Tuesday, February 03, 2009


How does a therapist help an emotionally unbalanced or unstable patient change? How can someone who behaves in a dangerously suicidal or homicidal way and whose thoughts are paranoid or distorted and by varying degrees out of touch with reality, be convinced to alter his behavior and thinking?

There are many therapeutic approaches. Some therapies are purely biological; some are psychological and some are behavioral. The optimal treatment is one that addresses all three spheres.

Biological therapies are reserved for those situations that clearly have a physiological or genetic basis. In such cases, failure to address the biological abnormality will prevent most psychological or behavioral interventions from succeeding.

The application of psychological and social therapies has the patient and the therapist explore the patient’s history, background, environment and thinking patterns. Past traumatic events are examined and relationships are explored. This kind of therapy is predicated on a simple belief: once a patient can put the environment from which they came into a sharper and clearer focus (psychological insight) and think in a different way about that environment, then that patient is better able to behave in a more appropriate and functional manner, one in which the patient can thrive and flourish.

Behavioral therapies focus simply on addressing and changing specific dysfunctional behaviors. One type of behavioral therapy that is generally reserved for patients exhibiting serious pathologies is Aversion Therapy. This kind of therapy is not structured to address underlying psychological issues or cognitive dysfunction. Rather, Aversion Therapy is by design meant to address only unwanted behaviors. The idea is simple and easily understood: A patient is subjected to discomfort when engaging in those unwanted behaviors.

Pedophiles and other sexual offenders are often treated with Depo-provera, a drug that reduces the sex drive in some patients. This kind of ‘chemical castration’ has proved effective in many patients for as long as they take the medication.

The same method of treatment has been used to treat substance abuse disorders. For example, alcohol abuses may be offered a daily drug called Antabuse, which causes makes drinking alcohol a most unpleasant experience; causing nausea, vomiting and other very uncomfortable side effects. In the case of sex offenders and alcoholics, this type of pharmacological Aversion Therapy works because certain dysfunctional and pathological biological functions/responses are restricted for as long as the medications are taken.

Aversion Therapy almost always results in immediate modification of the targeted behavior. Advocates of this therapy point to a near 100% success rate and how the cost saving benefits over conventional psychological treatment are enormous. On the surface, the arguments are impressive. There is only one problem. The so called successes of Aversion Therapy do not stand up to close scrutiny and even proponents reluctantly concede that Aversion Therapy is no psychological panacea.

For the most part, Aversion Therapy is only successful as long as the capability to apply the discomfort is there. The pedophile, once released into the community will soon learn that his response to stimulus is not punished when he is out of the treatment setting. The alcoholic and drug abuser understand that when not taking Antabuse or other medicines of that type, they can abuse substances at will and without repercussions. The truth is that for many patients, until and unless their underlying psychological issues and pathologies are addressed and treated, the recidivism rate will remain extremely high. When the impetus for appropriate behavior is removed, dysfunctional people will revert to dysfunctional behavior.

It is also important to recognize that for the most part, healthy people seeking psychological help want to address their negative pathologies and overcome them and redirect their lives. In such cases they are motivated to change their behavior because of the negative consequences that behavior brings to their life and to the lives of people around them.

On the other hand, there are many very unhealthy and dysfunctional people who do not see their negative pathologies as unhealthy; nor do they ever consider the consequences of their own malignant behavior, Sometimes they even view their own dysfunction as worthwhile or even noble, despite the havoc they wreak in their own lives and the lives of those around them. An example is the pedophiles who believe they are victims of a dysfunctional society. Their belief centers on the idea that their 'love' for children is actually healthy and contributes to a 'well adjusted' child. The alcoholic will often justify their drinking as a perfectly acceptable way of “relaxing” and taking a well-earned break from the stresses of his life.

Often these dysfunctional people get away with their behavior because they surround themselves with “enablers.” In psychiatry--and particularly addiction medicine where the concept originated--we talk about people who "enable" addicts. Enabling refers to any behavior or action that assists the addict in the continuation of their addiction and the behavior associated with it.

Enabling can be either intentional or unintentional, but enabling behavior allows the addict to continue their destructive behavior. An example of enabling behavior is a man or woman who, although they verbally disapprove of their spouse's drinking, repeatedly will go out and purchases alcohol for him/her. This is often found to be the situation even when the alcoholic in one of their rages routinely physically abuses the enabler.

Frequently enablers tell psychiatrists that they "only want to help" or that they are "afraid" of what will happen to them if they don't do the things that help the addict (e.g., the addict will beat them up or hurt them in some way).

In these cases, it is not only the behavior of the alcoholic that must change, it is the behavior of the enabler. And to insure that behavior does not revert back to some dysfunctional equilibrium, the maladaptive thinking that underlies both alcoholic and enabler must be exposed and insight developed. That, in combination with the aversive therapy described above can make all the difference in the world to whether long-term success is achieved.

The idea that it is psychopathology that drives behavior rather than the reverse is important because successful and long-term treatment requires addressing not only the dysfunctional behaviors (which many need immediate intervention to prevent acute loss of life), but also the impaired cognition and emotion that generates the behavior,

In parallel, in order to formulate policies in the West that will have any chance at all in bringing an end to the never ending Israeli-Palestinian conflict, it is the underlying pathology of the Palestinians (and much of the Islamic and Arab world) that must be addressed.

The Arab world and much of the West have enabled decades of dysfunctional and pathological behavior almost to the point of no return. The Palestinians, like the most malignant alcoholics and pedophiles, have come to believe that their behavior and the institutionalized hate, bigotry and calls to genocide that drive it, are both appropriate and healthy. They have made it clear that in order to be a "good Muslim" and a "decent" human being, all these malignant ideas must be embraced.

Within days of the recent Gaza incursion, Many Palestinians (except perhaps their distant leaders) understood that maybe years of firing rockets into Gaza wasn't such a good idea. The Israeli onslaught was a kind of Aversion Therapy that addressed only the negative behavior issues. Unfortunately, the incursion into Gaza did nothing to address the underlying cause of dysfunctional behavior—the irrational, pathological and institutionalized hate; and consequently, the rocket barrages began almost immediately after the Israelis withdrew.

In fact, within days of the Israeli pullout, even more threats of violence were proudly promised by the Palestinians. As in most cases of Aversion Therapy, the effects were short lasting and had no real long-term impact. In fact, the Palestinians knew full well that their enablers in the West would heap criticism and scorn on Israel for even trying to stop the Palestinian rockets which were being fired daily into civilian populations. They also understood that the enablers in Israeli society could be counted on to prevent Israel from delivering the coup de grace—the amount of force necessary and sufficient to unquestionably alter the Palestinian’s murderous behavior.

Sometimes, real cultural and societal change comes about as the result of real, permanent, and severe trauma. The Israelis held back (when do they not, really?) and thus they will continue to pay the price for their humanity towards those who want nothing less than to exterminate them.

So, how do peaceful and free countries develop policies that will bring about healthy change in an emotionally unbalanced or unstable society like Palestinian society (and by extension the entire Arab and Islamic world)? When members of those cultures and even the culture as a whole behave in dangerously suicidal and homicidal ways; when the established institutions and leaders are paranoid and by varying degrees out of touch with reality; can such societies be brought to alter their dangerous behavior and distorted thinking?

Clearly, there are very strong societal, cultural, and religious factors that keep the Palestinians so dysfunctional. Nor is the implication being made that Israeli or Western culture is somehow perfect and that there is nothing to be changed there.

But, consider this: The Jews who came to Israel after the Holocaust were probably some of the most damaged people in history. They were the first real victims of a wide scale technological application of genocide. After the horrific killings of millions of their number, they had every reason to demand their needs be attended to; and they had every reason not to be interested in contributing to the betterment of much of the mankind that stood by and watched them be murdered. In other words, they had every reason to hate.

The trauma of the Holocaust survivors cannot be understated- they had lost their mothers, fathers, husbands, wives, children, aunts and uncles—in some cases their entire immediate and extended families. Whole towns and villages were destroyed and forgotten. The Kaddish prayer for the dead was never recited for countless numbers by their family members, because there were no family members left to do it; no friends or townspeople left to recite the Jewish prayer.

But instead of nurturing their victimhood and refining their hate, the survivors focused on making a new and positive life for themselves and their descendents. These damaged and pitiful remnants from the Holocaust went on to make a desert bloom, build world class education and scientific institutions and become an economic first world nation. The State of Israel was a clarion Kaddish prayer in way-it was a prayer that affirmed life and the potential of man.

Where the Jews succeeded in transforming their trauma into something positive for themselves and the world, the Palestinians have failed spectacularly and accomplished the exact opposite.

And, they have had plenty of help in doing so. Perhaps the most guilty of enabling and encouraging Palestinian and Islamic/Arab victimhood and aggression have been the world community (through the UN) and the ‘compassionate’—and often counterproductive-- foreign policy of Western democracies and of the Israelis themselves. In a way this process is the equivalent of a psychotic patient attempting to convince his psychiatrist that it is the psychiatrist that is paranoid, and astonishingly, the psychiatrist agrees!

The intermittent Israeli bombing and incursions against Gaza or Lebanon are unsuccessful because they, by their very nature, only address the behavior of Hamas or Hezbollah; not the underlying pathology that drives them; and the underlying pathology is psychological projection and paranoia as manifested by anti-semitism.

On the underlying pathology, the Palestinians and their Islamic brothers have been given a complete pass by the Free World.

As we have seen since 9/11, when President Bush took the battle to Afghanistan and Iraq, the U.S. has not since been attacked. But the underlying pathology still exists and awaits further appeasement and enabling—which will likely accelerate in the Obama Administration over the next four years. Addressing malignant behavior though effective aversive military interventions can be helpful temporarily, in that negatively reinforcing any behavior will extinguish the expression of that behavior. And, if we were dealing with a relatively healthy, rational person (or culture), negatively reinforcing the behavior through aversion therapy (bombing the hell out of them) it would have a strong beneficial effect in eliminating it.

But when you are dealing with a severe underlying pathology--one that defines the very identity of the person and which is not in the least bit amenable to reason or even enlightened self-interest, then the behavior can only be stopped for a short while before its malignancy must re-exert itself--against all reason; against the best interests of the individual or even the society. As we have seen, the Islamic world’s behavior is often quite suicidal; and since the major cultural contribution of Palestinian society to the rest of the world is the development and celebration of the suicide-homicide bomber (and they are actually proud of this and celebrate these murderers of women and children as heroic); simple behavioral management of the targeted behavior (e.g., sending bombs/rockets into Israeli civilian populations) does not work short of catastrophic violence (and clearly, the Israelis and the West will go to great lengths not to inflict such human casualties). Japan, for example (another shame culture like the Palestinian/Arab culture) probably would not have surrendered in WWII without the horrific casualties inflicted on that country by the atom bomb. And that is a type of behavioral management the West (or Israel) does not really want to engage in.

That said, how do the policy makers in the West address the pathology that motivates Hamas or Hezbollah, i.e. the bigotry and hate that is constantly projected outward toward the Jews?

First and foremost, the West must stop enabling the Palestinians and the Islamic world. They must cease surrendering key values and freedoms when challenged by that world. For example, in the interests of “peace” and “tolerance” many countries in Europe have already permitted the abrogation of freedom of speech and prosecuted those who merely criticize Islam. Meanwhile Islam and its fanatics celebrate the silencing of their critics by increasing their own hate-infested and bigoted rhetoric. It is bad enough that such hatred is preached regularly in mosques within Islamic countries (which permit no criticism of Islam or any freedom of religion within their boundaries), but all too often, the appeasing multiculturalists of Europe and the US have been tolerant of such bigotry and look the other way when the hate directed at the West become too obvious.

Second, the West enables these oppressive and destructive regimes and positively reinforces the underlying psychopathology by treating the leaders of Hamas, Hezbollah, Iran et al, as if they are civilized and equal to leaders in the West. By granting respect for the bigoted ideas espoused by these leaders--e.g., holocaust denial and the need to “wipe Israel off the map”--as if it is perfectly ok and just a normal, healthy expression of their cultural identity—they give these leaders and their people the impression that their culture is equal to those in the West. Sadly, these dysfunctional regimes already have the grandiose fantasy that they are superior to the West.

The leaders, regimes, and bigotry must be completely, thoroughly and constantly denounced whenever it is expressed, and--even more importantly--there must be negative consequences to them for expressing those ideas; e.g., complete isolation from the civilized world. No ‘gentlemanly’ invitations in the name of ‘free speech’ from the idiot intellectuals at Columbia University or the morally depraved United Nations, which gives malignant leaders such as Ahmadinejad a podium behind which to vomit his hate and to distort reality. All they desire is to strut their psychopathology on a world stage, because they believe that their dysfunction is something that should be embraced by the entire world. Their behavior should have made them pariahs long ago; instead, the UN rewards them by putting them in charge of “human rights”. This is worse than mere psychological denial of reality—it is delusion and fantasy, pure and simple. Why are countries like Iran not expelled from the UN, rather than given a platform that reinforces the pathology that motivates their behavior? Why is Israel constantly singled out for condemnation? Why have the values of the West, which are ably and proudly found in the small country of Israel, become so inverted?

But in the West, there are many enablers around. Some of these people truly don't have a clue that their behavior is not all sweetness and light and that it encourages the exact opposite of what they think it does (e.g., some of the innocent groups--like the Episcopal Church--who are members of "United for Peace and Justice"). These "Do-gooders" are usually completely deluded about the nature of the terrorist and often cry that we must "try to understand" why the terrorists are angry at us and want to kill us. They believe that with enough soul-searching we can discover how to change ourselves and the terrorism will then cease. They are the same "useful idiots" who said the same things about communism and socialism in the last century as communist and socialist regimes murdered millions and enslaved even more. They are the dedicated pacifists and the genuinely good people who continue to maintain a denial so intense that they cannot see that they are supporting Evil.

A second kind of Western enabler is the individual or group engaging in enabling behaviors for manipulative reasons and for personal gain--primarily because it is financially or politically beneficial for them in the short run. They are deluding themselves as they appease the terrorists or the regimes that support terrorism so that they can earn a few more bucks from them; or politically benefit from opposing efforts to stop terrorists. In truth, they cynically doubt that the terrorist are really "all that bad", and believe that by befriending them, they can have the best of both worlds.

And then there is the third kind of Western enabler. This kind is as morally reprehensible as the terrorists themselves because their motivation is much the same as that of Hamas or Hezbollah or Al Qaeda: They do their enabling because they gain sadistic pleasure and feel admiration; and a sense of personal power over others from the acts of death and destruction that terrorism involves; yet since they don't directly participate in these actions, they consider themselves not responsible. They know that they are supporting terrorism and terrorist regimes, and that is why they behave the way they do. They hate freedom and individuality; they hate their own country and its values; and they desperately wish for its destruction.

Obviously, one of the major reasons why sanctions haven't worked is because many in the international community suffer from one variant or another of this enabling psychopathology. There is little use, therefore, in expecting that any positive change in behavior will result from UN action or sanctions.

More effort must be made to positively reinforce any factors that mitigate the anti-semitism; and tolerance for the intolerable hate and bigotry of anti-semitism must be absolute. Some of Israelis psyops during the last Gaza campaign are a good example of how one might approach this issue. Exposing the deceit and showing the truth is always a good method of combating distortion and paranoia; while at the same time offering opportunities to build a civilized society (such as the US has mightily achieved in Iraq).

Reward therapy (the opposite of Aversion therapy) can be used to increase the visibility for rational spokesman (or at least less irrational ones) for Islam. At least, give them the podium at universities and at the UN and celebrate their ideas—not the hate-filled ones. The West must stop being “fair” and tolerant when it comes to the intolerant and malignant behavior of groups like the Palestinians.

The truth is that it is very difficult to treat the underlying psychopathology, especially when that psychopathology is regularly infecting even the youngest members of the culture, indoctrinating them into the hatred, bigotry and dysfunction even before they have time to develop their individual rational faculties. Under the pressure of such coercive indoctrination by the state, very few escape the crippling damage done to their cognitive capabilities and thus are never able to function as normal or psychologically healthy adults. At the very least, these cultures must not be permitted to engage in this sort of child abuse in Western societies, and if Western countries cannot limit the damage they do to their children in Western nations (out of some perverted idea that "all cultures are equally good"), they don't stand a chance of halting such practices in the madrassas and on the TV and radio stations in GAZA or elsewhere in the Middle East.

The West must return to embracing and standing for the values and freedoms that have lead to their unquestioned economic and societal success and the greatest level of human happiness in the history of the world. We must not compromise those values of reverence for life or liberty; nor must we cooperate with those who would enslave the human mind and limit the pursuit of happiness in this world.

If peace is ever to come to the Middle East, we must treat the real and underlying issue, the hate and bigotry that permeates the region and which distorts and cripples the humans who live there.

The Palestinians and the Arab world must be shown that there has never been a successful civilization that has hate as its core value. There has never been a civilization that called for genocide that has ever succeeded in producing anything but destruction. This is not a 'slam' directed at Islam- that religion will survive, but it cannot hope to survive when used and manipulated by the dark side of human nature as a tool for destruction and death. The critique is directed as those who would use that religion as a political hammer and view the world entire as a nail. These dysfunctional regimes- the greatest assemblage of failed nations in history (given their obscene wealth, for starters)- will eventually dry up and their dust be cast into the winds.

Unless and until the underlying cause of Middle East tensions is addressed, the cycle will repeat itself. The institutionalized hate, racism and bigotry must be dealt with in a meaningful way. It must also be understood that the ultimate and most impacted victims of that hate are not the Israelis at whom it is directed, but the Palestinians and Arabs who do the hating. In their denial of reality, they have shut out of most of the 20th century and all of the 21st century to date. They have been by bystanders and not participants in the miracle of an ever evolving and progressive world. There are no medical or scientific breakthroughs coming from that part of the world and there are no economic powerhouses that fuel growth and innovation. From a region and nations that birthed scientific and economic achievement and superiority, there is now a vast desert of nothingness.

A recent UN Report on Human Development placed Arab world education levels at the bottom of the barrel, save for sub Saharan Africa, a region where schools barely exist at all. To make matters worse, first world teachers in the region are often poorly treated and thus are precluded from doing what they do best- teach the children in countries and cultures that need education the most.

Success and peace in the Middle East will come shortly after the hate and bigotry is addressed; seen for what it is; rejected and then finally gives way to rational self-interest and a transformation of psychological energy into something constructive and positive individually and culturally. Behavioral management and Aversion Therapy are only necessary until the psychopathology is appropriately “treated”—and not enabled—by the rest of the world.

How does change come in the Middle East? To quote Golda Meir, "Peace will come when the Arabs will love their children more than they hate us".

--this post was jointly written by Sigmund, Carl and Alfred and Dr. Sanity

UPDATE: "Daniel Pearl and the Normalization of Evil"...says it all about Western enabling.

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