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Friday, April 14, 2017

N is for Nonsense as in Nonsense Diagnosis and Treatment

Based on an assessment conducted by Sam-I-Am, the unnamed character in Green Eggs and Ham appeared to be suffering from sitophobia or the fear of food or eating, specifically, fear of eating green eggs and ham.  Over and over he refuses Sam-I-Am’s intrusive insistence that he eat, eat, eat! 

This unnamed character has the classical response to coming into contact with the feared object. He avoids it which is believed to cause his anxiety to decrease thus reinforcing his avoidance behavior. The patient clearly exhibits another classic feature of phobias, specifically generalization as the target foods are refused in all settings and under all conditions.  For example, per the report, the patient was quoted as saying:

I COULD NOT, WOULD NOT, ON A BOAT.
I WILL NOT, WILL NOT, WITH A GOAT.
I WILL NOT EAT THEM IN THE RAIN.
NOT IN THE DARK! NOT IN A TREE!
NOT IN A CAR! YOU LET ME BE!
I DO NOT LIKE THEM IN A BOX.
I DO NOT LIKE THEM WITH A FOX.
I WILL NOT EAT THEM IN A HOUSE.
I DO NOT LIKE THEM WITH A MOUSE.
I DO NOT LIKE THEM HERE OR THERE.
I DO NOT LIKE THEM ANYWHERE!
I DO NOT LIKE GREEN EGGS AND HAM!
I DO NOT LIKE THEM, SAM-I-AM.

Sam-I-Am uses exposure therapy to force the character to come into contact with green eggs and ham in an effort to break the link between the feared objects and the belief that something catastrophic will happen should he consume these foods.  According to the treatment summary, after tasting the triggering foods once, the unnamed character’s phobia completely disappeared and he ecstatically ate the foods absolutely everywhere, thanking Sam-I-Am enthusiastically. Following the single taste, the patient was reported as saying:

I WILL EAT THEM HERE AND THERE.
SAY! I WILL EAT THEM ANYWHERE!
I DO SO LIKE GREEN EGGS AND HAM!
THANK YOU! THANK YOU, SAM I AM.

While it would be nice to believe that treatment for phobias could proceed so easily and so rapidly unfortunately this kind of response is practically impossible.  Sam-I-Am’s report of the treatment outcome is unrealistic and unbelievable.  While exposure therapy works considerably faster than systematic desensitization, according to the treatment summary, the patient essentially decided to try the phobic triggering foods and willingly did so to get Sam-I-Am to leave him alone.  After one bite, the patient was allegedly over his food phobia, having decided he then loved green eggs and ham and would eat them anywhere at any time.  This is at best far-fetched and at worst a complete fabrication. 

An investigation of this case subsequently failed to confirm this outcome and in fact, failed to confirm that the patient existed at all.  As a result, Sam-I-Am’s license to practice has been revoked and he will have to pay a large fine. 

(Green Eggs and Ham by Dr. Seuss first published on August 12, 1960, Random House)

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