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

Wong's rationale raises the question: When does "overlearning" become an excuse for not accepting disconfirmation of behavioral principles (as in attempts to evade the strong evidence in favor of biological preparedness for specific learning)? If we take Wong's rationale seriously as a testable thesis, then it appears to be disconfirmed, as I will argue later in my discussion of the Paul and Lenz study. Reminiscent of the evasive Wilder et al. framing discussed above, Wong asserts that symptoms "can be parsimoniously viewed as" learned behavior; but the parsimony exists only if one does not try to reconcile the account with the network of overall scientific knowledge. Symptoms "can be parsimoniously viewed" as byproducts of unknown biological brain dysfunctions, as well; the point is not how symptoms can be viewed, but how they are most scientifically plausibly viewed when one considers all the evidence.

Turning to Wong's critique of biological psychiatry, the lack of parity is striking. For example, he criticizes the lack of reliability of psychiatric classification, but never even raises the question of the reliability of a functional analysis.

Wong asks: "Why does psychiatry represent schizophrenia and other mental disorders as being brain diseases without first obtaining definitive evidence?" His explanation, borrowed from the the critical psychiatry movement, is the following: "Medical sociologists and other critics of the new biopsychiatry point out that this perspective portrays mental disorders as somatic problems and therefore the appropriate domain of medical practice, and that it rationalizes psychiatry's hegemony over the other mental health professions....This ideological shift also gave psychiatry a rich and powerful ally: The pharmaceutical industry."

Actually, psychiatry was under siege in the 1960s and 1970s from the behaviorist critique, the antipsychiatric movement, attacks on reliability, Rosenhan's study, psychoanalytic dominance, internal theoretical fragmentation, and so on. The resurgence in its power occurred because medication was found to be a powerful treatment for the severely disturbed, and also because psychiatry at least attempted to systematically address the criticisms.

Wong is correct in his concerns, in my view, to the extent that there is a dangerous trend toward using medication reflexively and exclusively, when in fact the reduction of symptoms through medication should almost always be accompanied by psychological or behavioral intervention to build new skills and capacities. But the fact remains that behavioral, psychological, psychoanalytic, and social methods of change all had their day and, though touted by devotees (and though no doubt every group of devotees would argue it was politics, not evidence, that undid them), all failed to basically change the situation of the severely mentally disordered.

Anyway, there is a pretty clear answer to Wong's question of why psychotic behavior is considered a medical disorder. It has almost always been considered a medical and even physiological disorder, ever since at least Hippocrates and Aristotle through to Kraepelin's biological thesis at the turn of the 20th century. The reason has nothing to do with the recent factors mentioned by Wong, or Wyatt and Midkiff.