Thursday, March 11, 2021


A behavioral psychologist on the very fancy neuropsychiatric team once explained to me "Once you get them addicted to tokens, you can do anything." We had a community team "return" a developmentally delayed patient when the program we had designed for him in the six weeks we had him "didn't work." We always know why that is, when something works in the hospital but doesn't the moment they go out the door.  It's because the community team wanted some other answer, and sabotages the plan almost immediately. It always sounds plausible at first glance that it is only because in the hospital we have complete control over the patient, and they don't on the outside.  Inside and outside the hospital are different, certainly.  That is why we designed our programs with the community in mind. If they would just do that, it would work, as we repeatedly proved with the teams who did do what we recommended.

I always chuckled to myself on these "returns"  If you didn't want our first-best advice, why do you want our second-best? A few days after the admission, when their team would come down to meet with us and everyone buckled down for an all-morning meeting, the patient had immediately gotten back into the program and had stopped hitting people, screaming uncontrollably, grabbing females, or whatever. It would take 30-60 minutes of discussion about exactly what they had been doing back in the community that we would elicit that no, they hadn't been implementing the program as designed.  They had kept a few decorative items, but had gone back to doing what they were before, because that's the right thing to do, dammit! There were a very limited number of ways in which they justified this to themselves, but those all boiled down to the idea that they didn't want Jeremy to do things to get rewards, they wanted him to "get it" that you shouldn't hit people or grab women. These are DD and brain-injured people they are talking about here. 

The neuropsychiatrist once resorted to pulling out his wallet and opening it it, saying "I come in here every day to earn these green paper tokens.  If they stop giving me these tokens, I don't come in anymore." They sullenly got the point. 

I talk a lot about how genes matter far more than environment, but there is a big exception to that, which is incentives. We sell out our upbringings far more than we care to admit. There is a psychology to it as well.  We might refuse to engage in criminal activity for $5000, but over a year, with ten $0.25/hr pay increases, we might well arrive at the same place.

It has long been noted that people will believe what they see on the screen more than reality. "Didn't you see Deliverance?" Lots of people go on Twitter looking for humor, because that is a chemical hit we crave.  While there, we also find things that outrage us, another chemical hit. Those of us who dimly remember that there used to be another world before social media - before "likes," and emojis, and "reply alls" and RTs - have some awareness that we are growing addicted and force ourselves to fast from our devices or limit our use (though nowhere near as effectively as we expected).  There was a world before that world as well, before television and movies. Even movies used to be something you might see once a week at most. In the 30s, a kid might get to see three movies in a year - or none. But children now have almost no idea what even the world before devices was.  Jonathan Haidt pinpoints the increase in snowflake activity to the high school classes of 2013 and 2014, that is, the group which had devices since fifth grade. The depression, anxiety, and suicide rates soared right at that point. 

They are addicted to a toxic chemical. The devices provide the tokens, the chemical rewards that also carry poison. Their parents are less addicted, but somewhat, and they themselves were screen-addicted. Computer screens, and before that TV.  Radio was similar.  They were installed in cars for a reason.  Once addicted, people had to have them.  I am screen addicted to this device I am typing at now; less so to the new device that I text the family all over the country with throughout the day; podcasts and learning tapes for driving or walking is an addiction just getting under weigh. TV, radio, and movies, very little.  The world of books, less than before, because of eyesight, but also because of my new addictions.

As the psychologist said "Once you get them addicted to tokens you can do anything."  And we just about anything.


Sam L. said...

I don't do Twitter. No interest. Blogs, yes; some. Just the ones that interest me. Like, say, THIS one!

Assistant Village Idiot said...

Yes, and you keep coming back for more, like a pigeon hitting the lever, even though there are seldom any pellets here.

Texan99 said...

I'm always skeptical of the addiction analogy. I like to use "addiction" to refer to a physical phenomenon of something that substitutes hollowly, and ultimately falsely, for a biologically beneficial result. It should include diminishing response, require increased doses, and present withdrawal symptoms more severe than simply doing without whatever attractive feeling the addictive substance produces.

So I'm pretty comfortable with opiate addiction, but less with sex addiction, addiction to excitement/danger, etc. Those seem like garden-variety misdirections of the ceaseless desire to master anxiety and find meaning in life. Otherwise I'd be tempted to conclude that human beings have been addicted to powermongering, jealously, envy, security, comfort, and for that matter all culture, art, and music. Not to mention food, sex, and warm companionship, since we came down out of trees, if not before then.

We always face the challenge of doing what's right, and what makes us stronger, better human beings, instead of dulling our consciences with shallow, distracting entertainments or numbing habits. If communicating with like-minded people on topics of deep interest is an addiction, then maybe many of us would be better off living on a pillar in the desert, but wouldn't that isolationism qualify as an "addiction," too? The question is, are we substituting the conversation online for a direct, physical human communication in our ordinary lives, the duty of which we are neglecting? Is it really different from an 18th-century person conducting an extensive written correspondence with distant loved ones or colleagues? Is it more dangerous because the turnaround time is so brief, or because the channel of contact is so narrow, and generally so lacking in mutual emotional commitment?

Texan99 said...

About incentives: I have long believed that we err in assigning a proper role of incentives in our relations with strangers, because the incentives would seem crass and blunt in our relations with intimates. It's the mistake that causes people to deplore the beneficial results of a free market in our dealings with manufacturers halfway around the world, simply because we don't normally buy and sell things to our spouses and children. Even in our relations with intimates, we sometimes benefit from applying incentives directly to cure a problem: a direct demonstration that some behavior gets a better result than other behavior. It should be respectful and clearly communicated rather than sneaky and manipulative, but it's been known to clear up a lot of intractable power struggles and emotional ambush behavior. It's really a "see how much happier this arrangement makes both of us?" strategy.

Texan99 said...

Should our behavior with intimates always be aiming at doing the right thing without crass incentives? Sure, why else does God tell us he wants us to be sons instead of slaves or servants? But that doesn't mean we shouldn't start with an ambition at least to be good servants and work our way up to sons.

Jonathan said...

The word "addiction" is too imprecise. There's typically no problem if you're addicted to reading, popcorn or spending time with your spouse. The addictions that matter are the ones, by contrast, where the costs greatly exceed the benefits.

james said...

WRT Sam, is it an addiction if it is an ongoing conversation?