Neurosis: Just a Bad Habit?

Making love in a Volkswagen can be an impossible feat, as a University of Pennsylvania student discovered not long ago. His failure led to a year of impotence that ended only recently when Temple University Psychiatrist Joseph Wolpe cured him in two sessions. Wolpe's treatment; a controversial method called behavior therapy.

The difference between behavior therapy and traditional Freudian psychoanalysis stems from the way each defines neurosis. To psychoanalysts, neurosis is the result of unconscious conflicts that influence behavior in complex, mysterious ways. But to behavior therapists, the unconscious does not matter: neurosis to them is a collection of bad habits that were learned much the way Pavlov's dogs learned to salivate at the sound of a bell. Believing that what has been learned can be unlearned, the behaviorists apply conditioning procedures developed in animal laboratories to break old habits and build new ones. Unlike psychoanalysis, which may go on for years, behavior therapy is often completed in fewer than 30 sessions--and it claims success in 85% of its cases.

Desensitization. The new method has no more than 100 practitioners, though the number is growing, and its advocates include such prominent psychologists as Harvard's B.F. Skinner and the University of London's H.J. Eysenck. Last month, as the principal developer of behavior therapy in the U.S., Joseph Wolpe conducted a training institute at Temple for 30 American, Canadian and Mexican therapists who wanted to learn his techniques.

Chief among these techniques is "systematic desensitization," the process a mother uses when she accustoms a baby to the ocean by dipping in one foot first, then a leg, then the infant's whole body. In that case, the delightful feel of the water gets the better of fright. Similarly in behavior therapy, Wolpe uses gradual methods of confronting neurotic behavior to overcome anxiety. The Pennsylvania student, for example, was told that his failure had conditioned him to fear sex, and he was advised to find an understanding girl who would be patient with him until he had conquered his fear by degrees. Approaching her sexually on successive days, he stopped each time he began to feel uneasy; soon the connection between sex and anxiety was broken, and the link between intercourse and pleasure restored. For Wolpe and his colleagues, sexual problems are generally the easiest to cure, because sexual desire is stronger than fear.

When trouble arises not from relationships with people but from such fears as claustrophobia, Wolpe urges his patients to learn to relax. First, however, the patient is reassured: "You are not mentally ill, and there is no danger of your going insane." Then he is questioned about the situations that trigger his anxiety, and the triggers are ranked according to intensity. After the sufferer has been taught to relax completely--through muscular exercises --he is asked to imagine the least frightening trigger: in a person who fears death, it may be the sight of an ambulance. If he becomes frightened, he is told to let go physically, so that relaxation can in effect replace fear. If he remains unafraid, he is asked to think of the next trigger--driving past a cemetery, for example--until at last he can finally confront the idea of what terrifies him most: perhaps a corpse in a coffin.

Related techniques involve what behaviorists call reinforcement and aversion therapy (TIME, March 7, 1969; and July 11, 1969). Basically, the methods depend on the old carrot-and-stick approach, which rewards desired habits and punishes unwanted ones. Male homosexuals, for example, may be given electric shocks when they look at pictures of nude men and granted relief from the shocks when they view female figures (see cut). "What we are doing," explains Reinforcement Therapist Ogden Lindsley of the University of Kansas, "is very similar to what progressive businesses do. We constantly monitor performance. But instead of improving sales, we try to improve behavior." Such a pragmatic approach is seen as one of the major advantages of behavior therapy by its supporters. Instead of searching for the elusive causes of neurosis, as in psychoanalysis, behavior therapy deals solely with neurotic symptoms and tries only to correct disturbed behavior.

The use of physical punishment to eliminate symptoms is distasteful to some scientists, including Boston College Psychologist Joseph Cautela, who has found more subtle approaches. Recently Cautela has successfully treated obese patients by training them to imagine that they are vomiting; the idea of nausea was enough to curb their appetites. He has also taught patients to overcome intense fear of flying with a step-by-step fantasy in which the patient "travels" to an airport, rewards himself with the thought of something he likes, such as meeting a friend, then "boards" a plane, thinks of his reward again, and finally manages to take off in imagination--and eventually in reality.

Man's Freedom. To its critics, behavior therapy is shallow because it lacks a unifying theory to explain the human personality. Behaviorists are quick to reply that what counts is behavior therapy's effectiveness.

Much harder to dismiss are allegations that behavior therapy threatens man's freedom by manipulating patients like so many laboratory animals. San Francisco's Allen Wheelis, who is both psychoanalyst and thoughtful novelist, believes that a human being who submits to behavior manipulation "is treating himself as object and to some extent, therefore, becomes an object." In a similar vein, Los Angeles Analyst Judd Marmor recently wrote that the new method comes "uncomfortably close to the dangerous area of thought and behavior control." Not so, says Behaviorist Alan Goldstein of Temple University. "People come to us to have their behavior changed. It is not our choice. We don't tell them how they ought to behave."

This file is automatically generated by a robot program, so reader's discretion is required.