Friday, June 13, 2014

When Therapy Works

Sometimes therapy does work.

Take the case of Brian:

Things were not looking good for Brian. He'd been kept from the affection of his mother—and all other women—and raised alone by his father, who sexually traumatized him. Normal social interactions were impossible for him. He couldn't eat in front of others and required a series of repeated, OCD-like rituals before he'd take food. He was scared of any new thing, and when he got stressed, he'd just curl up into the fetal position and scream.

He also hurt himself over and over, tearing off his own fingernails and intentionally cutting his genitals. He was socially outcast, left to clap his hands, spin in circles, and stare blankly at walls by himself.

But, Brian is not a human being. Brian is a primate; specifically, a bonobo.

In the depths of his despair Brian was befriended by other bonobos at the Milwaukee Zoo:

Still, some other bonobos were kind to him. Kitty, a 49-year-old blind female, and Lody, a 27-year-old male, spent time with Brian. When he panicked, Lody sometimes led him by the hand to their playpen at the Milwaukee County Zoo. 

The zookeepers did not know what to do, so they called in psychiatrist Harry Prosen.

Here is the way Prosen treated Brian:

Prosen first prescribed Paxil, to help with Brian's anxiety, occasionally supplemented by Valium, on the bad days. "The beauty of the drug therapy," Prosen told Braitman, "was that the other bonobos could start to see him for who he really was, which was really a cool little dude."

Meanwhile, Prosen and the zookeeping staff began Brian's therapy, focusing on making changes to their own behavior and his environment. They spoke quietly and moved slowly and consistently. No sudden movements or loud noises. They made each of his days exactly the same, and only introduced new things slowly and deliberately. They had Brian hang out with apes who were younger than him, so that he could learn what he'd never been taught as a kid: play. 

Obviously, they could not use talk therapy. So they used a form of behavioral modification. They modified their own behavior and changed his environment. Since a traumatized Brian had become sensitive to sudden movements, they did not make abrupt moves.

And then, they added consistency to his daily life. They understood that consistent routines could provide him with a sense of security and stability.

Finally, they found a way for him to learn how to engage in social interactions with other apes.

Did it work?

Yes, it did:

By 2001, after four hard years of therapy and improvement, Brian had begun to integrate into the Milwaukee troop. The zookeepers saw it as significant that a new mother let him touch her 10-day-old baby, and over the the next few years, his behavior became more and more socially aware. They peg his 16th birthday, in 2006, as the time when he "started acting his age." He loves carrying around the babies in the troop, and even managed to have his own children. And, as his keeper Barbara Bell recalled, he went off Paxil at some point, after he took to sharing it (!) with the other apes. 

As the years went by, Lody grew old and frail. Brian began to take on the older male's leadership role within the troop. And when Lody died in 2012, Brian became one of the group leaders. It was a remarkable transformation for a sick, disturbed young ape to have made. 

For his part Prosen emphasizes the importance of Brian’s social integration, especially the help offered by other bonobos. They gave him what an individual suffering from anomie most needs: a hand of friendship:

Prosen, for his part, attributes Brian's growth to Lody and Kitty, the blind female who helped him out in his earliest, darkest period. While his therapy and the pharmaceuticals did some good, it was the community of zookeepers and animals working together that seems to have gotten him on the path to social integration.

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