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TOWARD A CONSTRUCTIONAL APPROACH TO SOCIAL PROBLEMS: ETHICAL AND CONSTITUTIONAL ISSUES RAISED BY APPLIED BEHAVIOR ANALYSIS
Behavior and Social Issues, Spring 2002 by Goldiamond, Israel
In all events, the pathological orientation is by now so prevalent that it is generally considered as self-evident, as though conceptualized among "the laws of the Persians and Medes, never to be revoked" (Esther, 1:19). Indeed, some of the patterns involved have at other times not been considered pathological, and may not be so in some other cultures. In our society and our time they are so considered, and the term mental illness (emotionally disturbed, etc.) can be considered as a metaphor implying treatment by means and agencies used for other illness. Indeed, the diagnoses, or classifications, are based mainly on patterns considered undesirable and therefore to be eliminated, controlled or overcome. Thus hallucinations, delusions, and thought disorders enter into the diagnosis of schizophrenia and labeling as a schizophrenic. Crippling fears enter into the phobic disorders. And so on. Persons may be viewed as disturbing others by the face they present and what they do-as well as by what they do not do. And, as has been indicated, learning how they may present themselves or behave in manners satisfying to themselves and others is not readily come by through focus on what is currently wrong. Given this discrepancy, solution may be elusive, and ascription of the patterns to a pervasive pathology whose outbreaks are unpredictable makes sense. As was noted earlier, vagueness of definition of pathology enters into the rationale for total institutions and the antinomy they pose for the larger constitutional system. A constructional model may deal with some of these issues otherwise and arrive at different conclusions, which do not always imply the antinomy, in some cases. This will be considered in greater detail in the next section
The conditions for choice of a constructional approach, a pathological one, or their combination, have not yet been systematically explored. Given the possibility that they may yield different cost benefit ratios, depending on the conditions (in which term I subsume the type of problem), the current preponderance of one approach over the other may have produced unnecessarily high cost-benefit ratios. These may contribute to (or at least provide arguments for) current challenges to the present system. Among these is the assault on the mental health professions being made not only by administrations on federal and state levels, but also by groups to their political left, by those concerned with civil liberties, as well as by such consumer-oriented groups as Nader's. This suggests a third parallel to the eliminative self-evaluations and therapist evaluations noted. This is an eliminative societal evaluation of professional practices. The recurrent emergence of new forms of psychotherapy, the continual reformulations of classic forms and approaches, and the apparent market for simplistic restatements of these and of behavior modification may also derive from dissatisfaction with the cost-benefit ratios presently obtaining. In those cases where the alternatives proposed are simplistic, the high cost of the present system may have been attributed, in part, to the complexity of its formulations. And recently being added to these challenges are those posed by the constitutional critics. On the one hand, institutions are being ordered by courts to provide the treatment which is their rationale, and on the other, their funds are cut, as are funds for professional training.
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