New myths and harsh realities: Reply to Paul on the Implications of Paul and Lentz (1977) for Generalization From Token Economies to Uncontrolled Environments
As part of a larger argument about why token economy treatment for schizophrenia was largely abandoned despite demonstrated behavioral gains, I (Wakefield, 2006) analyzed Paul and Lentz’s (1977) classic study of social-learning treatment of schizophrenia, sometimes cited as the best in this field. I argued that it failed to demonstrate or even test generalization of gains to uncontrolled natural environments, a serious drawback in an age of deinstitutionalization. In his response, Paul (2006) rejects my contention and argues that there are three sources of data in the study that support generalization: gains were maintained during a no-treatment baseline at 4 years into the study, during an 18-month period following a change in aversive time out procedures for aggressive acts, and during the 18-month follow-up of patients released to community aftercare. In this reply, I examine Paul’s counterarguments and argue that the evidence strongly supports my original contention that Paul and Lentz’s study provides no support for generalization.
Keywordsschizophrenia behavioral treatment token economy generalization philosophy of science history of psychology
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