Monday, December 30, 2013

Saturday, December 14, 2013

The Selling of ADHD

12/14/13. Medication for ADHD helps many people lead more productive lives. Yet --- the criticism of ADHD never stops.  The criticism of ADHD sells newspapers.

http://www.nytimes.com/2013/12/15/health/the-selling-of-attention-deficit-disorder.html?hp&_r=0

Saturday, November 23, 2013

The Brain's Way Of Dealing With 'Us' and 'Them'

11/23/03/ Robert M. Sapolsky reviews Joshua Greene's superb new book:  "Moral Tribes:  Emotion, Reason and the Gap Between Us and Them."

http://online.wsj.com/news/articles/SB10001424052702303531204579208190517321378

Friday, October 25, 2013

Wednesday, October 9, 2013

Ghaemi, Nassir. “On Depression. Drugs, Diagnosis, and Despair in the Modern World.” Baltimore: The Johns Hopkins University Press. 2013.

10/9/13.

My review of Dr. Ghaemi's new book.
 
Ghaemi, Nassir. “On Depression. Drugs, Diagnosis, and Despair in the Modern World.” Baltimore: The Johns Hopkins University Press. 2013.
Book Review.

To some intelligent consumers, mental health clinicians come in two varieties:  muddleheaded or simpleminded. In the mind of too many, either you go for help with your mental troubles for years in psychotherapy, or you get a pill after a fifteen minute conversation listing your symptoms.

Of course these stereotypes are silly --- but may illustrate the stigma and fear still associated with mental illness.

The recent slew of critical articles in the national press covering the roll-out of the fifth-edition of the “Psychiatric Bible” no doubt adds to this confusion and misunderstanding of mental maladies in the general public.  The DSM-V runs amok with poorly understood psychiatric diagnoses, consisting of a list of ingredients for many psychological disorders with no recipes for the causes or etiology of any of the increasing number of mental maladies. To ask what mental illness is, is to often get a story along the lines of some theory.

An expert in mood disorders, steeped in philosophy, existential biology (his term), statistics, rigorous research, psychiatric diagnoses, and psychotherapy --- Dr. Nassir Ghaemi brings his knowledge of science and the humanities in his new book to look at the complexity of depression. He has written books on concepts in psychiatry, statistics, and the psychology of leadership and mental illness.

Dr. Ghaemi asks what it means to experience despair or happiness in a post-modern world he defines as “the notion that the ‘modernist’ goal of discovering the truth, through reason and science has failed; our claims to the truth and knowledge, whether through science or democracy or other ideologies, are merely culturally relative opinions, with economic and political sources…” (1).

He says many people now live as if God is dead because hope has died, meaning has been sucked out of the world, and the ideals of the Enlightenment have perished in the nightmare of the gas chambers. Even if we don’t know it, he says, we are drenched in a culture where nothing is true or false so that a rational response to the world is cynicism and despair.  We spend endless time and money getting the world to bend to the desires of the self.

Dr. Ghaemi discusses the big lies of postmodern thinking and steers a course of adherence to scientific principles and existential understanding of the human condition – focusing on depression. He takes a dim view of the mental health clinicians he calls “pretenders” who only see the pharmaceutical companies as evil profiteers, selling snake oil for nonexistent conditions. Other “pretenders”, he says, embrace all views as true, producing an eclecticism which leaves patients on their own. Ghaemi says that critics of psychiatric drugs often ignore evidence of their benefits. His approach is to advocate a biological existentialism, which means that science and humanism are not in conflict.  

He describes depression as many things---not all requiring medication, and not all consisting of twisted thoughts tied to twisted neurons. Sometimes depression is a disease such as manic-depression, where episodes of despair and flights into disorganized exuberance come and go, and in severe episodes require the right medications to stop the horrors of a shattered soul, and block the nightmare of suicide. Sometimes depression reflects personality traits, such as a tendency to be anxious or sad all the time, with brief periods of more severe symptoms. Sometimes depression is a reflection of life, death, and existential despair --- that Freud characterized as, “The terrors of nature,…the cruelty of Fate, particularly as it is shown in death,…the sufferings and privations which a civilized life…has imposed,…the perplexity and helplessness of the human race,…the suffering which men inflict on one another.”  (2).

Dr. Ghaemi devotes chapters describing the work of some existentially oriented psychologists and psychiatrists who have deeply influenced his  clinical work and world view.

The following are some of these clinical guides along with their chapter headings and quotes:

Viktor Frankl, M.D., Ph.D. (1905 – 1997):  Learning to Suffer

He was an Austrian neurologist and psychiatrist as well as a Holocaust survivor. He founded Logotherapy, a form of existential therapy.

·       “The most horrible psychiatric outcome isn’t suffering – it’s apathy.”

·       “We shouldn’t fear suffering; we should fear not caring about whether or not we suffer.”

·       “The goal of existential psychotherapy is to try to help us learn to suffer.”

Rollo May, Ph.D. (1909 – 1994) and Elvin Semrad, M.D. (1909  - 1976): I Am, We Are

Rollo May was an American existential psychologist. He sought to analyze the structure of human existence with the aim of understanding the reality underlying all situations of humans in crises.

·       “I don’t think I’m either pessimistic or optimistic; I’m realistic. I don’t disparage your joy, but I think true joy only arises from acknowledging our despair.”

Elvin Semrad was an American psychiatrist who was an influential teacher of psychotherapy at Harvard’s Massachusetts Mental Health Center.  His approach was difficult to classify but he had an uncanny ability to empathically focus on the patient’s experiences. He would say that no one is psychotic in his presence.

·       “I’ve always thought that some of the things people suffer most from are the things they tell themselves that are not true.” 

·       “The psychiatrist’s job is to acknowledge, bear, and put into perspective suffering.”

Leston Havens, M.D. (1924 – 2011):  Holding Opposed Ideas at Once

An American psychiatrist known for his work on biological psychiatry, and his existential approach to psychotherapy.

·       “I teach the philosophy that we don’t know.”

·       “Experience is a comb you get when you’re bald.” 

·       “Creativity meant holding two apparently irreconcilable positions at once.”

·       “The goal of psychotherapy: personal liberation.”

·       “The goal of empathy is enough safety to begin to find out the painful truth.”

·       “Psychic health requires the ability to connect and disconnect, to connect with others and to leave and protect oneself from others.”

 Paul Roazen, Ph.D. (1936 – 2005):  Being Honest about the Past

Dr. Roazen was a political scientist who became a historian of psychoanalysis. Roazen was the first non-psychoanalyst whom Anna Freud allowed access to the archives of the British Psychoanalytical Institute. He interviewed surviving friends, relatives, colleagues and patients of Sigmund Freud.

·       “Freud used to quote the line from Schiller or somebody, to the effect that a person who does not lose his mind under certain circumstances has no mind to lose. Put that in your DSM pipe and smoke it – I do not think anything that DSM does or does not say is of any intellectual relevance…DSM is a question of what insurance needs require – period. In my view nothing to do with ‘science,’ certainly not the life of the mind.”

·       Dr. Ghaemi: “What can we learn about psychiatry today from Paul Roazen? Psychoanalysis as a dogma should be rejected. Freud as a thinker can be embraced. Biology as a dogma should be rejected. Medications, carefully used, can be accepted. Not all symptoms are diagnoses; not all diagnoses are very symptomatic. The concept of neurosis should be resuscitated:  it tells us much about the many people who have psychological symptoms but no psychiatric diseases.”

Alfred North Whitehead, a famous mathematician and philosopher, urged us to remember that knowledge keeps no better than fish. Therefore, throughout our lives,  we are all in the learning game, not the authorities’ game.

Dr. Ghaemi offers much fresh knowledge in his elegant new book.  

I think Dr. Ghaemi would agree with Anna Freud  who when she was eighty-five offered the following succinct statement of her credo to a depressed young man who sent her a lament about the chaotic state of the world:

“I agree with you wholeheartedly that things are not as well as you would like them to be. However, my feeling is that there is only one way to deal with it, namely to try and be all right with oneself, and to create around one at least a small circle where matters are arranged as one wants them to be.” (3)

References:

(1)  Ghaemi, Nassir. On Depression. Drugs, Diagnosis, and Despair in the Modern World. Baltimore, The Johns Hopkins University Press, 2013.

(2)  Schur, M. Freud: Living and Dying. New York:  International Universities Press, 1972.

(3)  Young-Bruehl, Elizabeth. “Anna Freud: A Biography. Second Edition.”  Ann Arbor: Sheridan Books, 2008.

Notes of a Psychology Watcher: Joseph Epstein, David Hume, Jonathan Haidt: on reading, passion, liberals, and conservatives.

10/9/13.
 
Notes of a Psychology Watcher

by, Steven J. Ceresnie, Ph.D.

The following article is published in the Michigan Psychological Association Newsletter, Fall, 2013.
 
On Reading Books

"The most complex lesson the literary point of view teaches --- and it is not, to be sure, a lesson available to all, and is even difficult to keep in mind once acquired --- is to allow the intellect to become subservient to the heart. What wide reading teaches is the richness, the complexity, and the mystery of life…

"People who have read with love and respect understand that the larger message behind all books, great and good and even some not so good as they might be, is finally, cultivate your sensibility so that you may trust your heart. The charmingly ironic point of vast reading, at least as I have come to understand it, is to distrust much of one’s education. Unfortunately, the only way to know this is first to become educated, just as the only way to properly despise success is first to achieve it…"

 --- Joseph Epstein in Narcissus Leaves the Pool.

Moral Reasoning:  The Emotional Dog and the Rational Tail

 The quote above from Joseph Epstein, teacher, editor, essayist and short-story writer, reminds me of the work of philosopher David Hume. In 1739 Hume wrote that reason is, and ought only be the slave of the passions, and can never pretend to another office than serve and obey the passions. Our moral intuitions are the way to understand moral truths.

 David Hume would approve of the work of Jonathan Haidt (pronounced “height”), professor of social psychology at the University of Virginia. He has brought Hume and Epstein into the laboratory, moving moral psychology from a rationalist model to an intuitive, emotional level.  He explains his moral model in his new best-seller, “The Righteous Mind:  Why Good People Are Divided by Politics and Religion.”

Professor Haidt, a committed liberal Democrat, defines morality as that which binds people together in teams that seek victory, not truth. Moral issues close hearts and minds to opponents – a confirmation bias –  as it makes cooperation possible within groups.

Haidt’s research shows that liberals are strong on evolved values he defines as caring and fairness. Conservatives value caring and fairness too, but tend to emphasize the more tribal values like loyalty, authority, and sanctity.

He says political parties are most emotional and argumentative on issues they “sacralize.” For the right, it’s taxes and abortion, among others. For the left they make sacred issues of race, gender, global warming, and gay marriage, among others.

To his credit, Haidt recommends reading economist Thomas Sowell’s “A Conflict of Visions,” a brilliant book describing the differences in beliefs about human nature found on the political right and the left.

When I reflect on the politically contentious time we live in and the complexity of the moral issues of the day, I am comforted by the words of Rabbi Abraham Joshua Heschel:

When I was young, I admired clever people. Now that I am old, I admire kind people.

 ― Abraham Joshua Heschel (1907 – 1972)

Monday, September 30, 2013

Thursday, September 12, 2013

Norman Rosenthal: "The Gift of Adversity"

9/12/13. Jane Brody reviews psychiatrist Norman Rosenthal's new book. You may remember that Dr. Rosenthal discovered Seasonal Affective Disorder.

http://well.blogs.nytimes.com/2013/09/09/lifes-hard-lessons/?_r=0

Saturday, September 7, 2013

The New Science of Mind

9/7/13. Psychiatrist Eric R. Kandel:  "...The problem for many people is that we cannot point to the underlying biological bases of most psychiatric disorders. In fact, we are nowhere near understanding them as well as we understand disorders of the liver or the heart..."

http://www.nytimes.com/2013/09/08/opinion/sunday/the-new-science-of-mind.html?hpw&_r=0

Monday, August 12, 2013

The Psychological Fallacy

8/12/13. When it comes to understanding the causes of psychological distress, many explanations are sensible, coherent, and wrong.

http://www.psychologytoday.com/blog/mood-swings/201308/the-psychological-fallacy

Thursday, August 8, 2013

James Q. Wilson and the Defense of Moral Judgment

8/8/13.

Sally Satel:

"Twenty years ago, James Q. Wilson powerfully articulated the idea that humans’ moral sense is innate, not learned.
The American Enterprise Institute celebrates its 75th anniversary this year. To commemorate the occasion, The American will periodically revisit some of its scholars’ books and republish some of their best essays as “AEI Classics.”  James Q. Wilson joined AEI’s Council of Academic Advisers in 1976. Here, Sally Satel discusses his great book The Moral Sense, published 20 years ago.
- The Editors

This summer marks the twentieth anniversary of James Q. Wilson’s The Moral Sense. Written in a time of creeping moral relativism, Wilson wrote in defense of judgment — and, in particular, of humans’ natural predisposition to form moral assessments..."

http://www.american.com/archive/2013/august/james-q-wilson-and-the-defense-of-moral-judgment

Wednesday, August 7, 2013

Explorations of the Mind with Daniel Kahneman

8/7/13. On intuition and the limits of our minds.

http://www.youtube.com/watch?v=dddFfRaBPqg

Randy Pausch: The Last Lecture

8/7/13. Randy Pausch, was a professor at Carnegie Mellon, gave this last lecture before he died from pancreatic cancer. In his lecture Professor Pausch spoke about the importance of childhood wonder.

http://www.youtube.com/watch?v=ji5_MqicxSo

Jonathan Haidt: Liberals, Conservatives, and Morality

8/7/13. A social psychologist who understands the development of morality ---- and the morality matrix for liberals and conservatives.

http://www.youtube.com/watch?v=vs41JrnGaxc

Monstrous

8/7/13.

Theodore Dalrymple:

Polyamorist Michael Philpott killed his children in pursuit of welfare benefits.
Philpott and his wife, Mairead, gave a tearful but misleading press conference after their children died--in a fire that they had set.
 
"Philpott and his wife, Mairead, gave a tearful but misleading press conference after their children died—in a fire that they had set.
 
A recent case in Derby, an industrial city in the English Midlands, has ignited controversy. An unemployed man, Michael Philpott (now 56), fathered 17 children by four women, all of whom he treated violently. For ten years, he lived in one house with two of these women: his wife, Mairead, with whom he had six children; and his concubine, Lisa Willis, with whom he had four. Tired of Philpott’s abuse, Willis left him in 2012 and took her children with her. Philpott, furious at this insubordination, wanted the children back. He, his wife, and a friend hatched a plot: they would set fire to the house in which his six children by his wife were asleep; Philpott would rush in and save them, showing himself to be a heroic and devoted father. He would then blame the departed Willis for setting the fire, which would result in her going to prison and his winning custody of her children. But the plan went catastrophically wrong: the fire got out of hand, and all six children died, five by asphyxiation and one by burns..."


http://www.city-journal.org/2013/23_3_otbie-michael-philpott.html

Science is Not Your Enemy

8/7/13. Steven Pinker, Professor of Psychology at Harvard University, defends science.

http://www.newrepublic.com/article/114127/science-not-enemy-humanities

Wednesday, July 31, 2013

Hyping Genes

7/31/13. Jerome Kagan, emeritus professor of psychology at Harvard University, discusses the media and sometimes scientists exaggeration of the role of genes in human behavior.

http://www.psychologytoday.com/blog/the-human-spark/201307/hyping-genes

Wednesday, July 17, 2013

I'm OK. You're Needy

7/17/13. Carolyn Daitch, Ph.D., my friend and colleague is interviewed in this informative WSJ article. Dr. Daitch is the author of "Anxious in Love."

http://online.wsj.com/article/SB10001424127887323394504578607662617614352.html?KEYWORDS=elizabeth+bernstein

Wednesday, July 10, 2013

Does ADHD Medication Boost School Grades?

7/10/13. 

http://online.wsj.com/article/SB10001424127887323368704578593660384362292.html?KEYWORDS=adhd+and+grades

My response:

To use a Motown analogy, stimulant medications to treat ADHD helps the driver clean off his windshield, and adjust his brakes and steering wheel. The medicated ADHD driver is able to filter out external distractions, stay on the road without impulsively taking wrong exits, and organize his travel to match his goals.

Shirley S. Wang (“ADHD Drugs Don’t Boost Kids Grades, Studies Find) gives an honest rendering of these studies and helps to answer the questions this article raises.

Ms. Wang states “…these findings suggest that medication alone isn’t enough to improve academic performance. The medicine may help with focus, but it doesn’t help with deciding what to focus on….Rather, it needs to be coupled with skill training, such as learning how to organize or prioritize.”

 ADHD, like other disorders of mental life, is not an isolated set of problems but is deeply woven into the developmental course of the patient.

ADHD is a disorder the patient has (a disorder in the “hard drive”--- the triad of distractibility, restlessness, and impulsivity, sometimes requiring medicine). ADHD is a disorder the patient is (may reflect genetic temperamental predispositions to emotional reactivity, and requiring help for the patient to gain insight into his personality and sensitivities --- to learn his psychological “trick knees)”. ADHD is a disorder that a patient does (may be associated with substance abuse, requiring counseling, and family support to stop excess drinking or taking illegal drugs). ADHD is a disorder of what the patient encounters --- such as a disorganized ADHD parent, or a family trauma, requiring the ADHD patient to seek psychological therapy to fix his software, to reroute faulty directions, revise faulty attitudes and emotions and learn how to enjoy being alive.

No wonder not all kids get a boost to their grades from ADHD drugs. A comprehensive treatment plan – more than only medication –  tailored to the unique child, family, predicaments and life-stories sets the foundation for improved academic work to follow, among other important, sometimes life-saving, developmental achievements.

 

Existential Psychopharmacology

7/10/13. Psychiatrist Nassir Ghaemi writes a tribute to his remarkable teacher.

http://www.psychologytoday.com/blog/mood-swings/201307/existential-psychopharmacology-tribute-dr-jacob-katzow

Sunday, July 7, 2013

Change Your Steps in the Stepfamily Dance

The Empty Nest and Marriage

7/7/13.

When I get older losing my hair,
Many years from now,
Will you still be sending me a valentine
Birthday greetings bottle of wine?

If I'd been out till quarter to three
Would you lock the door,
Will you still need me, will you still feed me,
When I'm sixty-four?
--- The Beatles

http://online.wsj.com/article/SB10001424127887324436104578579372436143196.html?KEYWORDS=elizabeth+bernstein

Evidence, Not Consensus, is What Really Counts

7/7/13. Matt Ridley's last article after a three-year run in the WSJ. His insights will be missed.

http://www.mattridley.co.uk/blog/i-may-follow-the-crowd,-but-not-because-it's-a-crowd.aspx

The Joy of Old Age (No Kidding)

7/7/13. Oliver Sacks, Professor of Neurology, turns four score.

http://www.nytimes.com/2013/07/07/opinion/sunday/the-joy-of-old-age-no-kidding.html?_r=2&

Thursday, June 27, 2013

Going to Synagogue, With a Punch Line

6/27/12. Ruth Wisse:  "Maybe Jewish humor is rooted in the incongruity of being chosen --- by God and by oppressors."

http://online.wsj.com/article/SB10001424127887323393804578556041646158214.html?mod=WSJ_Opinion_BelowLEFTSecond

Book Review: "Brainwashed: The Seductive Appeal of Mindless Neuroscience"


6/27/13. My book review:
 
Satel, Sally; Lilienfeld, Scott. Brainwashed. The Seductive Appeal of Mindless Neuroscience. New York:  Basic Books, 2013.

             “Fifty Shades of Gray Matter,” was the first title Sally Satel wanted but she had to go with “Brainwashed. The Seductive Appeal of Mindless Neuroscience.”

              The book has six chapters and an epilogue:

 1.    This Is Your Brain on Ahmadinejad:  Or  What is Brain Imaging?

 2.    The Buyologist Is In:  The Rise of Neuromarketing

 3.    Addiction and the Brain-Disease Fallacy

 4.    The Telltale Brain:  Neuroscience and Deception

 5.    My Amygdala Made Me Do It:  The Trials of Neurolaw

 6.    The Future of Blame:  Neuroscience and Moral Responsibility

 Epilogue:  Mind over Gray Matter

Satel and her co-author Scott O. Lilienfeld discuss the stunning progress in neuroscience and its implications for society, especially through the development of functional magnetic resonance imaging (fMRI) that takes pictures of the brain in action.

The authors do not aim to critique  the science and technology of brain scans. Rather, Satel and Lilienfeld sound a warning bell that we are witnessing premature applications of these seductive, techno-color images of the brain that promise to help diagnose drug addicts, understand the influence of neurological damage on criminal responsibility, and predict consumers’ buying habits, to name only a few topics discussed in this concise, elegantly written book.  

Psychologists, psychiatrists, and neuroscientists are alert to this warning and know we are in danger of losing the mind to this age of  neurocentrism.  

For example, in his new book, The Spark:  The Science of Human Development, Jerome Kagan reviews in detail the many problems using blood flow measures in the brain to understand emotions:

…many events evoke a brief feeling that lasts about a second and then disappears. But there is little change in blood flow to a brain site during the initial second. The peak in the blood flow signal occurs about six seconds after the event occurred and therefore, five seconds after the feeling may have vanished. The blood flow measure reflects a cascade of phenomena that include association to the event, a possible feeling, and perhaps a private query as to why the scientist presented that particular stimulus.

The rigor of psychological studies of the mind cited in Kagan’s book often take a back seat to the fMRI scans which measure brain activity by noting associated changes in blood flow. Since cerebral blood flow and neuron activity are correlated, when an area of the brain is in use, blood flows to the region also increases. We are flooded with observations of brain parts lighting up.  There are no shortages of interpretations when certain regions of the brain glow --- even though we know that brain regions have millions of interconnections, we sometimes confuse the meaning of excitatory and inhibitory functions on brain sites, and that the better people become at a skill, the less hard the brain appears to work.   

Yet this neuromania pervades the culture, supplying consumers craving certainty the illusion of simple black-and-white answers to their many shades of gray psychic distress.

For example, the other day I watched the Dr. Oz Show, a daily television program focusing on medical issues and personal health launched by Oprah Winfrey’s Harpo Productions and Sony Pictures. Dr. Mehmet Oz is a cardiac surgeon, and Professor of Surgery at Columbia University. I watched Dr. Oz interview  child and adult psychiatrist Dr. Daniel Amen on the topic:  “Your Brain:  Up Close and Personal.”  Dr. Amen  runs the many national outlets called Amen Clinics (sounds religious) in Newport Beach, California; San Francisco, California; Bellevue, Washington; Reston, Virginia; Atlanta, Georgia; and New York, NY.

According to Satel and Lilienfeld:

…Daniel Amen, oversees an empire that includes book publishing, television shows, and a line of nutritional supplements. Single photon emission computer tomography, SPECT, a nuclear-imaging technique that measure blood flow, is the type of scan favored by Amen. His clinics charge over three thousand dollars for an assessment…he grossed over 20 million in 2011…There is near universal agreement among psychologists and psychiatrists that Amen’s scans cannot diagnose mental illness.

In another chapter, Satel and Lilienfeld focus on neuromarketing --- a field with a long history. Using consumer motivational research, depth psychology and subliminal tactics to manipulate expectations and induce desire for products was the theme of Vance Packard’s (I read it in high school) classic book on advertising,  “The Hidden Persuaders,” published in 1957. Now, enter the fMRI and marketing. Some neuromarketers sell the idea that focus groups are not a reliable means to find out what consumers like or what they are going to buy. Instead of asking people about their buying preferences, neuromarketers bypass the conscious mind and go straight to analyzing fMRI’s of consumers to determine both their unconscious desires and decision making processes.

Satel’s specialty is treating drug addicts. She is frustrated with the accepted definition of addiction as a chronic and relapsing brain disease. To treat drug addicts, Satel reminds us, we must help them change their behavior and cravings for drugs. To do this, we appeal to their desire and motivation for change. To call something a disease implies there is a medication to stop the disease process. There is no such medication for drug addicts --- and for many other mental maladies. Drug addicts sometimes respond to incentives to change. People with disease are not able to reverse their disease voluntarily. To treat drug addicts, we have to understand minds.

In their last chapter, Satel and Lilienfeld turn their attention to neuroscience and moral responsibility. They wonder if advances in neuroscience bring us closer to solving the age-old dilemma of how much of our behavior is determined and how much is the result of our free will.  As Satel and Lilienfeld note, the proper use of reason is to recognize reason’s limitations. Neuroscience does not bring us closer to understanding this predicament.

We do have a choice about learning from neuroscience and accepting the limits of our new technology, without throwing out our minds with the brain water. We remain mystified  about how the water of the brain becomes the wine of self-consciousness. Our limits spring from the mystery of the generation of consciousness, the basic experience of humans on which our social and personal relationships rest. We do not understand how consciousness is produced, nor do we understand its full potential.

I believe I made a free choice to read Satel and Lilienfield’s superb book, but maybe the writer Issac Bashevis Singer is on to something when he says:

We have to believe in free will. We’ve got no choice.

Notes:

 (1)   Kagan, Jerome. The Human Spark. The Science of Human Development. New York:  Basic Books, 2013. 

 (2) The authors dedicate their book to James Q. Wilson, a brilliant social scientist. Please type James Q. Wilson into the search box for this site and some of his articles will be available for you to read.

 

 

 

Tuesday, June 18, 2013

"A Nation of Kids on Speed"


6/18/13. Drs. Cohen (physician) and Rasmussen (historian) tell us about the history of stimulant use --- as a weight loss drug, and as an antidepressant. It is obvious that these doctors have not worked in a clinical setting, diagnosing and treating people who need help.

These doctors know not what they are talking about. After 35 years of treating children, adolescents, and adults, I know that stimulant medication saves lives of those properly diagnosed with ADHD and associated disorders.

The relentless attacks on psychiatric medication never let up. People are down on things they are not up on.

http://online.wsj.com/article/SB10001424127887323728204578513662248894162.html?KEYWORDS=a+nation+of+kids+on+speed


My response:

           Regarding Drs. Pieter Cohen’s and Nicolas Rasmussen’s article, “A Nation of Kids on Speed,” these authors make evident that attention-deficit/hyperactivity disorder is a well-known disorder that is not known well.

 What is not known well:

·       There is a wealth of scientific data on the clinical description, epidemiology, developmental course, prognosis, etiology, evaluation, co-existing disorders, differential diagnosis, and treatments for ADHD.

·       There are some excellent long-term studies about the positive effects of stimulant medication for ADHD.

·       The psychostimulants methylphenidate (Ritalin) and amphetamine (Adderall) are the oldest and most established pharmacological agents in child mental health.

·       The benefits of stimulant medication for ADHD have been studied over more than 50 years.

·       Medications are underused in some regions and are prescribed too freely in others.

·       There is strong evidence that ADHD is a genetic disorder.

·       Most people who suffer from ADHD never get diagnosed or take medication.

·       People who have undiagnosed ADHD are at risk for substance abuse, depression, anxieties, and suicide.

·       These medications work for the vast majority of people who are properly diagnosed.

          The authors correctly note that psychological diagnosis is based on symptoms --- and as many recent criticisms of the DSM-V have pointed out, we have a psychiatric diagnostic manual that is more reliable (consistent) than  valid (the disorder exists). We rely on symptoms to treat such disorders as ADHD because we have no valid biological tests to diagnose ADHD or any psychological disorder. Our psychiatric diagnoses are significantly handicapped because we have no idea how the water of the brain generates the wine of consciousness.

Of course our reliance on symptoms does not mean we know nothing about psychiatric disorders. Even Drs. Cohen and Rasmussen insert one sentence in their half-page article that, “Stimulants can certainly benefit some young children with truly disabling ADHD.” They go on to claim, “history has already taught us that overprescribing stimulant to millions of Americans leads to dependence, addiction, and overdose.”

History may have taught this to Drs. Cohen and Rasmussen, but the clinical experience of many psychologists and psychiatrists informed by  rigorous, peer-reviewed scientific research on ADHD, has shown that many children, adolescents, and adults find stimulant medication like glasses-for-the-mind, enhancing focus, organization, planning, and effective self-monitoring. 
 
Do some people abuse stimulants – of course. People with substance abuse problems abuse stimulants --- and  some vulnerable people may be use stimulants to “self-medicate” to “treat” undiagnosed psychiatric problems, or use stimulants to stay up all night, or whatever people do who are impulsive, have faulty judgment and try to cope with psychic despair.
 
Psychiatric medications such as stimulants sometimes offer life-enhancing measures to improve the faulty “hard drive” improving mood stability, the ability to filter out external distractions, or improve self-control. Psychological therapies, often helpful with people with ADHD, do much to repair “software,” providing supportive settings to promote hope, reroute faulty “instructions” and teach people how to live better.
 
Until we have a medical test to identify ADHD, no amount of scientific knowledge, clinical experience, or testimonials from parents and youngsters will convince Drs. Cohen and Rasmusssen of the importance of treating  ADHD across the life-span.

I hope that Drs. Cohen’s and Rasmussen’s efforts to protect us from the dangers of the misuse of medication for ADHD does not generate the side-effects of growing-up with untreated ADHD --- side-effects such as school failure, depression, delinquency, and suicide.

Steven J. Ceresnie, Ph.D.
Psychologist
Independent Practice
Plymouth, Michigan

WSJ Letters to the Editor:
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Saturday, June 15, 2013

Pathological Altruism

6/15/13.


We don't think we'd ever heard of Oakland University, a second-tier institution in suburban Rochester, Mich., but Barbara Oakley, an associate professor in engineering, may help put the place on the map. Earlier this week Oakland's Oakley published a fascinating paper, "Concepts and Implications of Altruism Bias and Pathological Altruism," in the Proceedings of the National Academy of Sciences.

The paper is a concise summary of an innovative idea that informed Oakley's two recent books: "Cold-Blooded Kindness: Neuroquirks of a Codependent Killer, or Just Give Me a Shot at Loving You, Dear, and Other Reflections on Helping That Hurts" (Prometheus, 2011) and "Pathological Altruism" (Oxford University Press, 2012). The former has been described as a true-crime thriller; the latter is a dense, 496-page collection of 31 academic papers, edited by Oakley and three other scholars...

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