Makes You Stop and Think

“The most beautiful experience we can have is the mysterious. It is the fundamental emotion which stands at the cradle of true art and true science.”

--- Albert Einstein

 

“The first principle is that you must not fool yourself --- and you are the easiest person to fool.”

--- Richard Feynman

 

“Every atom in your body except for hydrogen and helium was made in stars long ago and blown into space when those stars exploded --- much later to be tossed into the air and soil and oceans of Earth and eventually incorporated into your body.”

“I’ve always been struck by the fact that the number of neurons in our brain is about equal to the number of stars in a galaxy:  one hundred billion.”

“If you traveled to the Sun on a high-speed train, say at two hundred miles per hour, it would take about fifty years to get there.”

--- Alan Lightman

 

“Man is equally incapable of seeing the nothingness from where he emerges and the infinity in which his is engulfed.”

--- Blaise Pascal

 

 

 

Thoughts on Human Nature*

We will create a revolution in our understanding of human nature, when we can explain how the brain generates the mind. We have no idea how the brain can produce a directive, willful “I,” how self-consciousness flows from brain tissue, and how we can go from tangibles such as neurotransmitters and molecules to intangibles such as thoughts, moods, and perceptions. We don’t know how brain facts become mind facts. There is not a twisted thought for every twisted neuron.

Early in his career, Freud wrote a book about how the brain worked and was connected to the mind — but he abandoned his work because of the unbridgeable brain-mind discontinuity. He went on to propose his convenient “fictions” of id, ego, and superego.

For psychologists, this brain-mind gap creates obstructions to learning about human nature, leads to accumulating more information than knowledge, and keeps many clinicians trapped in denominational conflicts such as whether to assume a biological, behavioral, psychodynamic or humanistic orientation.

It is not possible to imagine what the obliteration of the mind-brain problem will lead to in our conception of human nature.

My hope is that we will come to a greater understanding of the role of freedom in a world we are not yet able to see.

 --- Steven Ceresnie

*McHugh, Paul R., Slavney, Phillip R. The Perspectives of Psychiatry. Baltimore:  Johns Hopkins University Press. 1998, Second Edition.  

 

On Medication for Attention-Deficit/Hyperactivity Disorder*

 

            The idea of using medication to treat problems of behavior provokes deep feelings and equally strong opinions in many people --- despite that fact that medication for ADHD was first approved by the Federal Drug Administration in 1957, and there is much research support for the effectiveness of treating ADHD with medication.  This is even more true when the symptoms are interpreted in moral terms: a pill for laziness? a pill to stop procrastination? a pill for messiness? It is difficult for most people to understand that ADHD is a neurophysiological disorder, not a sign of moral failure.

 

            When parents refuse a carefully monitored trial of stimulant medication to treat their child with ADHD, I bite my lip when many parents don’t understand that medication may significantly reduce ADHD symptoms in their youngster and sometimes act like “glasses for the mind.”

 

            I am frustrated and sad because I’ve witnessed hundreds of youngsters and adults benefit from ADHD medication --- treatment that can save a child from a life of such problems as depression, anxiety, substance abuse, school, work and relationship failures, and unrelenting, harsh self-criticism – and begin to push adults with ADHD back to a more normal path – at home and at work.

 

Along with a carefully monitored trial of medication, I stress the importance of medication AND psychotherapy. Over the years, I’ve learned to take my cues from parents, youngsters and adults about when they are ready for psychological treatment.

 

I urge parents who are hesitant to try their child on medication for ADHD to talk with parents about their experiences about their children taking medication, to consult pediatricians and child psychiatrists, and to talk with experienced teachers. I urge adults to consider attending a group for adults with ADHD.

I used to give ADHD adults material to read – but when I inquired whether they found the material helpful, these adults would describe how they left the material in the backseat of their car, or a restaurant, or couldn’t find the articles among the stacks of papers on their desk.

Sometimes parents with an ADHD child or an adult with ADHD who initially refused to consider a trial of medication comes back to me – in several months, a year or longer and are now open to a trial of medication.

I evaluated a 10-year-old boy and recommend medication to treat his ADHD. His parents were not open to medication – “We know,” they say, “how the pharmaceutical companies are more concerned about profits than people. We are not going down that road.” These same parents report having dinner with their long-time couple friends, Bill and Jane. At the dinner, the mother of the son I evaluated, tells her friends that she went to a psychologist who had the nerve to recommend that her son take medication. To her surprise, Bill becomes angry, with veins popping out of his forehead, saying he recently started taking Adderall to treat his chronic, previously undiagnosed ADHD. In a loud voice, he described his anger at growing up with untreated ADHD --- and experiencing many of the side-effects of his parents’ refusal to allow him to take medication. Side-effects such as school failure, substance abuse, and years of relationship problems.   

A thoughtful, sophisticated teacher came to me about her 10-year-old son’s

psychological difficulties. She said, “I heard an advertisement for a brain clinic on a Christian radio station. I went to their website and I was impressed by their research and testimonials of their patients.” She then took her son to this neighborhood brain mapping clinic -- at a fee of two-thousand dollars for ten treatments. When I asked her son about the treatments, he said:

 

The first time I had to repeat some numbers I read – they put these things on my head to get my brain waves to go through head phones and I get to listen to it. It was different brain waves every time – and sometimes it repeated. I fell asleep once and it helped me sleep better. I’m not worrying about sleeping. I listened to ocean noises and that helped me listen better.

 

            When the brain clinic treatment did not work, the parents and the youngster experienced a successful trial of pharmacotherapy for ADHD.

            .

Many years ago, there was a news report of an adolescent who was taking Ritalin who committed suicide. Now that’s a tragic outcome and important for all clinicians to pay attention to and learn from. By coincidence, a pediatrician called me shortly after this report of the adolescent suicide, to tell me he had just moved here and was taking referrals for youngsters suspected of having ADHD and learning disabilities. He moved here from the state where this adolescent killed himself and he knew the child psychiatrist who prescribed this youngster Ritalin. What did not come out in the news reports of this tragedy, he said, was that the adolescent’s stepfather was molesting him for years.

Parents of a youngster with ADHD decided to consult a medical doctor specializing in holistic medicine for treatment of their son to avoid pharmacotherapy. The doctor recommended a stringent diet – a diet, the parents said, was impossible to follow. The parents said there were so many food ingredients to avoid, there was not enough information on food labels to guarantee they were complying with the diet. After a try of the diet failed, to the parents’ shock, the doctor recommended treating their son with caffeine suppositories. The parents changed their opposition to medicine and treated their son with a successful trial of pharmacotherapy.

Here is a list of the changes in ADHD symptoms when medication treatment is effective:

·         HYPERACTIVITY (trouble doing nothing): fidgetiness and restlessness decrease; patients are able to relax; then are able to stay at their desks or at the dinner table or at a movie or in church.

 

·         INATTENTION-CONCENTRATION is greatly improved. It is not only that patients can concentrate better; they can concentrate when they want to. Distractibility diminishes. Attention to spousal conversations improve and frequently is quickly manifested in better marital relations.

 

·         MOODINESS.  Both highs and lows decrease as do feelings of boredom; mood is described as more stable.

 

·         TEMPER. The threshold for outbursts is raised. Patients are less irritable and angry outbursts are less frequent, and less extreme.

 

·         DISORGANZIATION-ORGANIZATIONAL ACTIVITIES. This is evident at school, running a household, and work. Patients may spontaneously establish orderly strategies.

 

·         STRESS SENSITIVITY. Patients describe themselves as having their thin skin thickened, ability to take life problems in stride, feeling less hassled by daily existence.

 

·         IMPULSIVITY. Patients report that they do not interrupt others while listening to them; they think before they talk; that they have become tolerant drivers and that they may stop impulse buying. 

*Weiss, Margaret; Hechtman, Lily Trokenberg; Weiss, Gabrielle. ADHD in Adulthood: A Guide to Current Theory, Diagnosis, and Treatment. Baltimore:  Johns Hopkins University Press, 2001.

 

Nurture and Nature

“Unfortunately, psychologists know much less about how the environment influences a person’s personality than is commonly assumed. People often talk as if the environmental effects had been well understood for decades, and the new discovery was that there were genetic effects too. In fact, nothing could be further from the truth. The area of environmental influences on personality is a morass of unsupported or poorly tested ideas, and, ironically, it is behavior geneticists who have brought the most progress to the field. The irony is that behavior genetics was founded in order to discover heritable influences on human behavior. The methods such studies use, however, also allow us to identify non-genetic influences, and say quite a lot about them.”

--- Daniel Nettle

 

Golden Rules for Mental Health

“Be honest, realistic and loving with yourself and to those around you; assume a positive outlook and make brave, positive life choices, going against the grain when necessary; listen to your body and keep healthy and active; and do not tolerate persistent discontent, whatever its cause, even if it seems minor.”

 

--- Daniel Nettle

 

Preventing Problems is Hard to Do

Irving, a 90-year-old man has his son Michael buy him lottery tickets every week for thirty years.

 

Picking up the latest lottery ticket for his father, Michael sees that his father has won 10 million dollars.

 

Worried about how is father who has a bad heart would take the shock of winning 10 million dollars, Michael calls his father's doctor, tells him about his concerns, and the doctor agrees to call Irving under the pretense of repeating some medical tests, and then tell him about his winnings in the safety of his medical office.

 

Dr. Bloom thanks Irving for coming to his office to repeat some tests. Making conversation, Dr. Bloom asks Irving if he plays the lottery. Irving says his son has bought him lottery tickets for thirty years and he has never won anything. Dr. Bloom asks Irving what he would do if he won 10 million dollars in the lottery. Irving thinks for a moment and says, "You have been my doctor for many years. I would give you 5 million dollars.”

The doctor drops dead.

 

A Chaotic World

When Anna Freud was eighty-five, a depressed young man sent her a lament about the

chaotic state of the world, she sent him a succinct statement of her credo:

 

“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.”

 

--- Anna Freud