A Programing Contingency Analysis of Mental Health
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A Programing Contingency Analysis of Mental Health

Israel Goldiamond

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A Programing Contingency Analysis of Mental Health

Israel Goldiamond

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A Programing Contingency Analysis of Mental Health presents Dr. Israel Goldiamond's reflections on various ways we formulate behavioral and emotional problems, most often in traditional terms of mental health disorders, mental diseases or illnesses, psychopathological disorders, and so on – what he calls a pathological orientation. Here, Goldiamond argues for a groundbreaking alternative view from the vantage point of radical behaviorism.

The book begins by discussing contingency relations between behavior and its past and present consequences, along with other environmental events. It reminds us that this approach sits comfortably alongside other consequential systems in the social and biological sciences, particularly decision theory and evolution. This behaviorist system regards most important human behaviors as being emitted rather than stimulus-elicited. Described are some of the diverse origins of behavior, including the effects of environmental consequences and the programing procedures of social and cultural inheritance. The exposition includes decision matrices which rationalize some of the programed patterns and the accompanying thoughts and emotions commonly found in mental illness. As a result of this nonlinear contingency analysis, such patterns may be considered adaptive rather than maladaptive. The book describes programs based on those matrices and outlines how they might be applied to mitigate any problems or costs associated with those patterns. The book concludes by moving from individual analysis to social analysis, with particular reference to some societal contingencies that may maintain the pathological orientation and others that might shift our gaze in the direction proposed here.

Alongside Dr. Goldiamond's original work, this volume features a new introduction from Dr. Paul Thomas Andronis and Dr. T. V. Joe Layng, as well as an article tracing the history of the non-linear thinking of Dr. Goldiamond, first published in The Behavior Analyst. It will be a must-read for anyone working in the analysis of and clinical intervention in problems associated with mental health, or those more generally interested in the work of Israel Goldiamond.

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DOI: 10.4324/9781003260103-1
Mental illness is presently defined in a variety of ways. It is defined as a pathology of thought or affect that may or may not be manifest in behavior. It may be defined in terms of ways of relating to the environment. Agreement is not universal. Mental illness, for example is considered to be a myth (Szasz, 1961), a label of deviance applied by a society that may thereby exacerbate the problem (Becker, 1963; Scheff, 1966), a “disjunction between two persons,” one of whom is considered sane (Laing, 1969 p. 37). Where the patterns are interpreted to indicate pathology, the pathology may be defined biologically, in organic or genetic terms (cf. Rosenthal, 1970) or may be defined in terms of conditioned behavior disorders (cf. Rachman and Teasdale, 1969), in addition to the more traditional psychodynamic and other psychiatric formulations, which have been in transition since, at least, Kraepelin’s formulations.
These differences in interpretation represent, to a considerable extent, serious efforts to understand the patterns, to intervene when problems are perceived, and to relate intervention and understanding so that one or both may be advanced. Accordingly, the differences in interpretation relate to differences in professional intervention – and social consequences: for an example, we need not go so far afield as Nazi Germany but can reflect on this country’s “eugenic sterilization laws which were passed 
 [for] eventual elimination of insanity and feeblemindedness,” starting in 1907, and on the books of twenty-seven states in 1968 (Paul, 1968, pp. 77–78). The fact that such an approach is rationalized by a genetic model does not, of course, associate present supporters of such models with such interventions but does demonstrate the close relation between theory and practice in this field.
The fact that social institutions have been established for understanding, intervention, and training in this field suggests that its phenomena may not be trivial. And the fact that there is widespread involvement in the services offered suggests that the maintaining variables may be widespread. Accordingly, the study of the phenomena of mental illness and of the circumstances surrounding it may make contributions that extend beyond this special field.
The present discussion will focus on an analysis of these issues from the vantage point of radical behaviorism (Skinner, 1974), to be defined shortly. I shall focus, in part, on the relations between behavior and its past and present consequences and other environmental events. Since this system is generally unknown except, perhaps, in rumor, I shall first spell out the system and clarify its position on events such as emotion and thought. I shall relate this system to other consequential systems in the social and biological sciences, namely, decision theory and evolution. A point-by-point correspondence between evolutionary theory and radical behaviorism will be noted, with special attention given to the parallel between breeding and behavior-programing. Since the system considers behavior to be emitted rather than stimulus-elicited, I shall next consider the diverse origins of behavior and discuss the effects of environmental consequences and of the programing procedures of social and cultural inheritance upon such diverse behaviors. In the course of this analysis, some decision matrices that rationalize certain programed patterns found in mental illness will be presented, along with programs that might be applied. Finally, I shall move from individual analysis to social analysis with particular reference to some societal consequences that may maintain the pathological ideology; other possibilities will be noted.

2The analytic system to be used

DOI: 10.4324/9781003260103-2

2.1 Confusions between formulations

The term behavior analysis will be used here in the context of radical behaviorism, a term applied by B. F. Skinner (1945, 1974) to distinguish it from more traditional behaviorisms. The distinction is an important one. Attacks upon Skinner and his followers often cite the philosophy of the latter (Day, 1969) and the scientific paradigms they employ.1 In part, the confusion stems from the existence of at least two different underlying philosophies of and approaches in a science of behavior. These often use similar terms to study similar topics in different ways. In addition, two different sets of learning formulations similarly confuse differences between them. These two sets of differences intersect in part.
These differences in psychologies are of interest to others. Any definitions of mental health and mental illness must include a behavioral component. The general stance taken toward behavior must affect the specific concepts it helps to define. Further, an interesting paradox will become evident. Prevailing theories (and less systematic understandings) of mental health often explicitly reject the philosophic stances they associate with behaviorism. However, in so doing, they implicitly follow assumptions associated with behaviorism – of one kind, rather than another. Acceptance or rejection of these assumptions is among the differences between the behaviorisms.
One of my purposes here is to make explicit these assumptions and their major implications for theory and practice in mental health/illness. In so doing, it will be necessary to distinguish between the different uses of similar terms. The occurrence of this confusion has an understandable historical base that is irrelevant to the discussion. Accordingly, wherever necessary, I shall attempt to substitute terms that more closely approximate common usage; in such cases, technical jargon will be relegated to endnotes. Generally, my discussions of the philosophies and learning formulations will be limited to their relevance to the mental health issue under consideration.

2.2 Reactive and consequential relations

Rather than opening with distinctions in the philosophies, I shall open with the learning formulations whose differences contributed to the philosophies. These learning formulations may be designated as the reactive and the consequential.2 The former conceptualizes behavior in terms of its antecedent stimuli and explains behavior as a response (or reaction) to such events. The latter conceptualizes behavior in terms of its effects on the environment and explains behavior through the consequences it produces. The differences are quite meaningful in the psychological laboratory. In the former case, presentation of a stimulus will elicit the behavior, as in a reflex. In the latter case, it is the occurrence of the behavior that produces the stimulus, as in purchase of a commodity.
These differences reflect meaningful distinctions in other disciplines and approaches. This will be evident if we attempt to explain a patient’s violent outburst in a psychiatric ward. The observed events occur in the following older: an attendant informs a patient that as long as the patient smokes, the attendant will avoid the fumes by sitting elsewhere. The patient glares at the attendant and continues to smoke. Shortly thereafter, at the scheduled time, the head nurse enters the ward. The patient begins to scream, crawls and writhes on the floor, and is finally quieted. At the next day’s staff meeting, the head nurse accuses the attendant of insensitivity and holds him responsible for an outbreak that set the patient back.
If we state that the patient’s outburst was caused (precipitated) by the attendant’s remarks, we are adopting the linear causality of the reactive position. In those terms, the attendant’s provocation is the stimulus (L., to goad), and the patient’s outburst is the response (reaction). We can restrict ourselves to observables and a simple stimulus→response relation. We can infer an internal emotion as a mediating term or condition and consider a more complex stimulus→emotion→response relation. The attendant’s remarks elicited resentment and rage that elicited (or emerged as) the outburst. The conventional terminology is illustrative: the patient “acted out,” i.e., an inner response emerged or became a stimulus for an outer response. As is evident, the chain of reasoning is not restricted to the conditioning laboratory nor to observables. The disproportionality of the response to the stimulus arousing it is an “overreaction,” and it is this abnormality (in the literal sense) that suggests the existence of pathology. At the least, the behavior is maladaptive or disturbed.
If we state that the patient’s outburst, by clearly bringing to the attention of the head nurse the attendant’s slight, is governed by the retribution the outburst is likely to bring on the attendant, we are adopting the stance of the consequential position. As stated here, the patient’s outburst is governed by consequences it may produce at a later time. It is not governed by linear antecedents. Causality flows away from behavior, rather than toward it. We can restrict our statement to observables and an occasion- (when)-behavior→consequence relation, or an occasion (when) an if -behavior→, then consequence relation holds. We can infer concomitant internal intent: to get even←I’ll act up, or I’ll act up→(to) get even, but such inference is not necessary for the observable relation to hold. That such patterns do occur repeatedly without the patient having figured out the relations in advance, or at all, is suggested by the existence of concepts such as unconscious motivation. As is evident, the chain of reasoning is not restricted to the learning laboratory nor to observables. Presumably, yet another consequence is that the rebuke may serve to keep the attendant in line. Such retributive manipulation, while disturbing to the staff and eventually to the patient, is certainly neither abnormal nor unprecedented.3 Indeed, it may imply rather finely honed social skills on the part of the patient. At the least, the behavior is adaptive, albeit disturbing.
The two learning formulations, when extended to this situation, speak of different implications for mental illness and different approaches to the behaviors involved. The formulations may be considered to be laboratory-derived examples of different types of reasoning that find more general use. Comparison of systems whose terms tend to be defined explicitly, i.e., laboratory-based systems, may help to understand related systems whose differing implications for mental health may have been obscured by their greater reliance on implicit and less precisely stated terms.

2.2.1 The reactive formulation

As noted, in the reactive formulation, behavior is conceptualized in terms of its antecedent stimuli. Hence the designation, S→R behaviorism, and hence the very terms themselves. The behavior is the response (R) to a stimulus (S), or stimuli. That the response is a behavioral reaction to an action is implied by the accepted designation for the time-interval between a stimulus and its response, namely, reaction time. Stimuli elicit behavior in a linearly causal manner. The S→R relationship, of course, is conditional upon other circumstances. These can include present arrangements and past associations with other stimuli, as in those present relations derived from earlier conditioning.4
Classical mentalist approaches reject the automaticity implied. Nevertheless, mediation between S and R through (mental) image or affect (M) often simply adds a mediating term. Such mediation preserves the linear causality noted, namely, S→M→ R: the parents’ appearance (after an absence) so angered (upset) the child that a tantrum was produced. Linearity is also often found in formulations that impose organic mediation: the S→O→R models. Indeed, Pavlov borrowed the term reflex from physiology to designate the relation whose clarification is associated with him.

2.2.2 Consequential relations

As systematized by Skinner (1969, p. 7), the basic building block here is a “three-term contingency.” As noted, upon certain occasions, the critical stimulus follows upon (is produced by) behavior: Oc-(S→R) or, stated temporally, Oc-(B→S).5 Behavior is not a response (reaction) to a stimulus. Rather, the stimulus is the effect or consequence of behavior.6 It is the importance of that consequence, and its occurrence contingent on behavior, that will govern the likelihood of the behavior when the occasion for the (B→S) relation occurs. An occasion–behavior relation may emerge, Oc-B, but the occasioning events neither elicit nor cause behavior. The relationship between concluding grace and eating (an Oc-B relation) differs from the relationship between the loaded food tray and salivation (an S→R relation). There is actually a fourth element in the consequential relation, and that is the interrelation between the terms, which enter into the precise definition of the contingency, e.g., the schedule; on occasion X, each delivery of a consequence is contingent on every second occurrence of behavior, upon every fifth, etc., in any of a variety of ratios that are fixed or that vary around an average (as in a slot machine); the consequence is contingent on behavior at a fixed time interval since the last delivery or at variable intervals. Other schedules are possible that have profound effects on behavior, as will be noted.7
Classical mentalist approaches also reject the automaticity implied here. Mediating terms express anticip...