5. Therapy and Getting to the Maybe Range

• Phase Transitions and Psychopathology by James Brody, 2/18/98
  
  

Emmy runs her tongue against my wrist, her rough tongue eventually eliciting a little pain. A matrix of causes keeps her grooming me. I give her cat nibbles on demand and let her snuggle on my shoulder at night. There are older causes involving perhaps her genes and the survival value of mutual grooming as well has maintaining a healthy partner. The causal map produces more stable behavior than would be possible with fewer antecedents. Likewise, "therapy" should have the goal of slowing our reactions a bit, allowing us to assess multiple options and to play them out mentally before acting. The width of Maybe grows.

Personal loss, fatigue, excessively high stakes, or any other factor that pulls us down is apt to generate more binary response styles, to impair our limited abilities to generate options and to act upon them. Thus, a return of analog shifts in response intensity is a therapeutic goal that should allow the individual to track more closesly the corresponding analog shifts in his/her environment. People can then respond to multiple inputs or can "coast" instead of responding in a stop-go fashion to changes in ambient conditions. Thus, we need options for enlarging the "maybe" range, to risk our minds' drifting a bit nearer to chaos. Again, increasing the number of cells will have a less dramatic effect than increasing their interconnections. Having allies will do little unless we actually consult with them.

Physiological tricks ... rest, diet, reasonable exercise may have helpful effects on our interconnectors, those fine axons and dendrites that expand or contract our Maybe Range. Humor can disrupt phase lock. Doing something "surprising" can be helpful. Taking a "time out" gives an upset child or parent the chance to drop emotional surges that prevent finding behavior options as well as on-the-spot inhibition of yelling and defiance. Both parties need to examine options in a few minutes of privacy (14). A wise mother or spouse will not bring up the matter again once time out is past.

Learning ... the expensive adaptation. Bateson (1963) and others have commented that learning is an expensive option in comparison to instinct formation. The relative cost of learning ought to generate pressure towards creation of automatic action patterns whenever environment is sufficiently stable. Habituation, reinforcement, stimulus and response generalization, assertion training, desensitization, and the myriad behavioral recipes could be seen as nudging the client back to the Maybe Range, towards softening binary habits, thoughts, and feelings. Assertion training or desensitization may increase the relative balance of competing subroutines.

Cognitive therapy (Beck, forever ago) contains interesting steps that, like other learning paradigms, increase the relative dominance of subroutines. Break the cognitive drill into steps to highlight this possibility. The ritual of labeling a feeling, identifying automatic thought(s), separating "facts" apart from interpretation, and seeking alternate interpretations all depend on response inhibition. During the wait, the moments before anger or inappropriate joy, other neural assemblies, experienced as competing psychological adaptations and elicited by cognitive training, modulate not only our response sequence but also its intensity. Parallel processing has a chance to pull us back from some exaggerated display that might kill, cost some reproductive fitness, or embarrass us later. Sam experienced panic for decades; whenever he drove or attended public functions, he managed his travel according to likely bathroom availability should he have a sudden urge to relieve himself. A little sertraline muted his panic and allowed him to develop less binary reactions. For example, he recently began attending church again and experienced momentary panic when communion was announced. He suppressed his urge to leave and played with his young daughter, concentrating on her face during a few moments. The panic evaporated perhaps due to a combination of behavior coaching and medication. He also was uneasy visiting a sick friend in the local hospital. He had bad memories of his mothers demise in that same facility. However, his daughter was also born there; Sam went down to maternity and did better with inhibiting his anxiety.

Our settings ... Environmental manipulations can generate more options. Shifts in the relative dominance of motor subroutines allows greater reciprocal inhibition from previously muted skills, we move from digital to analog response styles. Some fairly standard behavioral treatments might help. Shifts in vocational choice or hobbies may draw upon under-used adaptations. Psychological adaptations have a strong genetic component, vary between individuals, and occur in different patterns within families. Encouraging a client to move from a socially approved area (computer programming, writing, or medical school) in which he has little talent toward one wherein he has more allows more effective inhibition of defeatist habits and expectancies. Brian Goodwin, 1995 remarked, "...it's simply a matter of finding a place where you can be yourself." Goodwin was discussing evolution, the statement is also valid for mental health. Amy, for example, currently holds 3 jobs and has commented that she doesn't have time to get in trouble. The mutually defined net of schedule constraints prevent her making impulsive changes in her work hours in order to socialize. There is no flexible time for making up any lost hours.

Building alliances ... Susie in an earlier example, did not run away from home. She inhibited her prepotent tactic of eloping and returning after her mother cycled from anger into worry. Instead she acted on a different strategy of calling a male friend (me, her doctor) with sufficient influence to be protective. It was too early in treatment for her to think, "I need to get to my Maybe Range, I will call Dr. Brody." Her 17 years of social reinforcement (her tactic usually worked) in combination with any Psychological Adaptations (powerful friends will protect me) account for her call. Janie, a different example, commonly sought allies who would agree with her, regardless of whether they offered good advice. She avoided ones who might disagree with her on any particular issue. It was a difficult change for Janie, to label a critical family member as an ally, as providing information that could be useful rather than punitive.

There are plenty of us who don't use alliances properly ... we may not build them, a fact that often scares our mothers ("But doctor, he's got no friends, teach him to make friends."). We depend on them to excess ("My child is such a follower") or we mislabel them, mistaking allies for enemies (the rare teen male who comments, "I make lots of mistakes so I need a teacher looking over my shoulder so long as she is on my side.") "Therapy," whether led by a parent or one who is on a more transient contract, nudges clients back towards Maybe, back towards a better match between delayed environmental possibilities and personal conduct.

The pills we take ... Medication may slow down entire assemblies but not always increase the complexity of the hook ups. However, we sometimes observe more complex, thoughtful, creative behavior in response to some medications, behavior that continues after medication ceases. One possibility is that previously suppressed (via lateral inhibition or through minimal inherent activity) sites become more active and compete more equally with dominant ones. Another is that increased motor/verbal output, even if clumsy, secondary to medication will be associated with shifts in feedback. Changes in feedback encourage "learning" and the ability for newly active skills to become more felixible, more graded in intensity, and to remain active even after medication is discontinued. All of these things underlie a client's response, "I can't believe I finally said that to my mother in law!"(15)

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