Behavior Analysis and Schizophrenia

It's Thursday night, and the deadline for my weekly writing quota is feverishly approaching ... yikes! With the hope of finding something interesting to talk about, I opened up my Google Reader ^[1]. To my luck, Psy D. John Grohol had posted an interesting article about schizophrenia and it's "causes".^[2] Lucky for me, we just had a big discussion about this issue in class today...

In case you're not familiar with schizophrenia, look it up.

Grohol says,

The reality is that after hundreds of research studies into the biology and genetics of schizophrenia, all signs point to the fact that schizophrenia may be caused by thousands of rare gene variants. In other words, if you have one of these rare gene variants, you would be at greater risk for the disorder.

It may be the case that certain genes predispose us to the way outcomes affect our behavior. However, genes don't cause behavior to occur; reinforcement causes behavior to occur, those "schizophrenic" behaviors are learned.

This is a big error that a lot of people make. They make the assumption that genes are responsible for our behavior. Does this mean that my mother has the dental assistant gene, and my father has the awning-guy gene? I must have the "wake up at 7:30am every morning and do homework all day" gene. Give me a break.

More from Grohol:

Of course, the problem with this is that there are only limited ways the pharmaceutical industry can help if this is the case (notwithstanding one of the researchers’ quotes in the article). In fact, if the disorder is caused by thousands of different gene variants, there may be some real challenges in developing treatments based upon this understanding.

He's hit that one right on the money. Even if we all had those schizophrenic genes, the pharmaceutical companies cannot do much, let alone help us learn "appropriate behaviors" that exist in "non-schizophrenics", or "normal functioning humans" (society has us so appropriately labeled).

In comparison, today’s pharmaceutical treatments could be see as the over-the-counter medications you can take to treat a cold — they help with the symptoms, but do little for the underlying disease (which we still can’t treat!).

I think a majority of Americans actually do believe that having a "mental illnesses" is equal to something like the flu: you catch it, you take your pills to get rid of the problem, and you slowly get better. Grohol is implying that behaviors resulting from mental illnesses are underlying symptoms of a "disorder", just like a sore throat and a runny nose is a symptom of the flu.

Some Behavior Analysts have suggested that we are making an error of reification by implying the cause of a behavior, and using that behavior as proof of the cause.

For example:
Why is Matt acting so strange?
He is a schizophrenic.
Why is he a schizophrenic?
He is acting strange.

Catch my drift?

It's time to dig a little deeper. Let's use an example of a class of "schizophrenic behavior" and compare them to what we would call normal...

Let's say you fantasize about death all day and all night. All you can think about is God, dying, heaven and hell.

It is very normal to think about these concepts. A majority of cultures have tackled the issue of life after death. In fact, many people (ie the Pope) have devoted their lives to religion, death, heaven, and hell.

The outcomes that control this behavior are the same for the "schizophrenic" as they are for us. Thoughts of God are comforting because they eliminate the uncomfortable notion of our lives being rendered meaningless the moment we die. What's so abnormal about a little bit of reassurance?

Obviously with a "schizophrenic" individual, the problem is that the reassurance is obsessive and often inappropriate. This is one of the main differences between "schizophrenics" and "normal functioning" humans.

The social outcomes for schizophrenic behavior are extravagant! Think about all of the attention you would get for acting strange. People underestimate the power of attention as a reinforcer. Attention works for "schizophrenics" as it works for you and I.

We fail to suppress these behaviors, especially in today's society where drugs are used to counteract "symptoms". When we verbally punish someone for their inappropriate behavior, we run the risk of that so called "punisher" actually strengthening the behavior. Remember, negative attention is still attention (I've found this to be especially true in most, if not all, group homes).

We fail to provide alternative activities that are incompatible with "schizophrenic" behaviors. I work once a week at a group home as a supervisor, and I am either passing medications or cooking dinner; I never have time to provide the residents with things to do to keep them from engaging in inappropriate behaviors. With a 6-resident to 2-staff ratio, it's impossible even if I'm not cooking or passing medications.

So how do we fix the problem? We eliminate the inappropriate social reinforcement, we use effective punishment (Don't get all worked up over my use of the term punishment. The only people who get worked up over this word are the people who don't know what it means. So if you're upset, look it up. And if you're still upset, you still don't understand), and we provide activities to take the load off of the "schizophrenic" behaviors and place them back onto "normal" behaviors.

To avoid simplifying this issue, I must admit that this may possibly mean a life-long commitment of the applications of the principles behavior to solve this behavioral problem.

That's the run-down, the behavioral run-down anyway. It's just another way of looking at the world. However, this world view offers a solution to the problem. It gets to the core issue: the behavior. It leaves the medical model in the dust; we don't need the medical model to survive as noble human beings who tackle difficult behavioral issues. All we need is some good training in applied behavior analysis, and a bit of dedication. Add it all up, and you've got yourself a solution! (And I've met my goal for the week once again!)

^{[1] I told myself the rule that I was not allowed to browse the internet; instead, I'm only on my computer to write and do research, otherwise I'd be procrastinating, and we all know how bad that is
[2] http://psychcentral.com/blog/archives/2008/
07/30/what-causes-schizophrenia-maybe-rare-gene-variants/}