This all seems so rational – what goes wrong? Why do individuals make choices that seem so self destructive? Why don’t things work the way they should? The ‘inner logic’ of each individual is created individually from random data and with unique history of experience. It is within this inner logic, that the choices are often in contrast with the outer logic. Dr. William Glasser has develop a group of concepts including Choice Theory, Lead Management, and Reality Therapy which provides some answer to these questions.
Counselors, to their own and their clients’ detriment, have been following the lead of psychiatrists, using the Diagnostic and Statistical Manual of Mental Disorders to diagnose what psychiatrists have decided to call mental illness (e.g., schizophrenia, clinical depression, and bipolar disease). But as of now, the psychiatrists have not provided evidence of brain pathology to support these diagnoses. Furthermore, psychiatrists, who completely disregard mental health, still claim to be members of the mental health establishment. This article suggests to the counseling profession that they publicize the fact that they are true mental health professionals who have been improving mental health for more than 50 years without drugs. The author [William Glasser], who has never prescribed a brain drug, suggests they take a close look at choice theory, the mental health concept he has now added to his reality therapy to help clients toward better mental health with no danger of doing any harm.
In his 1965 book, Reality Therapy, agreed with Thomas Szasz that mental illness, as it was then understood, did not exist. He now contends that we choose everything we do, including the behaviors and symptoms described in the DSM-IV and labeled mental illnesses. He see this as a new approach both to understanding and dealing with what is still called mental illness. After practicing psychology and then psychiatry for more than fifty years, he is painfully aware that we have made no measurable progress in reducing the number of people currently diagnosed and treated as if they are mentally ill.
It is because of this he believes that it is time to consider a counseling procedure that helps lonely, poorly functioning, people to understand that they are choosing what they believe they are suffering from. And from that understanding to learn to make better or psychologically sound choices. While Glasser does not believe in mental illness, he firmly believes there is such a thing as mental health.
When Glasser started out as a psychologist in 1947 and became a psychiatrist in 1957, the theory of mental illness was based on Freud’s explanation of unconscious conflicts. Today, Freudian psychology has been largely replaced by a new theory: mental illness is caused by an imbalance in the chemistry of the brain. But, regardless of the cause, psychological or chemical, the belief that mental illness is real and those suffering from it have little or no control over their symptoms has yet to be seriously challenged.
Glasser’s Choice Theory, a new theory of how our brain functions that supports reality therapy, directly challenges this belief. In his theory, he contends that when we are unable to figure out how to satisfy one or more of the five basic needs built into our genetic structure that are the source of all human motivation, we sometimes choose to behave in ways that are currently labeled mental illness. These needs are: survival, love and belonging, power, freedom and fun.
What is common to ineffective and unsatisfying choices, no matter what they may be, is unhappiness: there is no happiness in the DSM-IV. Choice theory explains that, not only do we choose all our unhappy behaviors, but every behavior we choose is made up of four components, one of which is how we feel as we behave. When we choose a behavior that satisfies our needs, immediately or eventually, we feel good. When we choose a behavior that fails to satisfy our needs, sooner or later, we feel bad. But the choice to be unhappy is not mental illness.
The brains of the people described in the DSM-IV are neither psychologically nor chemically so abnormal that they can never choose happiness again. To the contrary, the world is filled with formerly unhappy people, who chose many of the behaviors described in the DSM-IV and who, on their own or with the help of effective counseling, learned to satisfy their needs and be happy.
To Glasser, it is not a sick brain that is the cause of their unhappiness; it is their present inability to figure out more effective behaviors than the ones they are using. While the brain chemistry of a happy person differs from the brain chemistry of an unhappy person, that difference is not the cause of their unhappiness. It is the result of the choice or choices they are making. And it is no more permanent than the chemistry of any choice. The brain chemistry returns to normal as soon as the ‘sufferer’ has figured out, with or without help, how to satisfy his or her needs more effectively.
Our society is flooded with people who are choosing anxious, fearful, depressive, obsessive, crazy, hostile, violent, addictive and withdrawn behaviors. All of them are seriously unhappy; there is no shortage of unhappy people in the world. But, unfortunately, many mental health practitioners who believe in mental illness don’t see the unhappy people described above as capable of helping themselves or benefiting from counseling. They see them as ‘suffering’ from brain pathology, incapable of helping themselves without drugs. They reject counseling as useless or too time-consuming.
To fit the medical model that unhappy people can’t help themselves or be helped without drugs, they tout drugs as the panacea. Following a strange logic, they claim that drugs for mental illness are analogous to insulin for diabetes. But diabetics do not have a chemical imbalance; they are missing the chemical they need to digest carbohydrates. People who are unhappy are not missing a necessary brain chemical; they are suffering because they are unable to satisfy one or more of their basic needs.
William Glasser has created a counseling method that is a part of the cognitive behavior management family, but has a slightly different focus – one ‘doing’ and ‘choice’ – and provides some new and interesting metaphors for change. This material modifies some of Glasser’s terminology to make it consistent with other cognitive behavior management technology, but hopefully, maintains the essence of his endeavors.
Choice Theory states that the only thing we do is behave, and that almost all behavior is chosen by the individual person. We are driven by our genes to satisfy five [05] basic needs:
One of the core principles is that, whether we are aware of it or not, we are all the time acting to meet these needs. But we don’t necessarily act effectively. Socializing with people is an effective way to meet our need for belonging. Sitting in a corner and crying in the hope that people will come to us is generally an ineffective way of meeting that need – it may work, but it is painful and carries a terribly high price for ourselves and others.
So if life is unsatisfactory or we are distressed or in trouble, one basic thing to check is whether we are succeeding in meeting our basic psychological needs for power, belonging, freedom and fun. In this society the survival need is normally being met – it is in how we meet the other four ‘psychological’ needs that we run into trouble.
In counseling practice, the most important need is love and belonging, as closeness and connectedness with the people we care about is a requisite for satisfying all of the needs. Choice and Reality, along with other cognitive behavior management practice, is a practice of utilizing what Glasser has so aptly called an internal control psychology . This approach is offered to replace the external control psychology that is, unfortunately, the present psychology [life philosophy] of almost all the people in the world. This tradition of a forcing, punishing psychology is destructive to positive relationships. When used by anyone in a personal relationship it will always destroy the ability of one or both to find mutual gratification or satisfaction in that relationship, and will result in people becoming disconnected from those with whom they want to be connected. Disconnectedness is the source of almost all human problems, and is manifested in what is traditionally called mental illness, drug addiction, violence, crime, school failure, spousal and child abuse, to mention a few.
Dr. Glasser has defined the characteristics of both the internal control and external control ways of thinking [psychologies]. You will quickly note that the internal control set is oriented toward connection and the external control set is oriented toward control.