Astrid’s Journal

I have noticed something about myself, now that I’ve been in the psychiatric hospital for over three months: that I can’t stand it when someone refers to my difficulties as behavioral. There are some good reasons for my protesting against some statements that assume that my problems are behavioral, but today, as I read a book chapter about behavioral therapy for individuals with developmental disabilities, I realized that I’ve incorrectly been defying the entire concept of behavioral approaches to my difficulties.

One, in my opinion very good reason to protest when someone claims that I have a behavior problem, is when my so-called behavior problems are contrasted with any other category of mental disorders. Like, I became furious when a nurse claimed that “You don’t have a psychiatric problem, you have a behavior problem”. Well, le tme tell you: almost everyone who gets committed to the closed psychiatric ward, has exhibited some form of problematic behavior – othwrwise they wouldn’t have been committed -, so everyone on this ward has problem behaviors. Besides, on another level, each disorder within the DSM-IV, including pervasive developmental disorders, that my diagnosis is classified under, as well as so-called “real” psychiatric disorders like schizophrenia or bipolar disorder, is described in terms of behavior the patient exhibits. This was in fact the aim of the creators of the DSM-III in 1980, in order to make the DSM (that was previously heavily founded on psychoanalytic principles) more scientifically-based. And I still find it iinconsistent that there are so-called “behavior disorders” within the DSM-IV – but Asperger’s Syndrome isn’t one of them.

There is another reason why I oppose the logic that there are “real” psychiatric disorders and that these are different from so-called behavior problems, that is intervention-based. After all, if there are “real” psychiatric disorders and these are distinct from behavior problems, it’s obviously unethical and ineffective to use behavior modification strategies on the people with the “real” psychiatric disorders, if you think the problem behavior stems from the psychiatric disorder. Well, then a lot of nurses out here are engaging in a lot of unethical and ineffective treatment of many of my fellow patients. Why do they still ignore one woman when she keeps asking for cigarettes – whcih, they claim, comes from her mental illness -, and lock another woman’s room when she’s outside until she’s eaten something for lunch – which even I can tell comes from her severe depression? Both of these women have clear psychiatric illnesses, but both psychiatric illnesses indirectly manifest themselves in disturbed behavior, just like my autism (which you may call a developmental disability if not a psychiatric disorder) indirectly manifests inself in meltdowns.

Often, I’ve told nurses that they are too outside-focused and don’t care how I feel as long as I do what they want me to do. This obviously is an attack on behaviorist approaches, where I claim that it’s not just behavior that matters. I do think so – we’ve long passed the era when it was science to claim that people just behaved and cognitions and emotions didn’t exist -, but when I think of what strategies I do find helpful instead of which I don’t, I almsot invariably come to behavioral strategies myself – and the few that might be cognitively-based, still involve cognitive behaviors (eg. stopping a strng of thoughts before it overloads me). So what is the problem with some behavior modification strategies, that has gotten me to dislike the entire concept of behavior modification altogehter? It seems as if it lies within the statement that I often make: “I don’t *simply* have a behavior disorder.”

In the book chapter, there is a section about what behavioral therapy could be without a good functional analysis, and the author dared to call it dehumanizing. By this, he means the careless application of interventions without watching for the – often understandable – function the behavior has for the individual person, thereby simply punishgin a disturbing behavior despite its very genuine meaning. And I think: time-out policy. And I realize that I’ve incorrectly equated this careless why-bother-as-long-as-it-works intervention with behavioral interventions in general.