Root Cause Therapy

Not sure what to make of this. Jesse Singal has written many magazine articles and now a new book debunking some of the current psycho research. He does not aim at the touchy-feely get-in-touch-with-your-feelings crowd in a recent New York Times op. ed. He aims at therapies that rely on cognitive and behavioral theories.

He does not quite call their practitioners psycho hucksters, but he hones in on those who offer quick psycho fixes for social problems.

For instance, he shows some serious shade on the “broken windows” approach to policing, instituted by Mayor Giuliani. Since it was notably effective, though perhaps not in the way that its proponents claimed, one is not on very solid ground denouncing it.

The policy involves enforcing laws against small crimes, the better to create an atmosphere where lawlessness is not routinely tolerated. This is not a quick fix. It requires serious police work. It requires serious prosecutorial work. Surely, it is precisely the opposite of policing in today’s New York, where people are not only allowed to get away with just-about-anything, but where certain groups are allowed to believe that their criminal activities are righteous revolts against systemic racist injustice.

Anyway, this is anything but a simple fix.  

Singal is especially contemptuous of Dr. John Bargh, who did not merely propose policing petty criminals. Bargh even suggested that cleaner streets would improve the quality of New York life:

For Dr. Bargh, for example, seeing cleaner streets spurs prosocial behavior in a manner that, he says, can help explain New York City’s great violent-crime drop that started in the 1990s. (That’s why he lauds “broken windows” policing.) He acknowledges there were other factors, but he also states flatly in his book that the city’s resurgence “was a result of a new culture of cues for positive behavior being instituted.”

To which Singal responds:

Few criminologists believe that these sorts of cues for positive behavior can tell us much, if anything, about the great crime decline.

And also:

If reducing crime is a simple matter of priming would-be offenders with cleaner streets, then there’s little cause to become overwhelmed by the problems that surround us and also less reason to pursue expensive or politically contentious reforms (like truly attacking the root causes of crime).

First, cleaning the streets is not a simple matter. Picking up the garbage is not a simple matter. Policing bad behavior is not a simple matter. While cleaning the streets was one aspect of the broken windows policy, it was only one.

As for the “root causes of crime” those terms have been bandied about ad nauseam for far too many years. Yes, we know that better education, better housing and better job opportunities would reduce crime, but how can a child receive a better education if his classroom is in constant chaos, and if his neighborhood is run by petty criminals and if the teachers’ unions do not care about whether or not he goes to school. The best performing charter schools do not accept inattention, bad manners or a lack of elementary discipline.

And yet, saying that the broken windows policy will not solve the problem in and of itself is not the same as saying that it is useless, especially today when the city is descending into chaos.

No one in today’s New York would complain about cleaner streets, less graffiti, and more active policing. If it does not solve the so-called crime problem, at least it would be a step in the right direction.

Of course, like hustlers the world over, those who propose small solutions to big problems tend to oversell their remedies. Apparently, TED talks were invented so that they could do so with impunity.

Singal is on somewhat more solid ground when he calls out Dr. Bargh for a bizarre contention about how to cure depression:

In his 2017 book, “Before You Know It: The Unconscious Reasons We Do What We Do,” Dr. Bargh mentions a clinical trial in which severely depressed patients in a mental health facility appeared to improve after exposure to very high temperatures. He speculates that perhaps an outpatient approach involving soup could do the trick, too, since “the warmth of the soup helps replace the social warmth that may be missing from the person’s life.” Such remedies “are unlikely to make big profits for the pharmaceutical and psychiatric industries,” he writes, but they warrant further research.

Every day, millions of depressed people drink coffee to no apparent salutary effect.

A nice riposte, but not necessarily the most thoughtful. He might have mentioned Bikram yoga, aka hot yoga, which apparently offers some psychological benefits. And yet, the virtue of chicken soup does not lie in the temperature of the soup, but in a multivariable ritual, involved the killing of the chicken, the purchase of the chicken, the preparation of the soup, and the family dinner where it was consumed. 

Again, it is not quite as glib to say that family dinners are better for your mental health than a search for the root causes of depression or whatever, but, truth be told, the evidence tells us that a well-structured routinized family life provides more than a few benefits for children. It is certainly more effective than therapy that searches out the root causes for illness. 

Better yet, today's go-to solution for depression and a panoply of other psychic ills is medication. One does not imagine that pills attack the root causes. And besides, why would better social habits, the kind the promote better social connections, be a psychic benefit. Don't we all know now that social connections are good for your mental health? Isn't that one of the most important lessons from the covid lockdowns and social distancing mandates.

So, Singal is criticizing low-cost psycho tweaks, even though many of them are not low cost. He is suggesting that they appeal only to the simple minded. And yet, cognitive therapies have been shown to be more effective than therapy that searches out root causes.

Cognitive therapy involves what might appear to be a simplistic effort to reprogram the brain, but, rest assured, they are not as easy as people think, because we live in a culture where we imagine that finding root causes will automatically solve the problem.

Singal makes cognitive treatments appear to be worthy only of simpletons. Dare we mention that teaching people how not to flounder in depressive thinking is not quite the same as cleaning the streets or prosecuting fare-beaters in the subway system.

Take mind-set interventions, which are designed to shift people’s mind-sets from “fixed” (“I failed the test — I’m just stupid”) to “growth” (“I’ll do better next time if I work harder”). “For 30 years, my research has shown that the view you adopt for yourself profoundly affects the way you lead your life,” said Carol Dweck, the originator of that idea and a professor at Stanford, in her book “Mindset: The New Psychology of Success” (ideas she echoed in a TED Talk that has been viewed more than 12.5 million times).

Personally, I would much prefer that the person who fails a test does not imagine that he is just plain stupid or even that the test manifests unconscious bigotry. I would much prefer that he sees failure as opening a path to working harder. Why is that offensive? Would it be better if he went about exploring his memory bank for the abuse he received as an infant and that supposedly is root cause of his failure.

Mind-set interventions appear to be nowhere near as powerful as Professor Dweck initially advertised: A major, well-constructed 2019 study in Nature found some effect, but only a relatively small one and only for weaker students.

I am not going to argue about mind-set interventions, but I will point out that Dweck is merely selling cognitive therapy. And we know that the changes it prescribes do not just happen because you have heard a TED talk or because you read an article in a magazine. It’s really all about changing bad habits into good habits. Obviously, the TED talkers de-emphasize how difficult it is to get over bad habits, but theirs is not a simplistic approach to the problem

As Aristotle put it, the best and perhaps the only way to get rid of a bad habit is to replace it with a good habit. One hopes that the philosopher will not now be accused of offering simple minded solutions that ignore root causes.