Can you teach pigeons to play table tennis? Yes, with enough patience. You have to watch the birds until one of them makes a move towards the ball, and then reward it with food. Each time it, or its partner, makes a further chance move of the right kind you reward it again. It may take a very long time but in the end you’ll have them playing, even if they never learn to keep score. Behavioural reinforcement is the key.
You can do the same with human beings. My daughter, aged three, persisted for months in waking up at midnight and staying awake for at least an hour. It was exhausting. Then, following the ideas of the behaviourist Professor Eysenck, I told her that every night she slept through, and only then, her furry monkey would have a penny in the morning to take to Mrs Minty’s sweet shop. For several mornings she was disappointed, but one great night she earned her penny. After that, it was plain sailing. It took about a fortnight. She has been a good sleeper for the last five decades.
Behaviourism, as a method of treating personal psychological problems, became popular during the later 20th century. It largely replaced psychoanalysis for the purpose because it was so effective. For example, psychoanalysis might once have been used to cure a “bedwetter” by exploring problems in the unconscious mind, where a behaviourist would have prescribed a wake-up bell triggered by dampness. Apart from the better results, behaviourism was quicker and far cheaper. My daughter’s sleep cure cost a shilling.
Behavioural treatment methods vary widely according to the issue involved. A good example is provided by the treatment of phobia. Imagine that you have an irrational terror of cats. This may have been triggered by a frightening incident involving a cat, perhaps years before. Each time you have encountered a cat you felt panic and left the room. And the sense of relief at escape simply rewarded your evasive behaviour. That phobia, being continually reinforced, could remain with you for life, unless you had the good fortune to meet a behaviourist.
He might ask you to create a hierarchy of cat experiences, starting with incidents so minor that you felt no fear, and leading up to incidents so proximate that they caused terror and panic. Having taught you deep relaxation as a skill, he would first ask you to imagine the most minor incidents, checking that you were able to maintain relaxation. You would then move, item by item, up the hierarchy – being encouraged to extend your relaxation at each stage — until, by associating relaxation with increasingly threatening situations, the fear was quenched. It would be unlikely to return.
A contrasting example is provided by a patient who had a preoccupation with bed linen and towels. He simply could not help himself from pinching them. His therapist put him into a hospital, and required him to spend all day moving towels into and out of the hospital store. After a few days of intense activity he became fed up with the sight of a towel, and no longer felt any temptation to touch another.
My favourite case is a man who developed asthma as soon as he was in bed with his wife. His therapist merely turned the picture of his mother-in-law to the wall. (True story, not a gag.)
To me, the most intriguing therapy is Eye Movement. It is used for those with truly distressing memories with which they cannot cope. The patient is asked to move his eyes continually from side to side while reimagining the memory in all its aspects as graphically as possible. Gradually the memory is detoxified so that it loses its intensity, and can then be handled normally. A possible explanation comes from “rapid eye movement” sleep in which the memory sorts itself out as we unconsciously digest our memories.
Behaviourism can be applied to a wide range of fears, anxieties and even simple, but dysfunctional reluctances. Depression, claustrophobia, insomnia and many other conditions have been cured. It will not always be effective, but the measurable results have been impressive. And once we have understood the link between our behaviour and the stimulus which reinforces it, therapy can in some instances be self-administered. Indeed, a therapist may, in appropriate cases, teach their client how to work at their cure between consultations.
Nevertheless, there is something missing. At least psychoanalysis works at exploring the unconscious to enable understanding of the origins of trauma and to come to terms with it. This is a consolation in itself, although often an expensive one. By comparison, treatment aimed only at behaviour may seem reductionist, and even disrespectful to the dignity of our nature. As the pigeons show, the training of behaviour alone is equivalently effective when applied to the lower animals. Instinctively we prefer to look for answers which reflect both human understanding as well as human behaviour.
But the seventh cavalry is on its way – in the form of cognitive behavioural therapy. As its name suggests, this treatment retains the therapeutic force of behaviourism, while addressing our understanding directly. But the focus is on the present rather than the past. If you tell a cognitive behavioural therapist that you hiccup because your mother tried to drown you as a baby, he will raise an eyebrow and invite you to consider instead why you hiccup nowadays. This therapy is thought to be so valuable that it is actually state-sponsored. We will look at it in due course.