mean that the patient is suffering from a lack of chlorpromazine. Abandoning parity of reasoning, Wong (1996) elsewhere embraces explicitly what is here implicit, namely, the inference from behavioral influence on symptoms to behavioral etiology of symptoms. For example: "Whether initially established by positive reinforcement, negative reinforcement, or a combination of both, bizarre behavior in adults with psychosis often evolves into a variform and durable response pattern" (p. 326). Usually, though, Wong tries to verbally remain more neutral, suggesting that he is concerned about maintenance or perhaps just change of symptoms. These are each very different hypotheses.