This blog is a place to reflect on psychology, the most fascinating discipline in the world, outside the constraints of lab reports and lit reviews.

I glossed over something very important in my last post (‘Learning how to sit and operant conditioning’) and that is the resistance of the child, an issue that can be hugely confronting for the parents who are watching the therapy take place. Indeed, I’ve seen a mother call a halt to the whole program after being unable to bear watching her struggling child being physically prompted into a chair. I was certainly shocked the first time I saw an experienced therapist actually do this, and want to say something about it all here.

One of the most striking things about watching an ABA program in its early stages is its physicality. In a culture in which touching another person’s child is prohibited in all but the most exceptional circumstances, the hands-on method of ABA can be jarring. When I first observed a therapist at work, I gulped at how much touch was used to prompt, reinforce, and play. The therapist would take the child’s shoulders and steer them into the chair, sometimes pressing behind their knees to prompt the sitting action; tickle them and scruff their hair when they did well; and spin them around upside down on their play breaks. What was intensely apparent to me was the idea of ABA (at least in its early stages) as a physical interruption: the child’s staring or rocking would be disrupted by the physical prompts of the therapist. It was a way of commanding their attention and shaping it towards different objects.

The idea of ABA as an interruption to some of the characteristic traits of a child with ASD is illustrated very powerfully in Catherine Maurice’s memoir Let Me Hear Your Voice. Maurice (who had a PhD in French Literature) had two children with ASD, and her memoir charts the journey through their diagnosis and treatment, as she wound her way through the minefield of therapies available in New York in the late 1980s. She ended up using a combination of treatments for her children and ABA played a particularly important role, although Maurice herself was initially hugely suspicious of its behavioral principles.

In a social milieu dominated by psychoanalysis, behavioral therapies were considered to be an egregious violation of the child’s autonomy. ‘Behaviour modification is morally reprehensible’, a psychiatrist in Maurice’s memoir pronounces. Maurice herself had enormous misgivings about taking her daughter into behavioral therapy (the journey with her younger brother would come later), but the empirical validation for it was too compelling to ignore. In Lovaas’s (1987) famous experiment, nearly half the children in the experimental condition receiving behavioral therapy made major developmental gains, with many of them being able to eventually participate in mainstream schooling.

Despite her excitement about these results,  Maurice herself was initially horrified by what ABA entailed. She and her husband watched videos of children being taken through Discrete Trial Training (DTT) and felt appalled (for a discussion of DTT, see my post ‘Learning how to sit and operant conditioning’). It seemed so cold, and repetitive, and inhuman. But with few other choices, they found a therapist and began the program.

Like so many children with ASD, Maurice’s daughter did not want to be intruded upon, and certainly did not want to sit in a chair when she was told to do so. To Maurice’s enormous distress, her daughter would cry and collapse to the floor during this period, with the therapist calmly and firmly prompting her back to the chair. It was unbearable- Maurice was convinced that she was wrong to inflict such a therapy on her daughter, and also developed a throbbing resentment towards the therapist herself for so doggedly insisting that her daughter do things that caused her such distress.

Through gritted teeth, Maurice continued with the therapy, buoyed by her husband’s faith in Lovaas’s data, and the growing evidence of her daughter’s progress. But what I’m interested in here is the moment in the narrative when Maurice describes what for her will be a new way of thinking about her daughter’s autism, and her own relationship to it as a mother. Voraciously reading everything she could find about the condition, Maurice discovers a memoir by another mother of an autistic child- Clara Park’s The Siege. In the thick of the psychoanalytic craze for mother-blaming, and the idea that parents must somehow simply gently ‘love’ their children out of autism, Park finds solace and inspiration in one of John Donne’s religious sonnets. Here are the opening lines:

Batter my heart, three-personed God: for You

As yet but knock, breathe, shine and seek to mend;

That I may rise and stand, o’erthrow me, and bend

Your force to break, blow, burn and make me new.

This sonnet blasted open Maurice’s thinking about her daughter’s autism. It became her ‘cry to arms’. From now on, she would intrude and interrupt; she would not wait quietly at the door for her daughter to come ‘out’ somehow from her condition, but rather break that door down herself. Maurice writes, ‘I did not learn how to wait; I learned how to stalk and hunt, how to overpower.’ The language is so strong here, and surely to some it must jar- how could one use such words to talk about one’s child? How could one strike the tone of Donne’s sonnet in relation to one’s own daughter? For Maurice, however, a mother at her wit’s end, such a vocabulary became another kind of language of love- and indeed, it was partly the sonnet itself which made Maurice able to tolerate the intrusions of ABA therapy for her daughter in the first place. As she writes after the first painful session of ABA, ‘[i]t was because I had been charged up by the idea of an assault that I was able to even consider this behavior modification.’

Her daughter ends up making remarkable progress, changing in tiny steps in front of her eyes. But my point here is that it was terribly difficult for Maurice as a mother to see her daughter’s distress- her cries, her prone body on the floor- and that if she had not been fortified by Donne’s poem, she may never have begun the therapy in the first place. I thought of Maurice as I watched a mother similarly suffering while a therapist held her child in a chair, their body rigid with outrage and distress, their face a scrunched page of panic and refusal. The mother held her hands to her throat, and then to her mouth- and then she flew up from her chair, saying ‘Enough! They’ve had enough!’ It was unutterably awful.

And it was awful, if one looked at it shorn of context, or without the lens of behavioural principles- what it looked like was a stranger holding her child in a chair against their will, while they cried. Who in the world could bear this? No one! But it was also an instance of operant conditioning, in which task avoidance could not be permitted, and in which reinforcement would ultimately shape an entirely new set of behaviours (and possibilities and powers), as indeed ABA would end up doing for this remarkable child.

As a very gentle woman with years of experience as an ABA therapist once explained to me (when I expressed my own misgivings about working through a child’s distress): ‘We are not asking them to do anything unreasonable. We are only asking them to sit.’ Indeed- but in ‘just asking them to sit’, I feel acutely aware that we are also invoking the ‘break, blow, burn’ of Donne’s extraordinary poem.

I think ‘come sit’ must be seen through both of these lenses at once, the scientific and the literary-existential: it must be seen both as a simple instruction, and as a world-breaking, future-making instrument of transformation. This is how I think of it.

Studying behaviorism this year has turned everything I previously thought about psychology on its head.

At the start of the year, my image of ‘psychology’ and the ‘psychologist’ was the kind of stock standard notion shared by many with a humanities background. Psychology, I thought, was about language: clients would come to  talk about a particular problem and present a story of their predicament, while the psychologist’s role was to help the client with that narrative. It was primarily about words, I thought, all exchanged (according to this fantasy) in some lovely, quiet room with dark furnishings.

It was this image of psychology which I think turned me away from the discipline when I was much younger, because I could not marry it with the way the subject itself was presented. The university I was at had a very strong behavioural focus, and I simply could not see how experimenting on a rat in a maze could have any bearing on the conundrums of inner life I was longing to understand. So I abandoned it, convinced that Virginia Woolfe had more to tell me about the world than B. F. Skinner.

The fascinating series of lectures on learning theory which I attended this year have entirely changed my mind on all of this. What initially appeared to be a very dry, technical and indeed inhuman area of psychology was shown by the end to be intensely rich and exciting, and able to alleviate a host of painful predicaments.

The lectures (which predominantly explained classical conditioning and operant conditioning) were punctuated  by remarkable sequences of video footage in which people suffering from agonising ailments were treated using behavioural principles. For example, we observed part of the treatment that was given to a woman in Far North Queensland with a phobia of frogs. This poor woman! Far North Queensland is literally full of frogs- they can take up residence on a coffee pot, or in a bathroom, and are pretty much inescapable. However, this woman’s phobia extended far beyond a terror of being faced with an actual frog- she was also unable to bear to see even a drawing of a frog, so hence no longer even left her house to go to the letter box (because there may be an envelope with a stamp depicting the terrifying creature). Her suffering was simply immense.

How is one to deal with such a terror? It clearly is not something that one could simply change one’s mind about, or be helped to see differently- the physiological symptoms of fear and stress are too overwhelming for that. But what does work for phobias are treatments based on the principles of classical conditioning, such as systematic desensitisation and exposure therapy (note that I’ve written about the technical details of classical conditioning in my post on Classical Conditioning and Australian Politics).

The treatment employed for this woman was systematic desensitisation, so that is the one I’ll briefly describe here. The general hypothesis here is that the phobic person is trapped in an involuntary sequence of responses to the feared stimulus. That is, at the sight of a frog, heart-rate increases, breathing becomes more rapid and shallow, the skin flushes, panicked thoughts arise. The aim of the treatment is to neutralise this agonising loop by conditioning a new response to the stimulus. In particular, systematic desensitisation works to enable the person to experience a relaxation response when faced with the terrifying object, rather than fear.

So the psychologist in this case taught the woman terrified of frogs relaxation techniques, and then worked with her to construct a graded list of events related to the phobia. We weren’t shown the actual list during the lecture, but it might run something like this: 1) imagining a frog is one mile away in a river….15) imagine opening the letter box and seeing a picture of a frog on a stamp…..20) holding a living frog in one’s lap. The person is encouraged to employ their relaxation techniques (which might be focusing on the breath or systematically relaxing muscle groups), and then gently asked to imagine (or sometimes actually experience) each numbered event, not moving on to the next until each item can be imagined or experienced without fear.

In the sequence which we were shown, the woman was holding an envelope with a frog stamp on her lap (the therapy must have been really quite advanced for her to tolerate this). Her face was covered with her hands, and she was breathing deeply. Even though she was clearly using a relaxation technique, her distress was still palpable, and frankly shocking to me as I sat in that lecture theatre. Until that moment, we had been listening to a very technical explanation of the relationship between a conditioned and an unconditioned stimulus, and then suddenly were faced with the eruption of an intensely real human existence, projected enormously onto the lecture screen. Truly, it was heart-stopping.

What became overwhelmingly apparent was that the theoretical constructs of learning theory (arrived at over decades of frankly appalling experiments with animals, but that’s another story) were able to actually be used to transform the psychological and physical predicates of a human life. That woman’s life was tragically truncated by her terror, and behavioural therapy was ultimately able to free her from a prison of excruciating associations.

I left the lecture quite stunned. I had not understood the pitch of pain to which psychological suffering can consign you, and nor had I understood that there are aspects of human existence which are not amenable to words.

And to think I used to believe that only literature enlarged the world-

Learning about classical conditioning in psychology this year changed my understanding of the way that politics works, and shed light on why certain kinds of positions can become so intransigent.

Classical conditioning is one of the foundational theories of learning. In a nutshell, it describes learning through association. Think Pavlov’s poor dogs, with saliva collectors attached to their gums. Pavlov was principally interested in the work of digestive glands (and would win a Nobel prize for this research in 1904), and had assembled his little army of dogs in the lab to study it. But he noticed a strange thing- when the dogs heard footsteps coming down the hallway, they would immediately begin to salivate.

What Pavlov eventually discovered was the complex process of classical conditioning: in a series of trials using bells and tones, he observed that the dogs’ mouths would begin to water at the sound of a tone, which they associated with being imminently fed. But what struck Pavlov was that it was the tone that was able to prompt this reflexive physiological reaction, and not the sight or smell of the food itself. Somehow, the tone had itself taken on the meaning of ‘food’, and prompted an involuntary physical response.

It’s worth spelling out the detail of this fascinating process, because I think it underlies many of the ways in which meanings and values actually get distributed in our culture. Classical conditioning occurs when a previously neutral stimulus (such as the sound of a tone) is paired repeatedly with what is called an unconditioned stimulus (that is, any stimulus which produces a natural, reflexive response in the organism, such as food). Such pairings end up transforming that previously neutral stimulus (the tone) into what Pavlov called a conditioned stimulus, which is now itself able to elicit a similar physiological response as the unconditioned stimulus. Hence, after repeated experience of a tone being paired with the presentation of food, eventually the tone itself (now a conditioned stimulus) is able to trigger the same physiological response.

There are all sorts of extraordinary applications of this insight in psychology. For example, there is a terrible condition called anticipatory nausea that afflicts cancer patients going through chemotherapy. Through repeated ‘pairings’, the previously neutral stimulus of, say, arriving in the hospital car park for treatment becomes hopelessly associated with the treatment itself (and its attendant nausea). For such patients, simply arriving in the car park (now a conditioned stimulus) is enough to trigger the conditioned response (nausea and vomiting)- and treatment cannot proceed, with the patient being imperilled. But with an understanding of classical conditioning, such individuals can be helped, and the normal course of behavioural therapy in such situations is for a psychologist to counter-condition a relaxation response to the aversive stimulus. Eventually, the conditioned stimulus triggers rest and calm, rather than nausea.

But the really interesting point with all of this, which I think has direct relevance to politics, is that the individual’s reaction to the conditioned stimulus is involuntary. There is literally nothing that the poor dog or the cancer patient can do to actually change their minds about the reflexes of their bodies- the only way out of the loop is to undergo counter-conditioning.

When I was learning about this process, I couldn’t help thinking about the ceaseless demonisation of refugees over the last decade in Australian politics.

In this time (if not earlier, when Labor introduced mandatory detention in 1992), the word ‘refugee’ (maybe never a completely neutral stimulus in Australian political history, but certainly one that has had different meanings to those which burden it now) has been repeatedly paired with a whole collection of terrifying synonyms: queue jumper, illegal, and most pointedly, terrorist.

What I’m interested in here is the work of this association on what one might call the national organism. In the past, I had certainly noticed that the association was repeatedly made, but I used to think that this was just a problem of language, and that people could be encouraged to think differently about the situation. But if you take the notion of classical conditioning seriously, then reason and persuasion actually may have remarkably little ability to transform these connections.

Consider this: the choice of negative synonyms (terrorist in particular) is designed to trigger an unconditioned response (that is, fear, disgust, anger). Through repeated pairings, the word ‘refugee’ itself becomes a conditioned stimulus that elicits the same response. The problem here is that the conditioned response is itself involuntary– it is a physiological reflex, rising up in an individual with all of the force and apparent ‘truth’ that changing sensations inside the body create.  Because it is a conditioned response, one cannot use reason to appeal to it. Remember, the poor chemotherapy patients with anticipatory nausea simply cannot change their minds about their reaction to being in the hospital car park- they are painfully trapped inside a loop of physiological responses that can only be undone with counterconditioning.

I now see the conduct of politics as a cultural process of classical conditioning, a long labour of fusing particular associations in the actual bodies of individual citizens. This work actually embeds certain values (such as refugee= bad/dangerous) in the physiological circuitry of the citizen where they are not amendable to transformation through reason. If you take classical conditioning seriously, it may be that the only way to change such involuntary loops of physiological judgement is to conduct a massive trial of counter- conditioning across the culture, in which new (physiological) associations are established.

It was by no means a given that I would love statistics, particularly considering that I began ignoring maths when I was extremely young (because I thought it was incompatible with poetry- but that really is another story). After years of living life as though statistics and scientific thinking in general were completely unnecessary, I had an experience that completely changed my view of absolutely everything. Not long after I started studying psychology this year, I got a part-time job as a behavioural (ABA) therapist with a little boy who has autism. When you do this kind of therapy as a student (in Australia at least), you work one on one with the child through a host of different programs (aimed at developing cognitive, linguistic and social skills) devised by a psychologist. The student therapists, the coordinating psychologist and the parents meet every few weeks to discuss and update the programs. At one of the early meetings, the psychologist mentioned a new therapy for autism which was, she said, having great results. It was called Relationship Development Intervention (RDI), and she encouraged the parents to consider it. It was expensive and time-consuming (requiring up to 40 hours per week), but she thought they should think about trying it. I filed away RDI as one of the things I’d like to know more about myself.

Just by chance, not long after this I was given a copy of the Autism and Related Developmental Disabilities newsletter from the Douglass Developmental Disabilities Center at Rutgers University in the United States (Volume 25, Issue 1, Winter 2009).  The theme of the issue was scientific literacy, and how important it is for parents to become scientifically literate when their child is diagnosed with an Autism Spectrum Disorder. As the newsletter showed, without a basic knowledge of scientific method, it is almost impossible to properly evaluate the competing claims made for the host of therapies that exist for autism. Families are terribly vulnerable to so-called ‘miracle’ treatments and cures which may have no empirical support whatsoever.

And which treatment would be used as an example of the perils which can befall people in this situation? RDI! According to a review of the research by Suzanne Letso and Thomas Zane, the claims for RDI are hopelessly flawed. Of the numerous problems that could be mentioned here, the most striking are 1) the original research was never actually published in a scientific journal- it was submitted for peer review and then withdrawn, and then later cited in another publication as though it had gone through proper channels (but never had) 2) the RDI condition received 5 months more treatment than the control condition and 3) the whole study was a quasi-experimental design (so no cause-effect relations could actually be established between the treatment and any improvement in the children involved in the study).

Can I say that if I had submitted a research design like this (even as a lowly first year student), I would have failed! The results here are hopelessly confounded. Who can say what ’caused’ apparent improvements in the children? Was it the fact that they were five months older than the children in the control group by the end of the study? Was it that they had five months more contact with therapy full stop than the control children? Or was it indeed the virtues of RDI? Because of the faulty design of the study, there is absolutely no way of answering these questions, and certainly no way of being confident that RDI itself had an effect.

Anyway, my long-winded point here is that I had been sitting around a table with parents who were desperate to do the right thing by their child, and the psychologist (the authority) in charge recommended a treatment which has questionable claims to effectiveness. No doubt there may well be positive testimonies and anecdotal evidence of families finding genuine improvement in their children with RDI, but the fact is that there is as yet no substantial scientific evidence supporting it as a treatment for autism. The whole experience left me very shaken, and also absolutely desperate to begin studying statistics and research design- I thought, I want to KNOW what constitutes valid evidence for something! And if I’m ever in a position (many years in the future) to be recommending a course of treatment for a family (a treatment which will require all of their resources, their time, their stretched emotions and much of their money), I hope to be fully informed about its empirical support.

So this experience changed everything I had previously thought about statistics and research design- I no longer see it as an obstacle on the way to ‘really’ learning about psychology, but instead as an essential part of the discipline itself. Whenever my heart sinks when faced with a new statistical formula, I just remember that afternoon around the kitchen table with the psychologist and a mother desperate to do the right thing by her child, and I grit my teeth and get on with it.