Tuesday, July 8, 2008

The Urge

As I wrote on my website, psychotherapy should spend less time finding the "why" and more time working on the "what." Figuring out why people get things wrong is useless unless they know what to do to get them right.

This implies that it is wrong to think that human behavior is a mere expression of a mental process... of a thought, an impulse, or a fantasy. And it also implies that changing minds is not the best way to change behaviors.

A variation of this idea appeared last Sunday in The New York Times Magazine in an article by Scott Anderson:
"The Urge to End It All."

Anderson began by noting that despite the progress medicine has made in treating depression, the suicide rate has remained fairly constant. The problem, he says, is that mental health professionals have been looking at the "why," and not the "how" people commit suicide. It is about the means to act, not the meaning of the impulse.

When British homes were heated by coal, the heaters produced toxic fumes, especially carbon monoxide. The easy availability of this poison induced many suicides. When the old heaters were replaced by cleaner burning ones, there were, logically, fewer coal-gas suicides. But, not so logically, there were fewer suicides overall.

It seems that suicides increase when it is easier to commit the act and decrease when circumstances make it more complicated and difficult.

If you want to stop people from jumping off of bridges, you do not need to know why they want to jump. You simply need to build a higher fence. Not only will that reduce the number of jumpers, but it will also reduce then number of suicides.

This means that we should not believe that the self-destructive impulse is going to express itself one way or the other. In the absence of a convenient means the impulse will often simply fade away.

Freud would have called this repression; he insisted that the repressed impulse would always return, usually in more virulent form. Yet, the new research says that the impulse is not simply repressed. It vanishes.

How does this happen? First, the absence of a convenient means forces the person to think about what he is going to do. It gives him the chance to look at his action from the outside, as others might see him, and this of often none too attractive. Second, the impulse seems to look for a cue in the outside world. If the world provides the means to act-- with a free path over the side of the bridge or a loaded pistol-- then that might be taken as a sign that the impulse is correct. If no means are available, then the mind seems to reject the impulse as not its own.

While this does not apply to all cases, it does apply to a statistically important sampling. And it is sufficiently compelling to merit some serious thought.

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