November 11, 2009
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“Curb Your Enthusiasm” Used in Therapy
David Roberts, a clinical-psychology student at the University of North Carolina at Chapel Hill, had a summer job teaching social skills to a group of schizophrenic patients at a state hospital.
He had a particularly unresponsive group (“Many patients are flattened by their meds,” he explained recently) and tried in vain to interest them in role-playing everyday social situations, offering the patients rewards of points and tokens in return for not giving in to their urges to wander around, respond to phantom voices, or otherwise become disruptive—a traditional system of behavioral therapy.
During a break one day, Roberts, watching television in the hospital’s lounge, noticed that a change had come over his patients, who generally seemed immune to basic social signals. “They were laughing at the ironic commercials,” he said. “They were laughing at ‘Friends.’ They were laughing at all the places I was laughing.” Many showed a fluency in the kinds of social communication that Roberts had been struggling to teach them in therapy.
“We watched a scene from ‘Monk’ where Tony Shalhoub won’t shake hands with anyone for fear of germs, and walks away awkwardly. I asked a man who’d been an inpatient for ten years, and who was generally blank, what had happened, and he shook his head and gave me a wry grin. Unspoken communication is huge for someone like that.”
So Roberts began showing TV clips during therapy sessions. Soon he had narrowed his selections down to one show: television’s purest expression of social dysfunction, “Curb Your Enthusiasm.” Roberts considers Larry David to be the perfect proxy for a schizophrenic person. “On his way into his dentist’s office, he holds the door open for a woman, and, as a result, she’s seen first,” he said. “He stews, he fumes, he explodes. He’s breaking the social rules that folks with schizophrenia often break.”
He went on, “Or the one where Ted Danson and Mary Steenburgen invite Larry and his wife to a concert: the night arrives, they don’t call, Larry assumes they don’t like him, then it turns out he got the date wrong. It’s a classic example of a major social cognitive error—jumping to conclusions—that schizophrenic patients are prone to.” As the patients watched David flub situation after situation, they laughed, and they willingly discussed with Roberts how they might behave in the same circumstances. “That bald man made a mountain out of a molehill!” one woman called out during a session.
Roberts and his U.N.C. adviser, David Penn, began to formalize these findings, mapping out a teachable technique called Social Cognition and Interaction Training. They tested SCIT in four preliminary studies, and in post-training evaluations patients showed significant improvement in deciphering social situations. The technique has attracted attention—practitioners in Germany, Portugal, and China are now watching TV with their patients—and this fall Penn and a third researcher are conducting a randomized control trial funded by the National Institute of Mental Health.
Larry David said that he hadn’t realized how deeply the awkwardness on his show would affect people. “It just deals with how you’re supposed to behave,” he said. “A lot of the time, it’s just me expressing myself freely. I knew that my own mental health was problematic, but should I be worried? I mean, I blow up, too! Is this something undiagnosed? Do I need to see a clinical psychologist?”
