MODELS FOR MENTAL DISORDER by Peter Tyrer

Author:Peter Tyrer
Language: eng
Format: epub
Publisher: John Wiley & Sons
Published: 2013-07-19T16:00:00+00:00

The advocates of the social model are also unhappy about the spread of the cognitive-behavioural model, but for different reasons. The concept of conditioning and cognitive control worries them because, although they may at first be used to remove unpleasant symptoms, they can easily be manipulated to induce conformity. For example, homosexuality was formerly considered a criminal offence (as well as a disease in the official classification of disease) but in our more enlightened times is accepted as part of normal variation. Behaviour therapy in the past certainly has not helped the cause of enlightenment, as it was used to argue the case that homosexuality is a form of ­abnormal behaviour that needs to be extinguished. In its simplest form the client is negatively reinforced (e.g. by receiving an electric shock) whenever he shows a sexual response (e.g. engorgement of the penis recorded by a blood flow measurement called penile plethysmography) to a nude photograph of a member of his own sex and positively reinforced by similar responses to the opposite sex. The homosexual response is therefore treated as deviant and unhealthy. The techniques of brainwashing have been developed along the same lines and people can be forced to believe things and behave in ways that are entirely alien to them. However, this sort of argument follows from the effectiveness of behaviour therapy, not its supposed moral or political ­position. If someone wished to change his sexual orientation, or any other preference, the cognitive-behavioural model offers an effective, voluntary means of doing so, but it should never be forced on anyone.

The cognitive-behaviourist is aware of the powers that his treatment possesses but can claim with justification that, although all successful therapies can be abused, this is not a reason for abandoning them. He can also emphasize that in the therapeutic use of behaviour therapy the patient should be motivated to come for treatment and not be dragooned by an external agency. This is not just pious talk, because those who come for behaviour therapy against their will, be they homosexual, phobic or obsessional, will show little or no response. It is only in a society entirely ruled by Orwellian conformity that brainwashing would be commonplace and it is up to us as political beings to ensure that such a society never develops. But it would be quite wrong to deprive psychology of an effective treatment because of this potential danger.

The cognitive-behavioural model brings psychiatric disorders out from the murky caves of dynamic theory and examines them in the light of day. It records and treats what it observes, and scorns conjecture. Most psychiatric disorder is grist to its mill because it consists of abnormal behaviour and symptoms rather than disease. It has a firm, scientific base in experimental psychology and this enables it to plan and predict the effects of treatment instead of relying on empiricism alone. Although it is a relatively recent newcomer to psychiatry, its supporters are confident it will become the major impetus for progress in the future.

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