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.


  1. Glynn, S. M. (1990). Token economy approaches for psychiatric patients: Progress and pitfalls over 25 years. Behavior Modification, 14, 383–407.

    Article  Google Scholar 

  2. Liberman, R. P. (1980). A review of Paul and Lentz’s psychological treatment for chronic mental patients: Milieu versus social-learning programs. Journal of Applied Behavior Analysis, 13, 367–371.

    Article  Google Scholar 

  3. Mariotto, M. J., Paul, G. L., & Licht, M. H. (2002). Assessment in inpatient and residential settings. In J. N. Butcher (Ed.), Clinical personality assessment: Practical approaches (2nd ed.) (pp. 466–490). New York: Oxford University Press.

    Google Scholar 

  4. Paul, G.L. (Ed.). (1987). Observational assessment instrumentation for service and research–The Time-Sample Behavioral Checklist: Assessment in residential treatment settings, Part 2. Champaign, IL: Research Press.

    Google Scholar 

  5. Paul, G.L. (2000). Evidence-based practices in inpatient and residential facilities. The Clinical Psychologist, 53, 3–11.

    Google Scholar 

  6. Paul, G. L. (2006). Myth and reality in Wakefield’s assertions regarding Paul and Lentz (1977). Behavior and Social Issues, 15, 244–252.

    Article  Google Scholar 

  7. Paul, G.L, & Lentz, R.J. (1977). Psychosocial treatment of chronic mental patients: Milieu versus social-learning programs. Cambridge, MA: Harvard University Press.

    Google Scholar 

  8. Paul, G. L., & Menditto, A. A. (1992). Effectiveness of inpatient treatment programs for mentally ill adults in public psychiatric facilities. Applied & Preventive Psychology: Current Scientific Perspectives, 1, 41–63.

    Article  Google Scholar 

  9. Paul, G. L., Stuve, P., & Menditto, A. A. (1997). Social-learning program (with token economy) for adult psychiatric patients. The Clinical Psychologist, 50, pp. 14–17.

  10. Paul, G.L., Tobias, L.L., & Holly, B.L. (1972). Maintenance psychotropic drugs in the presence of active treatment programs: A “triple-blind” withdrawal study with long-term mental patients. Archives of General Psychiatry, 27, 106–115.

    Article  Google Scholar 

  11. Wakefield, J.C. (2006). Is behaviorism becoming a pseudo-science?: Power versus scientific rationality in the eclipse of token economies by biological psychiatry in the treatment of schizophrenia. Behavior and Social Issues, 15, 202–221.

    Article  Google Scholar 

  12. Wakefield, J. C. (2007). Is behaviorism becoming a pseudoscience?: Replies to Drs. Wyatt, Midkiff and Wong. Behavior and Social Issues, 16, 170–189.

    Article  Google Scholar 

  13. Wilder, D. A., White, H, & Yu, M. L. (2003). Functional analysis and treatment of bizarre vocalizations exhibited by an adult with schizophrenia: A replication and extension. Behavioral Interventions, 18, 43–52.

    Article  Google Scholar 

  14. Wong, S. E. (2006a). Behavior analysis of psychotic disorders: Scientific dead end or casualty of the mental health political economy? Behavior and Social Issues, 15, 152–177.

  15. Wong, S. E. (2006b). Response to the commentaries. Behavior and Social Issues, 15, 232–243.

  16. Wong, S. E. (2007) Scientific discovery, social change, and individual behavior change. Behavior and Social issues, 16, 190–196.

    Article  Google Scholar 

  17. Wong, S. E., Martinez-Diaz, J. A., Massel, H. K., Edelstein, B. A., Wiegand, W., Bowen, L., & Liberman, R. P. (1993). Conversational skills training with schizophrenic inpatients: A study of generalization across settings and conversants. Behavior Therapy, 24, 285–304.

    Article  Google Scholar 

  18. Wyatt, W. J., & Midkiff, D. (2006a). Biological psychiatry: A practice in search of a science. Behavior and Social Issues, 15, 132–151.

  19. Wyatt, W. J., & Midkiff, D. (2006b). Six-to-one gets the job done: Comments on the reviews. Behavior and Social Issues, 15, 222–231.

  20. Wyatt, W. J., & Midkiff, D. M. (2007). Psychiatry’s thirty-five-year, non-empirical reach for biological explanations. Behavior and Social Issues, 16, 197–213.

    Article  Google Scholar 

Download references

Author information



Corresponding author

Correspondence to Jerome C. Wakefield.

Rights and permissions

Reprints and Permissions

About this article

Cite this article

Wakefield, J.C. New myths and harsh realities: Reply to Paul on the Implications of Paul and Lentz (1977) for Generalization From Token Economies to Uncontrolled Environments. Behav. Soc. Iss. 17, 86–110 (2008).

Download citation


  • schizophrenia
  • behavioral treatment
  • token economy
  • generalization
  • philosophy of science
  • history of psychology