Sunday, 22 February 2009
Symptom substitution
Transactional analysis provides a good example of the hydraulic theory of personality. This is where the personality is described as a set of forces or energies. Some times those energies work in unison and sometimes they are opposed.
Take this example of the bed wetting child. It wants to feel secure but internally the Parent ego state tells it to stand on its own two feet and it is emotionally on its own (because that is what it perceives the real parents are doing in some way).
So we have two forces in the personality that are opposed and thus they collide. This collision of two forces creates an off shoot or third force which provides the energy or force behind the formation of the symptom. In this case it is feeling of anxiety and the behaviour of bed wetting. (There are also other causes of bed wetting I may add. It can at times be shame based or even a rebellious act as can be encropesis).
In such hydraulic theories the treatment goal is to halt the collision, thus the third force created ceases to exist and thus the symptoms go away. However other approaches treat the symptom on its own like with the bell at night when the child starts to urinate in bed. This according to the theory should simply lead to symptom substitution. Because the collision of forces has not reduced then either the symptom will resist extinction by the behavioural treatment or another symptom will simply arise.
From what I have seen behavioural treatments of bed wetting can be quite successful in stopping the child wetting the bed at night. Is the child cured? Well that is for another post.
I met a guy the other day who as a teenager and young adult had been a flasher. He had a strong compulsion to go out into public and expose his erect manhood to women in public places. He got caught a number of times, charged and convicted. This caused him great distress because he stated that his family suffered by such convictions. He said that he went and got aversion therapy which included him being given small electric shocks when various stimuli were presented to him. I had never before come across someone who was a recipient of such aversion therapy. He reports that after such treatment he never did it again. Cured or was there symptom substitution?
Aversion therapy was the big thing in the 1960s and 70s and was popularised in the movie A Clockwork Orange were Alex was given aversion therapy to quell his violent impulses. It has been used for a number of ‘symptoms’ and apparently was quite successful for helping people to quit smoking.
It got a lot of bad press because it involves punishing the client with electric shocks or using emetic medications. Also it was for a time seen as the wonder solution to homosexuality. This was in the era when homosexuality was considered a mental illness. So many, particularly male homosexuals, were given aversion therapy usually with small electric shocks to try and turn them into heterosexuals. Many professional organisations now ban their members from using aversion therapy although I do believe it is still used in some circles.
Some times I use symptom substitution as a form of treatment. For many years there has been the a debate in drug treatment circles about AA and other ‘addictions’. I have never understood this debate and it seems pointless to me but there are some who will speak disparagingly about the person who has a heroin addiction and stops using only to become ‘addicted’ to some religion. To my mind it is much better to be addicted to religion than it is to heroin. Some say AA involves an ‘addiction’ to a higher power and thus is not a ‘proper’ solution to a drug problem.
To my mind if someone can substitute are really bad symptom to a benign symptom then substitute the damn f**king thing! What’s the problem with that! In fact I think it is a quite a good solution because again it is another example of working with the pathology and not against it. So symptom substitution as a form of treatment? Seems OK to me.
Graffiti
15:49 Permalink | Comments (12) | Email this
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Hi Tony,
I just did a one and a half day psycho-therapy workshop and it was mentioned that homosexuality was seen as a mental illness. Dreadful to think of what some people must have gone thru.
I thought I would be doing my placement during second semester but now it looks like it may be starting this week!! I have an interview tomorrow and will most likely start this week. We go to the agency where we are placed one day a week and get to counsel real clients, as opposed to our classmates. Needless to say I have had a fair bit of anxiety today and am trying to tell myself to take one step at a time. I get too far ahead of myself I think and I also forget I'm a student and expect myself to do things perfectly.
Posted by: KazzaB | Sunday, 22 February 2009
It does seem that by using symptom substitution one is still healing aspects of more fundamental issues. Perhaps there is a good "containing" measure by doing so too.
Healing is universal; by that I mean - if a person is open to some form of healing in the first place they are more likely to start healing!
kenoath
Posted by: kenoath | Sunday, 22 February 2009
Hello KazzaB,
I am sure you will do fine in your placement and yes you are a student and the goal is to learn. I know I made a few and do make a few mistakes but I don't think I have ever hurt anyone.
Hope to hear about your experiences
Tony
Posted by: Tony | Sunday, 22 February 2009
I liked your comment on healing kenoath.
Perhaps we need to not take our theories so seriously and realize the theory of cure is just that, a theory.
Graffiti
Posted by: Tony | Sunday, 22 February 2009
I love a good theory Grafitti.
kenoath
Posted by: kenoath | Sunday, 22 February 2009
I gather that when you use the word 'healing' you mean that the client learns or is made to behave differently in society? I.e... the child stops wetting the bed, the smoker stops smoking, the alcoholic stops drinking and the homosexual learns to have sex with the opposite sex, the murderer learns to not kill people etc...?
I wonder if these people are sick or if instead society has closed the door to the way they tend to naturally work. We are nolonger hunters and gathers - things have changed. Our wars are very different to the tribal type of fighting of old and our behavioural patterns and mind sets (what is and isn't acceptable) have changed so dramatically - no wonder there are so many people who don't fit 'societies' mold.
But if practicing and learning to behave differently to fit in more with today's society (as seen by the client and/or by others in the clients environment) is called healing, then - yeah Tony, i'm with you. What ever works is fine with me too.
There's so much i don't seem to understand. Maybe one day i will see things differently and be 'right' too. Then again - perhaps not...
Posted by: roses | Monday, 23 February 2009
To be 'healed' in this theory then the collision of forces stops Roses. Changing the behaviour really has nothing to do with it.
So theoretically the healed alcoholic is the one who can drink socially. Of course this rarely, if ever happens and the healed alcoholic is the one who completely abstains.
Welcome to Monday Roses
Tony
Posted by: Tony | Monday, 23 February 2009
So...
When the alcoholic stops drinking and is able to social drink with moderation - that is not a behavioural change?
When the chronic smoker ceases to smoke - that is also not a behavioural change?
If a murder doen't kill people anymore then that too is not a behavioural change?
What then is a behavioural change?
Also...
We're not looking for healing but a more socially acceptable substitution for certain behaviours?
Isn't that changing behaviour?
Instead of over drinking or any drug abuse, they instead become overly religious.
Tony, i do hear what you're saying. If so called 'healing' is not apparent then, symptom substitution is better for the client than nothing at all. Is not the symptom we're substituting to do with behaviour?
Yes i understand the collision of forces is the issue of your intention but my issue with your intention is that perhaps symptoms are behaviours that society is saying it rejects and that's why anything is better than nothing - change wise for the client and their environment?
Honestly - world view wise, people with these 'symptoms' would probably do very well in another culture but just don't quiet fit into our culture. That's all it really is.
"Transactional analysis provides a good example of the hydraulic theory of personality. This is where the personality is described as a set of forces or energies. Some times those energies work in unison and sometimes they are opposed."
You said that at the begining of the post. I agree with the statement. I also can see that when those energies are opposed - sometimes - they would work well or be accepted more in another land where there are different beliefs, sociatal functions etc.
These symptoms or behaviours fit somewhere, are acceptable somewhere, are seen as quirky somewhere, just not here.
Posted by: roses | Monday, 23 February 2009
Hello Roses and thanks for your comments,
The best approach that I would suggest is that one work on the symptom (Behaviour) and the underlying cause as well.
But according to the theory the behaviour or symptom is largely irrelevant. If the collision of forces is stopped then any symptom will simply fade away
Graffiti
Posted by: Tony | Monday, 23 February 2009
Good morning Tony. Applied Ethics began yesterday (philosophy) so i'm learning to hear your argument. I realise now that you like to make arguments and you like to stick to your beliefs.
I've always been called hard headed.
Question...
If the symptom (behaviour) is "largely irrelevant" then why bother to find ways to make the symptom or behaviour go away? Why stop the collision of forces if the symptom it causes is largely irrelevant?
Posted by: roses | Tuesday, 24 February 2009
You replied to my comment - "Changing the behaviour really has nothing to do with it."
Isn't that what this post is all about?
Yet you posted - "To my mind if someone can substitute are really bad symptom to a benign symptom then substitute the damn f**king thing! What’s the problem with that! In fact I think it is a quite a good solution because again it is another example of working with the pathology and not against it. So symptom substitution as a form of treatment? Seems OK to me."
The only difference i can see is the substituted 'Symptoms' with the word 'Behaviour' - but symptoms and behaviour can be the same - the evidence of the collision of forces.
Ok, i'm going away now.
While you're being busy - don't forget yourself.
Posted by: roses | Tuesday, 24 February 2009
"To my mind if someone can substitute are really bad symptom to a benign symptom then substitute the damn f**king thing! What’s the problem with that! In fact I think it is a quite a good solution because again it is another example of working with the pathology and not against it. So symptom substitution as a form of treatment? Seems OK to me."
I agree. And I bet most clients would too. And given they
pay for treatment..
Posted by: Kahless | Wednesday, 25 February 2009
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