I’ve been reading “The Black Hole War: My Battle with Stephen Hawking to Make the World Safe for Quantum Mechanics,” by Leonard Susskind. One particularly intriguing part is that quantum mechanics is not deterministic, which is the notion that the future can be predicted if we know enough about the present. There is a certain comfort in a belief in determinism. We see that desire in psychology; people want to be able to predict what will happen, how people will be. Years ago I read a book called “Travels With Dr. Death.”  Dr. Death was a psychiatrist who made his living as an expert witness in death penalty cases in Texas. He always testified that if the individual was not executed, the prisoner would undoubtedly kill again.  In a quantum view, that confidence in predicting the future would be unfounded.

I think the quantum mechanics model is a good model for psychology. Anyone who says they can absolutely predict behavior is just wrong.  In quantum mechanics, like weather forecasting, you can make educated guesses, but you do not have absolute accuracy. The model works well with Lambert’s four therapeutic factors theory. These factors are qualities that cut across all types of therapy and affect outcomes.  The factors are extratherapeutic, common factors, expectancy, and techniques. He said that about 40% of change in therapy is due to exratherapeutic factors – qualities of the client and of his or her environment.  That includes things that happen unexpectedly or chance life events.

The medical model is deterministic, and for medical issues it is a great fit. Diagnose the disease; give the prescribed treatment for that disease. At some point perhaps all behaviors will be reduced to the neuro-cellular level. At that point there will only be a need for neurologists. And if it ever gets to that level, who controls the ability to determine behavior will be the critical moral issue of the time. But for now the diagnoses in psychology are behavioral, not biological, and are voted upon for inclusion and change with each edition of the Diagnostic and Statistical Manual. Diagnosis is not a result of a lab test or an x-ray, but of a conversation between therapist and client, which in some cases is a very short conversation.  And the diagnosis does not determine the outcome or even necessarily the treatment.  What plays a major role in outcome is the therapeutic alliance, the common factors of Carl Rogers-like mutual respect in counseling.

This desire for forecasting is especially acute after high profile shootings in this country. After the murders at VA Tech a few years ago, the commitment laws in Virginia were changed to make hospitalization easier. (I still remember a psychology “expert” on CNN the day of the shootings before any facts were known saying that it was the result of violent video games.)  But the laws in Arizona are similar to those currently in Virginia, and Gabrielle Giffords was still shot along with others.  In all the discussions after each, one thing I never heard mentioned was the extratherapeutic factor of culture.  Individuals “go mad” in culturally prescribed ways.  In the past couple of years in China, there have been at least two instances of stabbings at schools, very in keeping with the Asian culturally prescribed “running amok.”  There is a tradition of shooting in politics in this country going back at least to the duel between Burr and Hamilton, and the fighting literal and figurative between the Hamiltonian Federalists and the Jeffersonian Democratic Republicans. Later in our history, rather than slave states going to court for nullification and secession, fire eaters forced those issues into civil war. The second amendment guarantees the right to bear arms, but also mentions a well armed militia as a necessity. What has been forgotten is that the aim of the amendment was that we all be citizen soldiers with a responsibility to defend the country, and that there be no standing army. Standing armies were seen as a threat to democracy. Generals who became president from Washington to Eisenhower warned about the role of the military in government.  At the time of the Revolution, the threat was from British regulars and Hessians. Ike warned about the military-industrial complex and allegedly an earlier draft added congress to the mix. In our time, gun play is a frequent metaphor in discourse.  The “surveyor sites” over congressional districts on a web site in question in the Giffords’ case also had a phrase to not retreat but reload. Do surveyors reload?  And it was not the first time violence occurred. The home of the brother of VA 5th district congressman Tom Perriello (who had a site over his district as well) was vandalized earlier, as was Gifford’s office. http://www.roanoke.com/news/roanoke/wb/241055 Our culture and our words set our choices of how we act. But they do not determine it. We do have choices.  Despite the violence of late, times are still less violent than the 1800s (no canings in congress or duels) or even the 1960s with assassinations and riots. The question is, when will we remember the goal of citizenship and cooperation with each other? For contrast, Israel has universal military service and Switzerland has universal military service for males. Citizens are pretty heavily armed, and yet, the homicide rates are much lower than in the United States.  Countries without universal service but with gun control, such as Great Britain and Japan, also have lower homicide rates.  Perhaps the differences are due to cultural norms and expectations.

At this point, it is not possible to absolutely predict behavior. Like on the quantum level, chance events happen and there are just too many factors affecting outcomes for any guarantee.  What is clear is that outcomes for persons diagnosed with a condition such as schizophrenia, the outcome is better in third world countries than in the industrialized West. (See books written about previously such as “Crazy Like Us.”) The difference looks to be that they work together better with each other rather than relying on drugs and other attempts at quick fixes, and stay involved with each other. They realize that they are all in this life together, and work together. When the cultural expectation is that we work together and that people can get better, that expectation has a much better chance of being met.

“We cannot live only for ourselves. A thousand fibers connect us with our fellow men; and among those fibers, as sympathetic threads, our actions run as causes, and they come back to us as effects,” said Herman Melville. But those actions and effects are sometimes unintended and unforeseen. We do the best we can, and we adapt and flow. Having the self confidence, self efficacy and positive adaptability to deal with uncertainty is a major part of coping in this life and in reducing stress, anxiety, and depression.