PhD/PsyD question about "functional" view of mental health and illness

[Sonyax]

Hi,

I'm not a psych PhD student though I've taken college level psychology courses (cognitive and social mostly). My major is mathematics. I wanted to get a good answer to my question but in part I don't think my classmates know the answer and in part I'm embarrassed to ask my professor. So I found this wonderful forum and thought to ask here.

The thing is I'm hooked on Dr Phil. That's the embarrassing part. Because I am by principle against reality type shows. Now here's the question: Very often Dr Phil asks the people on his show, "How is that working for you?" I used to think that was brilliant. It seems so mechanical, so precise, not touchy feely at all. In other words, you're not asking the person to imagine to get in touch with their "inner child" but to look specifically at how some behavior is working or not working.

But then it occurred to me while watching his show a few days ago...the answer is never that clear! First off, working for WHO? And is it short term or long term? Also what about ethics? And what if something is working when it's about getting a particular thing you want but not something else equally important? And sometimes the person may not be after the right kind of thing in the first place (a drug addict's behavior to get drugs).

So some examples: Abuse DOES work, otherwise nobody would do it. Also if you're after a girl you like, certain very questionable behavior also work in the short term, and depending on the girl, also in the long term. Whether those behavior are ethical, that's a different question. Same thing in business. Or politics. My father is a rather famous politician in my city so I know this for a fact. So just because something works for some purpose does not mean it's "right" nor that it does not work does it mean it's "wrong."

So my question is: What is the source of all this functional talk? How do you guys use this idea of "what works" to help people? Is this common sense stuff (the way somebody might say, Hey you can't cram the night before an exam, or is there some kind of psychological research or philosophical mindset behind all these functional (if "functional" is even the right word) evaluations.

Thank you for humoring me. It may be that Dr Phil stuff has nothing to do with real psychotherapy. But something tells me that this is not too far off real therapy.

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[WisNeuro]

"How is that working out for you" can be a good statement to use actually, as long as it's in the right context. I think your argument is more in the philosophical sense. If someone is engaging in maladaptive behaviors that in some way are actually working out for them, they're usually not in our offices.

*Edit* This in no way endorses Dr. Phil, dude is an unethical hack.

 

[thewesternsky]

Most behaviours have positives and negatives to them. Some of these positives/negatives are in the short-term, and some are in the long term. What counts as a benefit or a drawback can be very subjective, so there's no "absolute truth" or "absolute right behaviour".... But thinking about this can be a nice way for people to move toward behaviour change.

You might want to do some reading on Motivational Interviewing-- It's a psychotherapeutic technique with origins in substance abuse treatment but it's used for various difficulties now. Some of your questions are answered quite nicely in that literature.

Also, it's not all subjective. A lot of positives and negatives of behaviours are backed by scientific evidence elsewhere in the psych literature. Even the "common sense" stuff often has its roots in scientific research. For example, the learning/memory literature supports the idea that frequent blocks of studying is more effective than "cramming".

 

[Marissa4usa]

You wouldn't ask that question if the person clearly wasn't bothered by the behavior in the first place. And even if they weren't bothered by that particular behavior/thought process, etc. per se, they usually do not like the long-term consequences (in which case this can be a powerful prompt). But as WisNeuro said, if they don't see that as a problem, they won't come see you in the first place.
And in cases where they are obligated (due to court order, etc.) to see a therapist, you wouldn't just blurt out this question anyways.

 

[AcronymAllergy]

You wouldn't ask that question if the person clearly wasn't bothered by the behavior in the first place. And even if they weren't bothered by that particular behavior/thought process, etc. per se, they usually do not like the long-term consequences (in which case this can be a powerful prompt). But as WisNeuro said, if they don't see that as a problem, they won't come see you in the first place.
And in cases where they are obligated (due to court order, etc.) to see a therapist, you wouldn't just blurt out this question anyways.

Agreed with this and the other posts above. For the latter example that Marissa mentioned, something like MI might be more appropriate.

The "how's that working for you?" comment (which always made me think it was something Ellis would've said) can draw attention to the volitional aspect of the behavior, and can lead to the person beginning to self-identify the negative consequences of the action. It can also draw some attention to the anticipated/expected goal of the behavior, and places some of the onus (and power) for change on the person.

As was said, if the person honestly feels it's working out well for them, except in special circumstance, then they probably aren't going to be in your office.

And as for ethics, there's a very personal component to that. Identifying and evaluating the ethics involved might then entail discussing with the client/patient what their values and morals include, how those values/morals line up with society, whether there's conflict between individual and societal values/morals, how ok the patient is with said conflict and/or the consequences that might result from it, etc.

 

[cara susanna]

[So some examples: Abuse DOES work, otherwise nobody would do it.

Ignoring the moral issues of abuse, and just speaking behaviorally... It's all about short term vs. long term. Abuse works very, very well in the short term, but not so well in the long term (seeing as how the perpetrator could get into trouble, the victim may leave, etc). A lot of therapy involves getting clients to see that something may be very effective short term, but not so great long term.

 

[erg923]

Ignoring the moral issues of abuse, and just speaking behaviorally... It's all about short term vs. long term. Abuse works very, very well in the short term, but not so well in the long term (seeing as how the perpetrator could get into trouble, the victim may leave, etc). A lot of therapy involves getting clients to see that something may be very effective short term, but not so great long term.

The "hows that working for ya" mentality of psychotherapy ignores all other aspects of psychology/cognition that we know, based on decades and decades of research, influence human behavior and decision making.

 

[WisNeuro]

The "hows that working for ya" mentality of psychotherapy ignores all other aspects of psychology/cognition that we know, based on decades and decades of research, influence human behavior and decision making.

I don't think she was arguing that the statement is the cornerstone of the therapy, merely that it is useful at certain points of the process, with clients of certain insight levels.

 

[cara susanna]

Yeah, I was more stating that sometimes therapy involves pointing out to the client that the behavior may be working well at the moment, but isn't the greatest long term solution.

 

[psych84]

The way I'd approach is to make the patient realize that their cognitions, their emotions, and their behavior not only dictate who they are, but there is a price to pay in having negative cognitions, emotions, and behavior. For example, abusing someone is not "free", you could go to jail for your behavior, displaying anger (an emotion) is very bad for your physical health, and always having negative cognitions is very taxing on the individual (stress, causes mental health issues, possibly physical consequences as well, high blood pressure, etc)

I don't think human beings are all that different from each other, we all just way the benefits/consequences of our actions, but benefits/consequences are informed by personality characterstics, and a host of other factors.

 

[cara susanna]

I'm an acceptance-based person, I would focus more on this idea that it's okay to have thoughts and emotions like that, but they can have them without reacting.

 

[WisNeuro]

Yeah, cognition is automatic from a CBT standpoint. Telling someone that it's wrong to have negative cognitions is not the way to go. Rather, as Cara said, looking at how you react to them and how those reactions reinforce mood states is what is important.

 

[psych84]

Yeah, cognition is automatic from a CBT standpoint. Telling someone that it's wrong to have negative cognitions is not the way to go. Rather, as Cara said, looking at how you react to them and how those reactions reinforce mood states is what is important.

Wrong? No. Unhealthy? Yes.

I think we agree.

 

[WisNeuro]

From a CBT standpoint, I actually disagree. Negative cognitions are very common. Everyone will have them throughout the day. If you dwell on them or ruminate, you can perpetuate a negative mood state. Which your behaviors can reinforce. I don't think there is literature that says negative cognitions in and of themselves are unhealthy, rather the affective mood state that comes from rumination on them is.

 

[erg923]

Wrong? No. Unhealthy? Yes.

I think we agree.

Negative is defined how, in your mind? Is anger negative? How bout regret? Guilt? All of those are adapatable in various scenarios.

The inevitability of negative thoughts and resultant negative affective states is inescapable. CBT isnt the power of positive thinking...

 

[psych84]

From a CBT standpoint, I actually disagree. Negative cognitions are very common. Everyone will have them throughout the day. If you dwell on them or ruminate, you can perpetuate a negative mood state. Which your behaviors can reinforce. I don't think there is literature that says negative cognitions in and of themselves are unhealthy, rather the affective mood state that comes from rumination on them is.

We know that negative cognitions cause anxiety/stress, for example. We know that a stress reaction will lead to increased release of stress hormones like cortisol. And we know that a constant increase and release of these hormones leads to certain neurological disorders, we know it depletes energy, impacts metabolic processes, decreases testostrone levels, ulcers, hypertension, etc

So negative cognitions while normal (if it occurs on occasion) are totally ok, but it is def not healthy to have them on a regular basis. Dwelling on things all the time, even without acting out on it, is simply not healthy. And I'd make the case that the relevance of preventing that person from negative behavior (aside from hurting themselve or others), let's say preventing them from abusing someone/or killing someone, would be that the resulting emotions, which would lead to negative cognitions, would lead to such a major stress response that they would lose all control/motivation to change.

 

[psych84]

The inevitability of negative thoughts and resultant negative affective states is inescapable. CBT isnt the power of positive thinking...

Not sure what positive thinking has to do with anything.

I just took issue with the idea that negative cognitions are not neccesarily unhealthy, ever. If they are constant, research has proven that they are.

But obviously some negative thoughts are inescapable and totally natural. I don't know who would deny that.

Everything is a matter of degree.

 

[erg923]

We know that negative cognitions cause anxiety/stress, for example. We know that a stress reaction will lead to increased release of stress hormones like cortisol. And we know that a constant increase in release of these hormones leads to certain neurological disorders, we know it depletes energy, impacts metabolic processes, decreases testostrone levels, ulcers, hypertension, etc

So negative cognitions while normal (if it occurs on occasion) are totally ok, but it is def not healthy to have them on a regular basis. Dwelling on things all the time, even without acting out on it, is simply not healthy. And I'd make the case that the relevance of preventing that person from negative behavior (aside from hurting themselve or others), let's say preventing them from abusing someone/or killing someone, would be that the resulting emotions, which would lead to negative cognitions, would lead to such a major stress response that they would lose all control/motivation to change.

My dissertation dealt with HPA Axis dysfunction is depression. Your statement is way, way, way too simplified.

1. No, we dont know this. Complex feeback loops within the endocrine system prevents establishing one on one associations between cortisol and various corticosteroids and the manifestation of most physical complications. And no, we dont know their casual role in neuropsychitric illness symptoms.

2. People who do not have negative affective states live in Monastaries and are self diciplined beyond anything we should expct from the average patient.

 

[psych84]

My dissertation dealt with HPA Axis dysfunction is depression. Your statement is way, way, way too simplified.

1. No, we dont know this. Complex feeback loops within the endocrine system prevents establishing one on one associations between cortisol and various corticosteroids and the manifestation of most physical complications. And no, we dont know their casual role in neuropsychitric illness symptoms.

2. People who do not have negative affective states live in Monastaries and are self diciplined beyond anything we should expct from the average patient.

I'm sure you'd agree that saying "we don't know" is a lot different than saying "no, that isn't true."

 

[erg923]

I'm sure you'd agree that saying "we don't know" is a lot different than saying "no, that isn't true."

True, but it essentially nullifies everything you just asserted as well.

Anyway, the point is that CBT is looking at the validity of our thoughts, not simply changing them to positive from negative. Sometimes our thoughts and emotion are, and should be, anger, guilt, shame, etc. Reluctance to embrace this reality doesn't do anyone any favors and only make us look like some kind of happiness doctor. Psychiatry/clinical psychology are not happiness promoters and happiness is not always the logical conclusion that we are going for.

 

[WisNeuro]

We know that negative cognitions cause anxiety/stress, for example. We know that a stress reaction will lead to increased release of stress hormones like cortisol. And we know that a constant increase and release of these hormones leads to certain neurological disorders, we know it depletes energy, impacts metabolic processes, decreases testostrone levels, ulcers, hypertension, etc

No, we know that affective mood states result in this, not mere cognitions. These are closely linked concepts, as one does follow the other, and perpetuates a cycle. This is a key part of CBT theory. It's not teh cognition itself, it's the mood state. Two people can have the same exact negative cognition with vastly different affective outcomes.

 

[sockit]

doesn't it depend on what's meant by 'negative'? like there are 'negative' thoughts that under some threshold (and given other conditions) can be channeled into adaptive behaviours, e.g. anxiety can lead to health-promoting/risk reducing behaviour, and a certain measure & kind of perfectionism can support the levels of achievement that some careers depend on. whereas (i thought) depression was associated with particular attributional styles leading to more or less stable schemas that it's hard to see having a use anywhere, and the C part of CBT tries to dissemble those a bit through reframing, while the B part - new contingencies & rewards - is what makes those alternate frames feel plausible, via different affective outcomes.

i've watched a bit of dr phil (accidentally, promise, visiting people) and have heard talk about 'payoffs', so i assume he's coming from a behaviourist pov (wherever he ended up).

 

[AcronymAllergy]

Yeah, I don't know anyone (at least in psychology), here or elsewhere, who would say that we should never have negative thoughts. Heck, I explicitly tell my patients this when I start therapy (i.e., we're not trying to eliminate negative thoughts or experiences; life is hard, and sometimes bad stuff happens). With CBT, it's of course thought distortion and/or an excessive preponderance of negative and interfering thoughts irrespective of the situation that would throw up some red flags.

 

[smalltownpsych]

doesn't it depend on what's meant by 'negative'? like there are 'negative' thoughts that under some threshold (and given other conditions) can be channeled into adaptive behaviours, e.g. anxiety can lead to health-promoting/risk reducing behaviour, and a certain measure & kind of perfectionism can support the levels of achievement that some careers depend on. whereas (i thought) depression was associated with particular attributional styles leading to more or less stable schemas that it's hard to see having a use anywhere, and the C part of CBT tries to dissemble those a bit through reframing, while the B part - new contingencies & rewards - is what makes those alternate frames feel plausible, via different affective outcomes.

i've watched a bit of dr phil (accidentally, promise, visiting people) and have heard talk about 'payoffs', so i assume he's coming from a behaviourist pov (wherever he ended up).

Agree with your point about negative thoughts and this often becomes attributed to "negative" moods as well. As Erg pointed out earlier, having congruent or rational thoughts or moods is the goal for many of my patients. Many of my patients difficulties stem more from attempts to avoid the negative than from failure to have "positive" thinking.

Finally, Dr. Phil is ultimately right in that "how does that work for you?" is the ultimate question in treatment. If something works, why change it? I might want to change your behavior because I see it as maladapative, but I have little power to do that. Unfortunately, I get referrals every day from people that want me to "fix" someone else's behavior. It doesn't work that way. If your behavior/thoughts/emotions/relationship patterns are causing you distress, then you might be willing to do what it takes to change them because it is not working for you.

 

[futureapppsy2]

Ignoring the moral issues of abuse, and just speaking behaviorally... It's all about short term vs. long term. Abuse works very, very well in the short term, but not so well in the long term (seeing as how the perpetrator could get into trouble, the victim may leave, etc). A lot of therapy involves getting clients to see that something may be very effective short term, but not so great long term.

Slightly off-topic, but this made me think of an article I read fairly recently on a behavioral model of the stay/leave decision making process in domestic violence*.

As an, eh, moderate behaviorist, I believe that everything someone does is reinforcing to them on some level, or else they wouldn't keep doing it (for example, in the context of the above-mentioned article, someone may stay an abusive relationship because doing so decreases the perceived risk--and associated anxiety--of being killed if they tried to leave). As clinicians, we can help the client modify the antecedents, contingencies, expectancies, and establishing/motivating operations in order to make other, adaptive behavior more reinforcing and therefore, more likely to occur. I think motivational interviewing works really well from a behavioral point of view because it really works on changing the expectancies and motivating operations around the target behaviors. We can also teach adaptive replacement behaviors that serve the same or similar functions (e.g., teaching exercise as a replacement behavior for self-injury.

*Link and citation, if others are curious:


Miller, K. B., Lund, E. M., & Weatherly, J. N. (2012). Applying operant learning to the stay-leave decision in domestic violence. Behavior and Social Issues. 21, 135-151.
http://www.firstmonday.dk/ojs/index.php/bsi/article/view/4015

 

[dale.gribble]

Finally, Dr. Phil is ultimately right in that "how does that work for you?" is the ultimate question in treatment. If something works, why change it? I might want to change your behavior because I see it as maladapative, but I have little power to do that. Unfortunately, I get referrals every day from people that want me to "fix" someone else's behavior. It doesn't work that way. If your behavior/thoughts/emotions/relationship patterns are causing you distress, then you might be willing to do what it takes to change them because it is not working for you.

Yup. "How's that working for you" is excellent kindling for producing a more in-depth and productive assessment of one's behavior and ultimate therapeutic goals. But I guess it depends on your approach and how well that meshes with a functionalist approach on the whole. I imagine non-behaviorists aren't too keen on it.

Completely inconsequential to the main topic at hand, I always encourage others to probe the herd mentality of "Dr. Phil is an unethical hack" before blindly adopting it. I forget where, but there's an outline of all of the hoops people have to jump through to get on his show along the lines of "if you have a therapist and they don't support your being on the show, we won't consider you" as well as "if you can't produce a list of therapists in your home area whom you'd be willing to potentially see after the show, we won't consider you" and other super-ethical guidelines. I think it's subsumed within some APA proceedings of some event where he had the keynote or something like that.

Fully disclosed, I'm also biased because I recorded a segment with Dr. Phil for episode that never aired, and know that my experience was completely opposite of what people assume.

I also take a GREAT deal of self-serving comfort from the excellent faces he makes with challenging guests and the comments he makes, because he gets to act out all of the reactions we're not allowed to act out but all want to at times with such clients.

 

[smalltownpsych]

Also, it could be argued that the publicity for psychologists that Dr. Phil gets helps us all. I agree with you about the herd mentality and the reflexive shoot from the hip attacks and I always wonder why we are so quick to attack one of us who is so successful. Finally, in the clips I have seen, he demonstrates some skill in working with people and is good at challenging his clients in his folksy kind of way. In my experience, challenging peoples views, perspectives, beliefs, thoughts, behavior patterns, etc. while mainlining rapport is the hard part of psychotherapy. I have seen too many in the field who might make the client "feel better" but no real change happens because they don't challenge.

 

[cara susanna]

He lost his license, though. I'm not saying that he needs one for his current work, but doesn't that kind of set off an alarm bell?

 

[463951]

He lost his license? I thought he let it expire. I really don't know though. And I am no Dr. Phil fan, for the record.

 

[cara susanna]

Oh, I was kind of right but kind of wrong. From Wikipedia:

On October 21, 1988, the Texas State Board of Examiners of Psychologists determined that McGraw had hired a former patient for "part-time temporary employment".[15] Specifically, the board cited "a possible failure to provide proper separation between termination of therapy and the initiation of employment,"[16]issued a letter of reprimand and imposed administrative penalties.[17] The board also investigated claims made by the patient of inappropriate contact initiated by McGraw, but the "Findings of Fact" document issued by the board on October 21, 1988, at the end of its investigation includes no reference to any physical contact of any kind. It specifically identified "the therapeutic and business relationships" as constituting McGraw's sole issue with the board.[17] McGraw fulfilled all terms of the board's requirements, and the board closed its complaint file in June 1990.[18]

 

[463951]

I didn't even know about that! Interesting...I thought he let his license expire so that he could do what he does, be an entertainer, and not be liable for any ethics complaints.

 

[dale.gribble]

Yeah, he lost it, although people (including myself) used to misconstrue the "inappropriate contact with former client" thing as sex.

I don't know if he's currently licensed. On one hand I can see how he would just let it expire, but on the other hand it'd be stupid to not maintain it just to be safe. I don't know about the laws in CA, but if he were to not have a license and call himself "Dr." in, for instance, MN, he'd be breaking state law...but I can also see how that privilege could be bought.

The way I think of it is that I generally believe people write to shows like that because they feel as though they have no resources left (even though I imagine many are the type to write off regular therapy as pointless hippie garbage), or, rather, are incapable of seeing the proper road to take. Take, for instance, the situation of a family trying to deal with a family member is an addict. Outside of an extreme context such as being on Dr. Phil, they're not going to consider many of the most healthy ways to deal with the situation because they're the most difficult, and I think the more others try to explain away the rationale of such measures, the less interested the family becomes. The type of folksy stuff he delivers is appropriate because it shocks people into thinking differently, which is sometimes needed. It just so happens that almost all the guests need such a shock, so it ends up seeming as though that's all he knows how to do. And a lot of times, it's stuff that needs to be said to people, but the rest of us aren't allowed to put so bluntly (with the caveat of I'm biased because I'm not at all the lovey-huggy-let's-cry-together type of clinician).

Finally, I wish he'd stop whoring his family's products on nearly every ****ing episode lately. I'm sure they're all for some sort of good cause(s), but I honestly don't care about your wife's ****ing lip gloss brand named after your granddaughter and I don't need you to reference your latest book as though it's so universally applicable that you can mention it in EVERY episode. That kind of **** about the show gets on my nerves.

 

[CogNeuroGuy]

From a CBT standpoint, I actually disagree. Negative cognitions are very common. Everyone will have them throughout the day. If you dwell on them or ruminate, you can perpetuate a negative mood state. Which your behaviors can reinforce. I don't think there is literature that says negative cognitions in and of themselves are unhealthy, rather the affective mood state that comes from rumination on them is.

There are some good studies out there that look into co-rumination and its effects on negative moods vs. rumination by itself, especially when looking at personality traits and tendencies and which personality types are more prone to ruminating and the potential effects rumination will have on certain types of people. Just as an FYI.

 

[erg923]

Yeah, he lost it, although people (including myself) used to misconstrue the "inappropriate contact with former client" thing as sex.

I don't know if he's currently licensed. On one hand I can see how he would just let it expire, but on the other hand it'd be stupid to not maintain it just to be safe. I don't know about the laws in CA, but if he were to not have a license and call himself "Dr." in, for instance, MN, he'd be breaking state law...but I can also see how that privilege could be bought.

The way I think of it is that I generally believe people write to shows like that because they feel as though they have no resources left (even though I imagine many are the type to write off regular therapy as pointless hippie garbage), or, rather, are incapable of seeing the proper road to take. Take, for instance, the situation of a family trying to deal with a family member is an addict. Outside of an extreme context such as being on Dr. Phil, they're not going to consider many of the most healthy ways to deal with the situation because they're the most difficult, and I think the more others try to explain away the rationale of such measures, the less interested the family becomes. The type of folksy stuff he delivers is appropriate because it shocks people into thinking differently, which is sometimes needed. It just so happens that almost all the guests need such a shock, so it ends up seeming as though that's all he knows how to do. And a lot of times, it's stuff that needs to be said to people, but the rest of us aren't allowed to put so bluntly (with the caveat of I'm biased because I'm not at all the lovey-huggy-let's-cry-together type of clinician).

Finally, I wish he'd stop whoring his family's products on nearly every ******* episode lately. I'm sure they're all for some sort of good cause(s), but I honestly don't care about your wife's ******* lip gloss brand named after your granddaughter and I don't need you to reference your latest book as though it's so universally applicable that you can mention it in EVERY episode. That kind of **** about the show gets on my nerves.

Its alot smarter that he let it expire vs keeping it active. Otherwise, licensing complaints would inevitably abound from the people he see, as well as from other professionals due to the methods he uses, I'm sure. His current method is pretty sneaky, actually. Im practicing psychology and counseling, but "officially", I'm not.

 

[dale.gribble]

That's true; didn't think of it that way.
I'm sure it makes the various hand-offs to other professionals much easier, and I'm sure whatever leftover risk is covered by some sort of other protection. I wouldn't be surprised if a simple "this is not therapy" sort of statement in a consent is enough to do the trick.
Thinking about it, I have noticed he's bringing on a lot more licensed professionals to come in and back him up lately. I wonder what sort of incident led to that.

 

[smalltownpsych]

He got into trouble in 2008 when he met Britney Spears in her hospital room. I believe that there was a complaint to the psychology board about him practicing without a license. Also, he is able to keep the board off his back because he has lots of money, power, and attorneys. That is his protection.

 

[AcronymAllergy]

Its alot smarter that he let it expire vs keeping it active. Otherwise, licensing complaints would inevitably abound from the people he see, as well as from other professionals due to the methods he uses, I'm sure. His current method is pretty sneaky, actually. Im practicing psychology and counseling, but "officially", I'm not.

My take as well. Without the license, he's able to say that whatever it is he's providing, it's not explicitly psychotherapy; rather, it's entertainment (which could be bolstered if he provides guests with information/resources to find providers in their area if needed). Sort of like how, for example, Judge Judy is acting in the role of a judge, but isn't actually handing down any decisions that are backed by law; rather, the amounts "won" by plaintiffs/defendants come from a communal pot for the show, with any remaining funds split between the two people, and with both agreeing not to then pursue the case via a real court.

And yes, having lots of money and accompanying legal protection never hurts, either. I'm sure his show's law team has set things up so that he's shielded from most concerns and is in compliance with appropriate laws.

 

[aanders8]

Coming in late here, but to the OP:

I have (somewhat limited) training in theoretical and philosophical psychology, meaning essentially that I spend much of my time asking questions about what assumptions are we making when we use certain words/methods in research. I see the use of "functional," "works," and "adaptive" as psychology's attempt at value-neutrality and the instrumentalization of human behavior. This value-neutrality is a result of a desire to treat humans (beyond IRB protocol) as the objects of our study much as a chemist would treat molecules. Your question, "what about ethics?" is key. Really, what about ethics? In saying a certain behavior is "adaptive" or that it "works" what really is a psychologist saying? Anyways, if you're interested below is an article about instrumentalism in psychology.

Instrumentalism and Psychology: Beyond Using and Being Used - Blaine Fowers, 2010 in Theory and Psychology