心理学与生活-第85章

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Putting　the　blame　on　science。　

We　do　not　know　the　causal　agent　for　most　mental　disorders　because　mental　disorders；　unlike　
most　physical　illnesses；　have　no　easily　identifiable　germ；　bacteria；　virus；　organic　damage；　or　
psychosocial　factor　that　has　been　associated　with　the　majority　of　cases。　The　medical　model　
contends　that　we　will　eventually　identify　biological　causes　for　mental　disorders。　The　psychosocial　
model　points　to　life　experiences；　stress；　and　sociocultural　forces　as　causes。　Currently；　a　synthesis　
of　these　two　theories　prevails；　biological　and　psychosocial　forces　interact　as　causal　agents。　Mental　
disorders　seem　to　be　like　headaches　in　that　they　may　result　from　any　of　many　causes。　Therapists　
of　different　theoretical　orientations　have　their　own　explanations　for　mental　disorders。　

Diagnosis　of　most　mental　disorders　must　be　made　based　on　signs　and　symptoms；　what　the　
mental　health　professional　observes　in　the　patient’s　behavior；　and　the　patient’s　description　of　his　
plaint。　Symptom　patterns　are　usually　not　clear…cut　or　easily　associated　with　a　particular　
diagnostic　category；　and　mental　health　professionals　do　not　get　diagnostic　help　from　analysis　of　
blood　or　urine　or　X…rays。　

Putting　the　blame　on　the　therapists。　

Research　suggests　that　the　personality；　experience；　and　talent　of　the　therapist　are　more　important　
in　determining　the　success　of　therapy　than　the　type　of　therapy　utilized。　In　other　words；　the　
person…therapist　is　more　important　than　whether　the　therapy　is　psychoanalytic；　humanistic；　
behavioral；　or　eclectic。　

It　is　more　difficult　for　therapists　to　be　objective　than　it　is　for　medical　practitioners　to　be　so；　
because　the　therapist　cannot　entirely　avoid　intrusions　of　his　or　her　own　values　and　preferences　
into　the　perception　and　interpretation　of　the　patient’s　behavior　and　disclosures。　This　problem　is　
accentuated　when　the　therapist　and　the　patient　have　divergent　socioeconomic；　cultural；　or　ethnic　
backgrounds；　or　perhaps　are　of　different　genders。　

Carl　Rogers　said　that　to　be　effective　a　therapist　must　be　empathic；　able　to　feel　with　the　client；　
warm　and　accepting；　and　genuine。　Empathy　and　warmth　cannot　be　merely　a　professional　facade。　
Yet；　the　important　criteria　for　admission　to　most　graduate　and　professional　schools　are　
intellectual　ability　and　academic　achievement；　rather　than　warmth　and　genuineness。　There　may　
well　be　a　gift　or　a　talent　that　is　an　important　ingredient　in　therapy　that　many　therapists　do　not　
possess—or　that　was　selected　out　of　postgraduate　admissions。　

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Putting　the　blame　on　the　patients。　

For　convenience；　we　can　put　people　who　undergo　psychotherapy　into　one　of　two　categories。　
First；　there　are　those　who　are　in　therapy　because　they　were　coerced　or　forced　by　family；　authority　
figures；　or　the　courts。　Second；　there　are　those　who　voluntarily　seek　therapy　because　their　
abnormal　behavior　is　causing　them　pain　or　problems。　It　is　not　difficult　to　understand　why　
therapy　often　fails　when　patients　are　coerced　or　forced；　but　why　does　it　fail　to　help　those　who　
actively　seek　help　with　the　intention　of　cooperating　and　doing　their　share　in　the　therapeutic　
process？　

Freud　thought　that　neuroses　served　a　purpose　for　the　patient。　The　ego　uses　abnormal　thinking　
and　behavior　as　a　means　of　protecting　itself　from　impulses　of　the　id　and　unconscious　conflicts。　
Behaviorists　admit　that　mental　disorders　can　have　advantages。　They　can　make　it　possible　for　
people　to　avoid　unwanted　responsibilities；　to　excuse　failure；　and　to　manipulate　others。　Therefore；　
the　willing　patient　may　have　a　conflict。　In　order　to　be　relieved　of　the　pain　and　misery　associated　
with　the　disorder；　the　advantages　gained　from　it　must　be　sacrificed。　Take　the　addict　as　an　
example。　The　addiction　causes　problems；　and　even　physical　pain；　yet　the　person　may　feel　that　life　
would　be　unbearable　without　the　addictive　substance。　In　the　case　of　anxiety　disorders；　the　
conflict　is　not　so　clearly　perceived　by　the　patient；　who　would　generally　deny　getting　any　rewards　
（secondary　gains）　from　holding　on　to　the　disorder。　

Many　disorders　develop　over　a　period　of　years；　sometimes　beginning　in　childhood。　Patterns　of　
abnormal　or　maladaptive　thoughts　and　behaviors　bee　an　integral　part　of　the　personality；　
affecting　the　person’s　view　of　reality　and　all　his　or　her　patterns　of　thought　and　behavior。　Freud　
believed　that　restructuring　of　the　personality　was　a　necessity　in　successful　therapy。　This　idea　was　
that　once　the　offending　conflict　or　problem　was　identified；　the　person　would　need　to　rethink　and　
reconstruct　other　aspects　of　the　self　that　developed；　in　order　to　acmodate　the　abnormal　
patterns　of　thought　and　behavior。　Most　current　therapies　do　not　aim　at　reconstruction　of　the　
personality；　but　perhaps　they　should　be　more　mindful　of　the　possibility　that　you　cannot　excise　an　
abnormality　without　affecting　the　personality　structure　from　which　it　is　removed。　

Consider　the　example　of　a　hypochondriac　who　has　spent　a　good　part　of　his　life　monitoring　his　
body　and　looking　for　pathology　to　explain　every　irregularity　of　function　or　unfamiliar　twitch。　His　
illnesses　have　brought　him　sympathy　and　attention；　and　he　has　used　his　poor　health　to　explain　to　
himself　and　others　why　he　has　not　“climbed　the　ladder　of　success。”　After　his　life　is　endangered　
by　an　unnecessary　surgery；　he　goes　to　a　psychotherapist　for　help。　The　issue　is；　will　he　be　able　to　
give　up　his　hypochondria　and　its　benefits？　Can　he　change　his　perception　to　see　himself　as　a　
normal；　healthy　person　living　in　a　world　in　which　illnesses　and　the　danger　of　infection　can　play　a　
relatively　minor　role？　

It　is　not　easy　for　people　to　give　up　their　maladaptive　behavior；　just　as　it　is　not　easy　for　any　of　us　
to　break　bad　habits　or　improve　aspects　of　our　personalities。　The　therapist　is　in　the　position　of　
trying　to　teach　old　dogs　new…or　better…tricks。　

Prefrontal　Lobotomies　

The　doctor　who　developed　the　prefrontal　lobotomy　was　given　the　Nobel　Prize　in　Medicine。　Ask　
students　if　they　have　seen　movies　such　as　“One　Flew　Over　the　Cuckoo’s　Nest”　and　what　their　
perception　is　of　the　procedure。　Do　they　consider　it　barbaric；　without　any　possible　redeeming　
value？　If　the　answer　to　that　question　is　“yes；”　then　you　can　play　devil’s　advocate　by　presenting　
the　following　scenario。　

Imagine　that　you　are　a　doctor　on　staff　in　a　mental　hospital　in　the　late　1940s。　Your　mental　hospital；　
constructed　to　hold　700　patients；　now　has　over　1；300。　Many　of　these　are　violent　and　need　to　be　
tied　to　their　beds　or　kept　in　locked　cells。　Antipsychotic　drugs　will　not　be　invented　for　another　five　

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to　ten　years。　Patients　regularly　attack　one　another；　as　well　as　the　attendants。　Other　patients　run　
through　the　hallways；　screaming　and　yelling。　You　have　one　patient　who　has　been　in　the　hospital　
for　25　years　and　has　essentially　been　kept　in　confinement。　You　hold　no　hope　of　recovery。　
However；　you　know　that　there　is　a　therapeutic　technique　that　will　take　only　a　half…hour；　and　if　
successful；　will　result　in　a　significant　decrease　in　episodes　of　violent　behavior　in　this　patient。　
Again；　if　the　procedure　is　successful；　the　patient　will　appear　to　be　much　happier　and　more　
content　with　life。　You　also　know　that　for　most　patients　receiving　this　procedure　there　will　be　little　
difference　in　measurable　IQ。　You　know　of　no　behavioral　test　that　routinely　shows　any　mental　
deficit　from　the　procedure。　Would　you；　as　this　patient’s　doctor；　use　this　procedure？　

When　put　into　this　context；　most　students　begin　to　understand　why　prefrontal　lobotomies　were　
used　as　frequently　as　they　were　in　the　1940s　and　1950s。　Most　college　students　find　it　difficult　to　
imagine　a　world　in　which　there　were　no　drugs　that　could　be　effectively　used　in　place　of　
procedures　such　as　prefrontal　lobotomy。　Visiting　a　mental　hospital　today；　it　is　difficult　for　most　
of　us　to　imagine　the　general　level　of　uproar　and　violence　in　the　hospitals　as　recently　as　the　1940s。　
The　1948　movie　“Snake　Pit；”　starring　Olivia　DeHavilland；　portrayed　the　horrors　of　life　as　a　
patient　（and　staff　member）　in　state　mental　hospitals　during　that　“pre…chemotherapy”　era。　

Identifying　Therapists　

Ask　students　to　pile　a　list　of　therapists　in　your　area。　They　should　gather　information　about　
the　therapists’　professional　degrees；　fees；　areas　of　specialization；　forms　of　treatment；　and　other　
factors。　You　might　divide　them　into　groups　and　have　each　group　attempt　to　locate　therapists　
from　a　particular　theoretical　orientation　（i。e。；　psychodynamic；　etc。）。　They　might　call　some　
therapists　for　such　information；　consult　a　local　mental　health　association；　check　the　web　pages　of　
professional　organizations　such　as　the　APA；　and　consult　phone　book　listings　as　ways　of　gathering　
this　information。　

Should　Psychologists　Prescribe　Medication？　

Since　your　text　contains　an　excellent　review　of　psychopharmacology；　you　might　want　to　discuss　
the　issue　of　whether　counseling　or　clinical　psychologists　should　be　able　to　prescribe　medication。　
Some　have　argued　that　it　is　ludicrous　to　have　family　physicians　and　surgical　specialists；　who　may　
have　no　psychological　training　at　all；　able　to　prescribe　the　entire　range　of　psychoactive　drugs　for　
treating　mental　illnesses；　while　psychologists；　who　specialize　in　treating　mental　illnesses；　cannot　
prescribe　any　medications。　Although　it　is　true　that　historically　most　psychologists　did　not　have　
the　training　in　pharmacology　that　physicians　were　given；　in　recent　years；　many　graduate　
programs　in　psychology　have　added　coursework　in　physiology　and　pharmacology　to　narrow　this　
gap。　While　most　would　agree　that　psychologists　probably　should　not　be　able　to　prescribe　
nonpsychoactive　medications；　the　wisdom　of　prohibiting　them　from　prescribing　any　medications　
seems　doubtful。　Since　psychologists　are　pressing　for　legislative　changes　in　some　states　that　would　
allow　psychologists　to　prescribe　some　medications　in　some　circumstances；　this　issue　is　likely　to　
bee　more　important　in　the　near　future。　How　do　students　feel　about　this　issue？　Do　they　see　
any　potential　dangers　if　psychologists　begin　prescribing　medicine？　

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BIOGRAPHICAL　PROFILES　

Albert　Ellis　（b。　1913）　

Obtaining　his　Ph。D。　from　Columbia　University　in　1947；　Albert　Ellis　made　early　contributions　to　
psychoanalytic　theory；　although　he　has　since　bee　one　of　its　major　dissenters。　Rebelling　
against　what　he　perceived　to　be　rigid　psychoanalytic　dogma；　Ellis　established　Rational　Emotive　
Therapy　or　RET　in　1955。　The　development　of　RET　is　considered　by　many　to　represent　the　
informal　founding　of　cognitive　therapy；　popular　in　many　forms　today。　Ellis　has　also　influenced　
the　development　of　sex　and　marital　therapy；　and　his　book　Sex　Without　Guilt　is　recognized　as　an　
important　cultural　impetus　to　the　American　sexual　revolution　of　the　1960s。　

Frederick　“Fritz”　Perls　（1893…1970）　

Fritz　Perls　was　born　in　Berlin；　studied　at　the　University　of　Freiburg；　and　obtained　his　Ph。D。　at　the　
University　of　Berlin。　In　1926；　he　became　Kurt　Goldstein’s　assistant　at　the　Institute　for　Brain…
Injured　Soldiers；　w