During the last century, and part of the one before, it was widely held that there was irreconcilable conflict between knowledge and belief.

                                                                    Albert Einstein

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When considering the causes of behavior, especially abnormal behavior, including behaviors that define diagnostic syndromes, the discussion usually takes one of three directions – biology, environment (learning), or some combination of the two.  Individuals in the mental health and behavioral health fields frequently become devoted to one of these three worldviews.  Data show an ebb and flow of the strength of each worldview within the professional community over the years (Durand & Barlow, 2003; Davidson & Neal, 1994).  The biological causation model has gained substantial influence over the past 30 years, but the validity of empirical support for it remains a topic of ongoing debate (Wyatt, 2003).

The extent to which professionals in the mental health field come to subscribe to one of these worldviews is of interest, as are the variables that influence those processes.  That is because once a worldview of abnormal behavior is in place, one tends to interpret instances of behavior (hallucination, delusions, irrational fears, feelings of depression, and “normal” behavior etc) in light of that worldview.  Those interpretations then influence the practitioner’s efforts at prevention and treatment, as well as the consumer’s acceptance of specific forms of prevention or treatment (Langer & Ableson, 1974).  Yet, at times the data supporting a particular view of causation and treatment of a given behavioral disorder are not as powerful or convincing as one might suppose (Seligman, 1998).

The strength and influence of a worldview is evident in the story of Wilhelm Reich.  Reich was a physician-scientist, born in 1897 in the Austrian province of Galicia.  Reich graduated from the Medical School of the University of Vienna in 1922.  He was a student of Sigmund Freud, and a psychoanalyst before his clinical studies led him into the laboratory and into investigations of the energy processes in nature.  Reich ultimately came to the United States where he went on to claim that he had discovered a universal cosmic and biological energy present everywhere and detectable through specified experiments. He called this energy orgone. He built a box-like apparatus with organic material on the outside and metal on the inside that he called an “orgone accumulator”, which he believed collected and accumulated orgone energy that existed in the atmosphere. He claimed that exposure to orgone, particularly through sitting in the accumulator, promoted health and vitality, and was an effective treatment for cancer. He also claimed to detect another energy, oranur or deadly orgone radiation (DOR), which produced negative health effects and reacted to orgone. He also built a device he called a “cloud buster”, with which he claimed he could manipulate the weather by manipulating the orgone in the atmosphere.  Thousands of people came to accept his worldview as evidenced by their purchases of the “accumulator” and other of his devices, yet they failed to be helped.  Reich was taken to court for shipment of fraudulent devices by the Food and Drug Administration (FDA). The court ordered his books and research burned and his equipment destroyed. Reich was given a prison sentence, and he died in federal prison in 1957 (Swalley, 1997).

A more recent example in which a theoretical model of causation influenced clinical practice with negative effects was frontal lobotomies (Stuss & Alexandar, 2005). The frontal lobe is thought to be the control center in the brain, specifically affecting the planning, initiation and regulation of goal-directed behavior (Mahurin, Velligan, & Miller, 1998).  In the mid 1930’s scientists began experimenting with frontal lobe cutting in chimpanzees.  In these experiments aggressive animals became much calmer. The docile chimps looked to be much better off than prior to the experiment.  These experiments transitioned into accepted medical treatment interventions for the mentally unstable (Stuss, et al., 2005). However, psychiatric patients who underwent frontal lobotomies experienced significant neurological deficits as a result.  Patients were noted to exhibit little spontaneous facial expression, they had difficulty interpreting environmental cues, and experienced problems with speaking, also known as Broca’s Aphasia (Kolb & Miller, 1981; Brown, 1972).  These patients had trouble responding to questions, and their associative learning skills were impaired (Kucharski, 1984).  This treatment was an accepted alternative in many hospitals. Patients on whom the operation was performed had a variety of diagnoses, including schizophrenia, obsessive-compulsive disorder, and affective illnesses. People did not begin to realize the ramifications of the operation until it became clear, through observation, that lobotomized individuals were far from normal or happy, and that in actuality, the appearance of a less crazed nature had simply been mistaken for (what was in some cases) a total loss of the individual’s personality (Burgler, 2005).

Given the evident ease with which conceptualizations of causality arise in the professional communities, and given the impact of those conceptualizations upon treatment, it is important to understand the extent of support for any claim of causation. It is equally important to understand the variables that contribute to the rise of any given worldview of causation because those variables may well be unrelated to research evidence that would confirm or disconfirm the model. Read more commentary to explore the social and environmental influences upon the professional’s worldview development regarding the etiology of abnormal behaviors and how these variables influence treatment practices. 

 

Donna M. Midkiff, PsyD