For just about any other kind of health problem, we talk about how lifestyle (diet, exercise, etc.) plays a huge role in the etiology of disease. Lifestyle changes can prevent disease, they can slow its progression, and in some cases even reverse it, depending on what we’re talking about.

Diabetes, cancer, heart disease…all are illnesses that affect a substantial portion of the population. And in each of these cases, a significant amount of time, effort, and money is allocated toward learning how to reduce the risks of developing such debilitating conditions. Furthermore, as a quick perusal of the ADA and AHA websites show, lifestyle modification is a crucial part of the strategy for managing these health problems. Indeed, as time goes on, doctors are emphasizing the fact that all the drugs in the world cannot make patients healthy if they make unhealthy decisions.

They claim that 47% of adults will suffer from a diagnosable mental illness during their lifetime. I take issue with the label ‘illness’ as that implies a degree of severity and irreversibility that simply isn’t the case. They also claim that 23% of us will suffer from clinical depression. By contrast, only 10% of the population aged 20 or older has diabetes.

Psychiatric problems (illness or not) can be just as deadly and debilitating as any other medical issue. Why then is there little or nothing in the way of preventive education? Why then do primary care physicians prescribe antidepressants and psychostimulants often without so much as a referral to a therapist?

We are surrounded by messages telling us how we know if we ‘have depression’ or ‘have ADHD’, and what drugs to ask our doctor for. But have we ever been told how to prevent ourselves from becoming clinically depressed? Have we ever been shown how to deal with depression, ameliorate our anxiety, or learn how to focus better?

I find it hard to believe that unlike diabetes, unlike heart disease, unlike cancer there is nothing we can do to prevent ourselves from suffering from mental health problems. Indeed, the fact that some people appear far more resistant to depression and anxiety than others in similar circumstances, combined with the relatively weak heredity of such psychiatric problems, would seem to indicate that mindset and worldview play a substantial role in resistance to mental health problems. And, even more convincingly, depression is on the rise in this country. Which would point to something we are doing rather than something inside of us being the culprit.

Relapse rates for those treated with antidepressants alone are considerably higher than for those who received combination therapy or only psychotherapy; in fact, only about 1/3 of those who take anti-depressants alone see a full resolution of their symptoms while 1/3 don’t respond at all. Da Vinci, Michaelangelo, Edison, and countless other accomplished people fit the textbook definition of ADHD, yet never took a pill for their ‘condition’.

Simple logic dictates that if systemic disease can be prevented or at the very least mitigated by behavioral modification, then certainly mental health problems would too. Scientific evidence backs this idea up quite firmly. And yet it would seem that they’re far more interested in telling us we have a psychiatric illness, then telling us what we can do to prevent being so labeled or how to fix it.

I guess you could call it a benefit of living with your parents. Mom knocked on the hovel’s door where I was busy avoiding studying and told me to come watch a 60 minutes segment on the treatment of depression through deep brain stimulation.

I think she does this just because it’s funny to see me in a rage. Cursing, throwing things (like my 8lb miniature pinscher), and semi-coherent rants equally populated by erudition and epithets characterize these award-winning performances. I’ve been told that at the climax of one of these fits, no one’s sure if I’m going to stab whoever I’m screaming at or bludgeon them to a more symbolic death with logical debate.

I get annoyed with the perception of mental healthcare (both laymen and many practitioners), not the least because like leftists they seem unable to think of long-term effects. In the case of laypeople, it’s because they haven’t been educated enough. Not exactly their fault. When it comes to practitioners, they simply have no excuse.

Now, I am not criticizing these particular clinical investigators. I have only this news report to go off of. And if they were up front with their patients on how brains work and the potential side effects related to this particular procedure (not just surgery in general), I have NO beef with them as far as ethics goes. Theory on the other hand, I do.

These doctors are using a technique called Deep Brain Stimulation of a certain area of the brain that has been found to be overactive in people with intractable depression: Area 25 (part of the Anterior Cingulate Cortex which is itself part of the Limbic System).

The fact that they’re stimulating an already pathologically overactive part of the brain should be a huge red flag that dealing with the brain is not quite as simple as action–>reaction. By stimulating it, they actually tone it down through an induced negative feedback process. Which I’m not going to explain in full because I’m lazy.

What they’re doing is theoretically sound–in the short term. The question in my mind is the longterm stability, efficacy, and safety of such a procedure.

Virtually everything in physiology revolves around the concept of homeostasis, or maintenance of a constant environment. There are several great examples of this. One being the baroreceptor reflex which attempts to keep blood pressure fairly constant. If the blood pressure stays abnormally high long enough, eventually the receptors stop reacting to it. The reflex is reset at a higher blood pressure because the neural receptors have filtered it out as noise. And now you’ve got a chronic hypertension problem.

A slightly different thing happens with the hunger-controlling protein leptin and its positive correlation with body fat percentage. Eventually, body fat percentage can get so high that leptin release can no longer increase. In these individuals not only is there a mental disconnect between eating and satiety, but a physiological one as well.

The patient who they interviewed in this segment talked about how everytime they increased the frequency and strength of stimulation, she was better for a while, and then fell right back into the pit of depression. She was considerably better off than before, but was still significantly depressed. Is it possible that her Area 25 simply adapted to the stimulation after a while and went back almost to the way it was, just as in the barorceptor reflex?

But they also showed a patient they consider their greatest success story. She had the same overactive Area 25, but has been nearly symptom free for months now. The difference in her face before and after is just amazing (as it is in the other lady for that matter). Could it be that her problem was like the leptin-body fat disjunction? With her Area 25 simply becoming too overactive to be compensated for? It would explain why she reacted more permanently than did the other patient: the stimulation returned her Area 25 to a level where her brain could compensate.

The fact that neither patient is adequately described by the same physiological model is our first clue that we still dont’ know exactly what’s going on and that depression may be considerably more complex than just an ‘overactive brain area’ or ‘chemical imbalances’.

But what scares me more is that neural tissue is some of the most sensitive stuff in the body. It pretty much dies if you look at it funny. Which kind of sucks because nerve cells, like muscles can’t regenerate; you’re born with the neurons you will die with. And one of the well-known factors in this is excessive and/or unnatural stimulation. This is the etiology of meth psychosis, the ‘holes in the brain’ in chronic ecstasy use, and drug-related Parkinson’s. Many of these substances work by stimulating neurons to release more of certain neurotransmitters (norepinephrine, serotonin, and dopamine). Chronic use causes these sensitive cells to die. Just as higher baseline production of insulin in those genetically predisposed to Type II diabetes eventually results in the pancreas burning out and an inability to produce full amounts of insulin later in life.

The brain represents one of the most complicated feedback and control systems many will ever study. Fewer still will take the time to think about all the different ways the brain reacts to external and internal changes before they make the simple declaration that something ’causes’ something or something ‘cures’ something. Short term and long term effects are often completely opposite. What looks like one thing in two patients could easily be two different things presenting the same way. And changing mood through SSRI’s doesn’t result in a normal looking brain on PET but an even more abnormal one.

The complexity of this system causes me to have the opinion that most of these pathologies are rooted in the persistence of certain thought patterns. If they last long enough, they can reset the brain as in the baroreceptor reflex. If they get too strong, they can escape their feedback loop, as leptin does. But what we see in our initial workup, on the MRI or the PET must be treated as a symptom. Treat it, because it needs treating, but remember that the actual cause is at least one step removed from whatever you’re looking at.

Sorry it’s late. And sorry I haven’t been psychblogging more frequently. Been really busy both on the blogosphere (CAID, Homeland Stupidity, and Liberty Papers) and in real life (two jobs, conferences, geriatric dog, etc). I’ll step it up a bit. Anyway, because I suck, I’m reminding you that we are looking for hosts who don’t suck. If you’re interested, give me an email with what works. Next Carnival will be June 13 over here. But the 27th on is completely open.

Dave over at Dare To Dream takes a really comprehensive look at the prison system and recidivism. The piece covers elements in the equation all the way from cradle to grave. Highly recommended.

The esteemed Dr. Sanity discusses the Sanction of the Victim, in which the very forces that work to correct societal problems are the ones blamed for it:

Only by withdrawing the “sanction of the victim,” –i.e., refusing to be manipulated in this manner–refusing to give aid where there is scorn and not even grudging gratitude; refusing to shoulder the burden of all as they beat us upon the back and tell us to go faster, do it better, and jump higher; refusing to pay their debts; fix their problems; or protect them from their own, deliberate, suicidal behavior–only then will the looters and the parasites be forced to recognize reality.

In Recourse to Authority, ShrinkWrapped discusses how the internet has affected mental health in ways both good and bad.

The Good:

I consider it a major benefit that my patients must take responsibility for their decision and not simply rely on my authority in areas that affect their lives.

I’d have to agree, I’m not much for authority. And I think that the idea of an authoritarian mental health professional is kinda contradictory to the goal of helping your patients to reach self-fulfillment.

The Bad:

We used to be able to rely on our news gatherers to tell us what is going on in the world. We used to be able to rely on scientists to make sense of confusing information. We can’t do that anymore and it is unsettling, confusing, and disorienting.

Assistant Village Idiot brings us a conversation he had with a psychiatrist with Bush Derangement Syndrome. Normally, I don’t much go in for the ‘psychology of politics’ thing, but I thought this was a rather good example of how rationality in humans is highly context-dependent. While the basic position may or may not be irrational, the psychiatrist’s reasoning sure as heck is.

My own submission blurs the lines a bit as I talk about my own experience with chronic pain and injury and its relation to my empathic abilities in Schizoid Tendencies Are A Two-Way Street.

Dilys talks about why some people may prefer not to be happy, thinking that it’ll give them power over others. And discusses that while this may work in the short run, it’s a bad long-term strategy.

Joe Kissel brings us an entry about handheld machines that can aid in entering relaxed or meditative states using only blinking lights and simple tones. It highlights, among other things, the powerful animal ability to impute complex patterns onto relatively simple stimuli. I’d note that sitting out on the field watching fireflies and listening to the crickets chirp often has the same effect on me that these machines do for him.

Unicovia accuses the media of doing exactliy what Dilys was talking about. Namely, that their entire business model is based around only presenting the bad, no matter what good is happening.

Peter Kua of Radical Hop brings us an inciteful discussion about fear; when it is justified and when it’s just holding you back.

I confess that I’m one of those personality test junkies. The Spark, Psych Central, Similar Minds, love em. Don’t know why, half the time the tests spit out blatanly false profiles. Still, it’s fun. And in the case of the more psych-oriented ones, sometimes scary.

For one thing, I routinely come up as extremely schizoid and schizotypal. While those characterizations are generally true, I fail to see how they necessarily reflect anything wrong with me.

At the most basic level, each of us is an individual. Each of us is our own person with our own hopes, dreams, preferences, and temperament. While schizoid and schizotypal tendencies could potentially signal personality disturbances, what they actually measure is how well you fit in. And if ‘not having the personality some shrink wants me to’ is now a disorder, I have a serious problem with that. There needs to be a little more theoretical and empirical justification than that.

As Tim Flynn, the guy who runs Similar Minds points out,

don’t think Schizoid personality is a valid disorder, some of the smartest people in history were schizoid because they occupied a remote end of the intelligence bell curve. Schizotypal personality can encompass highly original thinkers as well as totally insane people so I think it’s a flawed type. I think the remaining eight disorders are generally valid.

I would think much of my readership understands from personal experience exactly what he’s talking about right there. Lord knows I do. I’ve also found it pretty easy to deal with, though. Probably because I went to public school where smart kids would get the crap beaten out of them for not fitting in. And because you can be as creative as you want to be no matter how little creativity your friends and acquaintances display.

No, what I’ve really found boosts my schizoid and schizotypal tendencies into the stratosphere is the chronic nerve damage I’ve been living with for the past 9 years. You’d never know it to look at me that I suffer from a rather painful atrophic nerve condition. Which is part of the problem. I’ve coped too well. Which seems weird until you think about it for a bit.

As I said earlier, schizoid and schizotypal tendencies aren’t a reflection of anything internal, but rather how you interact with and compare to external society.

Tim defines schizoid personality disorder as where an “individual [is] generally detached from social relationships, and shows a narrow range of emotional expression in various social settings.” I’ve often heard it simplified as a lack of empathy or understanding for what’s going on in other individuals’ heads.

And the thing about empathy is that you have to–at least at some level–have a handle and an appreciation for what another is going through. ‘Normal’ people simply can’t understand my kind of pain at all. Imagine that you’re in so much pain that when you take the highest recommended dose of muscle relaxants you actually sleep less than eight hours because the sleep is that much more refreshing. Can’t do it, can you (those of you who aren’t royally screwed up)? Which means if we were looking at your personality using me as a reference point, you’d be the schizoid one.

Flipping it around, because I’ve built a pretty damn impressive pain tolerance up (to the point that much of it happens subconsciously), when people freak out about painful injuries/conditions, often enough I have to work very hard to bite back scorn and ridicule. Dredging up empathy? Yeah, right.

As an example, skinning your knuckles, stubbing your toe, scraping your knee, or getting a splinter are all things that suck.. When I think about it dispassionately, I’m able to admit that when such things happen to me, my brain is indeed filled with the frantic firing of C-fibers and my body does indeed tingle, burn, and throb. But in real day to day life, that kind of thing often flies so far under my radar I don’t realize I’ve hurt myself until I bleed all over something.

This can make things quite uncomfortable for me when something like that happens to someone else. As everyone else is rushing around screaming for bandaids and alcohol, I’m wondering what all the fuss is about. This apparently means I have a disorder.

Of course, a funny thing happens when we start talking about people who are really physically screwed up. I’ve found I’m considerably more affected at an emotional level by their plight than most are. Which has to do with the whole empathy being dependent on personal experience thing. When you see one of those stories or meet one of those people, you often think to yourself “I can’t imagine what that must be like.” Because of my peculiar position, I often can. Using someone who’s really crippled as a reference point, the ‘normal’ person becomes even more schizoid, whereas I start to approach normality.

My big cautionary tale here is that all ’schizoid’ means is ’statistical outlier’. Could there be a psychological problem there? Sure. But there doesn’t have to be. Sometimes the reason you can’t relate to other people is that they can’t relate to you. And if that is the case, what the mental health professional needs to worry about is considerably different. People are social creatures, and like all social mammals, we derive much of our psychological strength from others. My worry as a therapist would thus be making sure these people are able to cobble together an ad-hoc support structure given the fact that sociality won’t work as well for them as it does for others. This is one of the reasons I want to work with kids with chronic illness. No, I don’t know how much it sucks to be them, but I have a much bigger clue than most do, and I’m hoping I can use my own experience to give me a better window into their minds and thus better serve them. If we begin treating schizoid characteristics as the problem instead of just a signal of the problem, we risk making psychology as much a matter of conformity as it is about mental health. And that scares me.

Good group of posts here. I’m going to host the next two but from number 5 onward, I’m opening it up. If you’re interested, let me know. Preference will be given to those with lower readership. The 1st carnival pulled in somewhere between 500 and 1000 hits due to linkage from the heavy hitters. It’s a pretty good way for some of the lesser knowns out there to be seen by others. Also, the TTLB community should be up and running by the next edition.

Now on to the submissions…

ShrinkWrapped presents Unintended Consequences, “Accidents”, and Unconscious Processes:

When a patient consciously intends a particular outcome and a different, unhappy outcome occurs from their action, it is always vital to investigate whether or not the unintended consequence was an accident or was unconsciously determined.

Assistant Village Idiot brings us an egregious example of over-thinking the nature and complexity of a patient’s psychological problems despite a minimum of contact and testing in Psych Testing Hall of Shame. After reading it, I don’t even know what to say. It’s my firm belief that most psych problems are rooted in relatively simple experiences, whether past or present. Not everyone has a psych problem worthy of a Jungian treatise. Sometimes–most of the time–they’re just over-extended.

Roy over at Shrink Rap asserts that Freud set back psychiatry by over a century. He contends (rightfully) that Freud singlehandedly pushed us away from the brain-centered perspective it had in the early 1900’s to ’so how does that make you feel?‘.

Personally, I think the current neurochemistry-centered models are entirely too simplistic, and if anything more harmful than Freud in that they ignore the beautifully complex and plastic nature of the brain.

Which happens to be a great segue into mentioningmy own submission for the carnival. I talk about the similarities between the mind and muscles, and how adopting a mind training and injury treatment approach could eventually mean less mental illness as years go by. A sprained elbow is rarely indicative of an underlying pathology or disorder. It’s much more likely to be the result of poor training, overuse, or improper technique. Same applies to a person’s psyche, in my opinion.

Joe Kissell over at Interesting Thing of the Day describes one of the more peculiar phenomena of the mind. Synesthesia is when a stimulus in one sensory modality is perceived in another. Hearing the color blue, or seeing cold. Interesting stuff.

From Dare To Dream comes yet another example of the press jumping on research findings before they’ve been properly vetted by the academic community…not to mention unwarranted assertions by study authors. This instance involves a possible link between childhood trauma/sexual abuse and schizophrenia.

Piebolar bares her soul to us once again, giving us a view into the mind at the other end of the therapeutic relationship as she describes the changes that have come over her since beginning neurontin. I wish her the best of luck in her journey, as I’m sure all who read her entry do.

Cerebration asks if blogging may be unhealthy. It all depends on how you approach it, I think. A blog could be cathartic, allowing you to literally see what’s going on in your own head. Or it could merely be a reinforcer, serving to intensify unhealthy though patterns. *shrug* This is why I’ll be in school and training for another 8 years and why no one should listen to my advice as anything more than a layperson’s. Cerebration also points out a couple articles that might be useful to those in need of a psychiatrist.

Peter Kua of RadicalHop.com brings us The #1 Way to Eliminate FEAR: Chant This Mantra Daily!.

Generative Transformation presents The 3-fold Path of Wisdom. It’s a discussion of the path to wisdom and how all the worldly constructs we surround ourselves with can hamper our spirituality.

How To Produce An Acute Schizophrenic Break, posted at Spiritual Recovery, discusses some of the ways in which schizophrenic breaks are similar to various religious practices, as well as to simple loss in the ‘real’ world. I had to poke around for a bit due to the buddhist allusion and saw some pretty interesting stuff. It’s a blog about a schizophrenic and her recovery.

Introduction:
I’ve talked about how the brain reacts a lot more like muscle than it does like hormonal or other physiological systems. And I’ve mentioned that I tend to think of most mood and affective problems more like injuries than illness. But I want to spend a little more time on the idea of mind-as-muscle and how it ties in to developing a more realistic model of diagnosis and treatment of ‘minor’ psychiatric problems.

I’ve often heard it said that the mind is what the brain does. And moving weight (actually, producing torque) is what muscles do. But there’s a lot more to lifting weights–especially if you’re cross-training for a sport and not just ‘getting big’–than just slinging lead. It’s much the same way for the mind. Good genes are of course important for building strength. Bone density, tendonal elasticity, muscular growth potential are all things that are in many ways limited by genetics. But a few strands of DNA are hardly the whole story. Building a body capable of moving a lot of weight at rapid acceleration for long lengths of time requires a proper training regimen. And this prescription can help people with not-so-good genes achieve some pretty stellar heights themselves.

Diagnosis And The Power Of Words:
I’ve never met a man who never trained who could bicep curl a 50lb dumbbell. And I’ve met plenty of men who, though more than strong enough, injured the hell out of themselves attempting such a feat. Could you imagine if a doctor told the first that he needed steroids? And if he told the second that it wasn’t his fault, that he suffered from a joint imbalance?

It just wouldn’t be done would it? The doctor would say to the first man that there was nothing wrong with him, he just had to learn how to develop his musculature, and to the second that he had to learn how to use his body.

But when it comes to the mind, the very first thing that many mental health professionals turn to is the DSM-IV TR, and they ask themselves “What kind of disorder does this guy have? What kind of disease? What kind of treatment should we pursue?” Loaded words, every one of them. There are fortunately still mental health professionals who after such a rummage through The Book wouldn’t immediately turn to the prescription pad, but rather to the therapist’s couch. Still, the words we associate with psychological issues–ones of illness and of defects–set the tone from that point on. Which is why I make it an issue to refer to them as issues, problems, or injuries.

Now, I’m not a very PC guy (if you hadn’t noticed), but words can be important. Particularly those that have to do with a person’s health. The labels ‘disease’, ‘incurable’, ‘chemical’, and ‘genetic’ aren’t very empowering; they make a patient feel like there is very little in his power. None of that compares very well with a skinny kid being told he needs to change his diet and put in a little time, but soon he too can be benching 300 lbs, as long as he really wants to hit that goal.

The Importance Of Proper Training:
Every fall, like clockwork, college freshmen join the gym and start lifting, wanting to get huge to compensate for their lack of confidence in themselves and who they are. And every fall, with increasing frustration, I drop my own weights to stop the idiots from killing and/or maiming themselves. I then give them the two minute lesson on exercise nutrition, and another two minute lesson on planning an effective workout to increase your strength at a decent, but safe, pace.

The mind is a lot more complex, a lot more fragile, and a lot harder to strengthen than your average shoulder joint. Yet most of these kids received a good deal more instruction in my short-tempered canned rants on the latter than they ever had on the former. So, if they became depressed, anxious, or otherwise upset, I’d think the default position would be that they were inadequately prepared and/or trained to deal with the world and the goings on inside their heads.

From the first day of orientation at university until the day I graduated, I was a regular at the gym. And you know, I never saw most of those kids for more than a few months. Which honestly, was probably a good thing. Most of the ones that did stick with it were textbook cases of the whole Male Distorted Body Image Disorder thing:

Guy: “I’m soo tiny.”
Girl: “Guy is cute, but he’s too big. Almost grotesque looking.”
Nick: “Dude, you’re more than big enough. Trust me, girls do not go for that kind of thing.”
Guy: “Yeah they do!”
Nick: “You just heard her say that they didn’t!!!”
Guy: “Well, yeah she says that. But she means I need to get bigger.”
Girl/Nick: “Moron”

Anyway, now that I’m completely off point (but have hopefully brought your attention to a VERY big problem among males), I thought I’d say that one of the reasons I think these guys failed so often was that they were after something that weights couldn’t give them. They wanted self-esteem, they wanted self-acceptance, they wanted to fulfill an image that they’d produced of their ideal selves.

And I think when a lot of people come in the door of a therapist’s office, they’re after something that a strong mind won’t necessarily give them. They want to be happy (which isn’t exactly the word I’m looking for). While there’s certainly nothing wrong with being blissful, it’s not exactly what I’d call a natural state of being. But sounding like Eeyore in the depths of your resignation isn’t exactly right either. What people should be after is a happy medium…a state of mind that I think the word ‘contentmen’ captures pretty well. To me contentment isn’t just about affect (happy), or philosophical acceptance (resignation), but about an emotional and cognitive mindset that allows you to roll with the punches. It’s about training a mind that’s strong enough to get you through the low points in life and flexible enough to keep you from breaking when you go through it.

Muscles aren’t supposed to be big. They’re supposed to be strong. They just happen to get big doing it. A mind isn’t supposed to be invariably happy, it’s supposed to help you get things done, something that only really happens if you’re content.

Strong Is Only One Step Away From Brittle:
Even though I approached lifting with a good deal more preparation and sanity than did most, I was still susceptible to adrenaline-induced lack of judgment, overtraining, and–especially in the damaged arm–sprains, strains and twists. If I did see a doctor, she wouldn’t declare that I had a cartilage defect or a musculoskeletal disease that causes my brachialis to sprain when I’m skullcrushin 165. She’d tell me I was an idiot, no one had any business using weights that large, and then she’d put it in a splint, cast, or sling as necessary. After hitting me again, for being a doofus (this is what you get for using docs you’re related to), she’d then tell me not to come back to her office if I hurt it again lifting.

Strong people break too, they’re just a lot less likely to. And when they do, chances are that they don’t have a disease, don’t have a disorder, but simply pushed themselves farther than their conditioning went. They need to be treated that way. Figure out just what pushed them there. And if it can be removed, remove it. If it can’t, make an action plan to deal with it. Maybe it’ll involve a couple weeks or months of pills, maybe it won’t. But the patient will think of it as transitory.

Conclusion:
The main point of this piece is simply that we must treat the mind in a way that reflects both its biological nature and its more abstract psychological workings. If my 7th grade swimming coach had looked upon the 5′ tall 74 lb kid and simply said ‘Well, he’s a skinny wimp, never amount to anything much’, he wouldn’t have been able to turn me into a state level swimmer within the year. He certainly wouldn’t have believed that that scrawny creature would grow almost a foot taller and nearly triple in weight (mostly muscle…mostly lol). If we don’t recognize that the vulnerable patient in front of us can become a resilient, self-willed individual whose strength of character we’d be envious of, we won’t ever learn to ‘cure’ psychological problems. And if we don’t recognize that sometimes the stronger you are, the harder you break, we seriously risk not being able to rehabilitate these individuals.

The man you see on the street is rarely as muscular or athletic as he could be. The same is just as true of his mind.

Linky

Before we go much further, I just want to point out that we’re talking about teenagers. There is no more tumultous, melodramatic, crazy, unbalanced time in a person’s life. Internally, as hormones rage and social emotions develop whole new levels of complexity, and externally, as people attempt to define you by the girl on your arm, the clothes on your body, the people you hang out with, and the way you talk. In other words, if there was one period in your life where psychiatric problems would most likely be due to an inability to cope, it’s this period. This is the one period that, more than any other, where therapy can have the strongest and most long-lasting ameliorative and preventive effects.

The probe uncovered a troubling trend of physicians taking liberties with their own clinical guidelines, often bypassing psychotherapy as a component of first-line treatment. Instead, the study shows, in the years 1995 to 2002 they increasingly relied solely on the drugs that were supposed to support, not supplant, counseling.

This quote really says it all, as far as I’m concered. They are trying to replace therapy with meds, which will be to the detriment of every one of these kids. In most of these cases something is making them depressed. It would be to these kids’ benefit to understand what that thing is and why they’re letting it bother them, instead of waiting until they’re 35 to go see a therapist and talk about their awful teenage and college years, and finally figuring out what it was all about, wouldn’t it?

the guidelines of the American Academy of Child and Adolescent Psychiatry call for trying talk treatments first in depressed children and, in the most severe cases, combining pharmaceuticals with psychotherapy. Part of the reason for this recommendation is to increase the odds the physician will monitor the medicines’ effects and ensure patients’ compliance.

But what the Stanford team found was that while office visits by depressed teens more than doubled over the seven years studied — soaring from 1.4 million in 1995 to 3.2 million in 2002 — the use of psychotherapy in that period sank from 83 percent of the visits to 68 percent. At the same time, reliance on drugs increased from 47 percent to 52 percent of the cases.

That may not seem like such a big change — until you consider the dramatic increases in the diagnosis of depression in children and realize the actual number of youngsters on anti-depressants more than doubled during the period studied, the scientists said.

What’s more, as the drugs took center stage, they shoved talk therapy to the back burner, they said. So much so that it was forsaken altogether in between 42 percent and 52 percent of doctor’s visits by anti-depressant-using children, the Stanford team reported.

Not a good thing, especially because in our culture of therapism, psychiatrist visits are likely to only increase, meaning more kids put on robot pills instead of being helped with their social and psychological issues.

bah!

I call BS. The study does say that they can guage our testosterone levels from our faces. To which I say of course. That’s kind of a ‘duh’. Signalling theory predicts that various aspects of our bodies serve as visual markers of aspects of our internal condition, particularly with regard to reproduction and health. Examples include the link between waist-hip ratio and fertility, and facial symmetry as a signal of health and a bountiful juvenile growth period.

Beyond determination of basic secondary sex characteristics (external genitalia, body hair, fat and muscle distribution, boobies, etc.), estrogens and androgens also affect the degree to which we express those things. “He has chiseled features,” or “she has a jaw like a man,” are cases in point where testosterone is concerned.  Guys with baby faces and girls that don’t have hairy arms are examples of low testosterone.  Or, take a look at the faces of pro wrestlers who aren’t fat like John Cena (i think that’s his name).  Their faces almost look like caricatures of male-ness because nearly everything they do has a stimulatory effect on testosterone release.

But this part:

“Women’s ability to estimate men’s interest in infants from face photographs is perhaps the most novel finding to emerge from the study,” researchers wrote in British journal the Proceedings of the Royal Society B: Biological Sciences.”

This I find a little more sketchy.  Testosterone has little to do with paternal care from my readings (and this is what I research, albeit at the wild animal behavior level).  Instead what matters is prolactin levels.  Obviously from the root stem we get that its a hormone involved in milk production.  But it’s also vital to the initiation, maintenance, and focus on parental care in both males and females.  Good dads in the animal kingdom have high prolactin levels.  And considering that some animals with very high prolactin levels also have high testosterone levels (alpha male capuchins, wolves, and, well, me), I’d think that we can safely say there isn’t that much correlation between the two.  And because prolactin levels only increase when babies are around, there’s little reason to believe that it affects appearance in a way that could be guaged by the study.
This is speculation but what I think we’re seeing is a secondary cultural effect.  Our culture has created an expectation that males with high testosterone are whores with little interest in long term relationships (especially at the college level).  And in consequence, low testosterone males have chosen the alternative mating strategy of appearing to be nurturing and caring.  Having recently left undergraduate study, I can attest that this does indeed seem to be the case.  Not only do males feel like this is the way they should behave, females assume this is how males will behave as well.

Being a big aggressive looking male, most people assumed I was a manwhore, where nothing could be further from the truth.  And to this day, most people laugh or look in disbelief when I tell them with 100% certainty that I want to be a child and adolescent psychiatrist.

Like I said, I see plenty of high testosterone aggressive males all over the animal kingdom who are great fathers.  In fact, low testosterone males in a lot of taxa actually choose the ‘hit it and quit it’ method when it comes to making babies.  An example are orangutans. The big 200lb honkers with the big old fleshy cheekpads are the ones with high testosterone.  While they aren’t particularly good fathers, they do at least stay around the females they mate with.  There are other males, though, who have low testosterone, so low in fact that they pretty much look like females.  They’re the sneaking type, even going so far as to rape the females.

It happens in fish too, who actually can be good fathers.  The big aggressive males make a nest, fight off all comers, and take care of babies.  ‘Sneaker’ males are about the same size as females and don’t fight or defend territory, instead they try to fertilize eggs laid in a big male’s nest before he has a chance to.  Again, they don’t parent.

Where am I going with this?  Nowhere special.  Just making the point that although my dispossesion is a bit like Marv from Sin City, I love kids.

Interesting new treatment. Basically they implant a device that stimulates your vagus nerve at periodic intervals. The vagus has all sorts of connections all over the place, from your voicebox to your heart to most of your digestive tract. Interestingly, a lot of vagus nerve terminals release serotonin as their neurotransmitter, just like the brain neurons implicated in control of mood and depression. What that has to do with anything? I couldn’t tell you. Most can’t at this point.

This is going to come as a surprise, but I’m not summarily giving the Indian Cowboy stamp of disdain to this somewhat drastic procedure. This is for two reasons:

1) It’s only indicated in people for whom nothing else works.

2) The lead times between procedure and onset of relief on this are significant and long enough that it’s unlikely to be abused.

With 300 million people in this country alone, there will be organic, idiopathic causes of brain disease. It’s just a fact of life. While I think the number psych treats this way is significantly overstated, they do exist, and we need to be able to do something for them. This is the kind of stuff that is perfect for them. It actually rewires these peoples’ brains to respond like a healthy person’s.

With most therapies, whether behavioral, pharmacologic, or ECT, we tend to see improvement 3-12 weeks after starting. However with VNS (Vagus Nerve Stimulation), the lag time approaches 1-2 years. I’m going to turn to the articles to give you a better understanding of what’s happening before I add in my own thoughts

Article 1:

Patients in the study generally responded around 12 to 24 months after beginning the treatment. Dr. Charles Conway Saint Louis University presented his research results Thursday at the annual meeting of the American Psychiatric Association.

The most surprising finding from the study, conducted by Conway and physicians from Washington University in St. Louis, were the long-lasting benefits of the treatments.

“There are a number of subjects who have gone into remission and stayed in remission for the past four or five years,” Conway said.

Very promising. It’s the nonresponsives and the ones who turn to pharmacology who tend to have the highest rate of relapse, as he said. Which means they tend to do the most damage to themselves and their families in the interim. It’s very encouraging that we now have a way to treat those who we’re just unable to get through to.

Conway studied the neuroimages of the patients undergoing the treatment. He noted that the brain reacted systematically to the vagal nerve stimulation, and by the end of the two years patients were experiencing a significant decrease in activity in the prefrontal region, which is more active in patients with depression. The studies suggest that the brain is experiencing long-term changes.“The areas that are going activation and deactivation are all areas we know to be involved in depression,” Conway said. “What appears to be happening is further in the treatment it’s almost as though there is some brain adaptation to the stimulation.”

And let’s flesh it out a bit with a quote from Article 2:

When Dr. Conway examined the neuroimages of four patients 24 months after they began receiving vagal nerve stimulation, he found brain activity that was similar to what doctors see in patients who have received ECT. “There actually appears to be decreased activity in regions of the prefrontal cortex, which is very much parallel to the findings of treatment response in ECT, and the opposite of findings seen in medication-response to depression.”

He found unexpected action in the prefrontal cortex of the brain that is similar to brain activity in depressed patients immediately after they have received ECT and before its effect wears off.

First, I have to snigger at the remark Dr. Conway said, about medication-response to depression looking opposite of a healthy and an ECT brain. Told you they were just covering up the real problem.

Anyway, ECT is generally considered the most effective treatment for depression. After it, your brain looks normal under a PET scan. It’s just that it doesn’t last long. What they’re finding is that after you wait that average of 21 months (which kinda sucks) your brain looks normal, just like it does immediately after an ECT. Which is another part of the reason I don’t mind this so much. It’s making your brain look normal, instead of covering up one abnormality with another drug-induced abnromality (see previous paragraph).

Now, the most interesting thing about all of this is the difference in times between most psychiatric therapy and VNS. The VNS time of 1-2 years instantly make me think of recovery of function after a stroke. It’s an almost perfect fit. In other words, VNS looks like a neuroanatomical, self-healing cure. Instead of a neurophysiological, self healing cure we tend to see with CBT, acceptance therapy, or drugs. The difference is that in the latter, we’re not looking to change the way the nerves connect to each other, just the way they function and fire. In the former, the brain is literally rewiring itself. This is why when a person has a stroke and loses the ability to speak, he can re-learn using different brain areas. I’m not 100% sure that’s what’s happening with VNS, but I’d put a small flutter on it.

Pottering around blogcarnival.com revealed no carnivals dedicated to psych. Which is unfortunate because there are a lot of psychbloggers out there. Many of whom get plenty of traffic. I’m bored and my summer job don’t start for a couple more weeks, so I figure why not start one. Plus, I have Dr. Sanity’s approval.

I couldn’t think of how to say that this carnival is intended to be a pretty open and encompassing affair so I stole and lightly massaged some verbiage from The Tangled Bank’s homepage…

This is an egalitarian activity. You do not have to be a Ph.D., you don’t have to write articles with ten-syllable words, you don’t have to discuss esoteric details. All you have to do is express some enthusiasm for [psychology and psychiatry] or encourage study of the same.

Got an interesting post about Cognitive Science? Want to discuss your personal experiences with mental illness? Do you want to talk about the failures of current psych theory (a favorite of mine)? Or about a problem with the status quo in the mental health profession (another favorite of mine…even moreso for Dr. Helen)? Maybe you want to talk about the psychology of individuals who believe in certain ideologies (that’s Dr. Sanity’s big thing. You could even discuss ‘discredited’ theories like those of Freud and Jung (which still have some merit in understanding the mind, even if they are of little therapeutic value). Heck, I’ve got a post or two about the Axis II psychological disorders my dogs seem to suffer from every now and then. Even silly tongue-in-cheek stuff like that is good too.

Point is, it’s all good. If it has to do with psych, it’s well-written, and it’s an actual commentary from your point of view rather than simply a link and a quote with a quick “I like this”, then send it in. Should Fun times will be had by all.

I’ll be hosting the first one on Thursday, June 1st, so get your links in to me by about 6pm the Wednesday before. Feel free to send multiple submissions, since I have no idea how popular this will be these first few carnivals. That may change if we get to be anything like the size of Tangled Bank, Skeptics’ Circle, or Grand Rounds. We’ll start out bi-weekly and if it looks like it’ll work we might move up to once a week. Once it’s off the ground I’ll open up hosting opportunities to those who are stupid enough to take on the work.

You can either submit by sending me an email at:

indiancowboysblog@gmail.com

Or by using the Blog Carnival Submit Form.

Let’s have some fun with this.

These are almost getting formulaic I know, sorry. I’ll stop when the scientific integrity starts, k?
linky

One thing that this new article makes really apparent is that these so-called psychiatric disorders often present with the same symptoms, especially in children.

“Many symptoms of depression also present with other psychiatric disorders,” noted Dr. David Fassler, a Burlington, Vt., child and adolescent psychiatrist, clinical associate professor of psychiatry at the University of Vermont and author of “Help Me, I’m Sad: Recognizing, Treating, and Preventing Childhood and Adolescent Depression” (Penguin, 1998).

“For example, irritability can be a sign of depression or anxiety or attention deficit or bipolar disorder or a reaction to a learning disability, so a proper diagnosis is critical,” he said.

In a further entanglement, numerous conditions with overlapping characteristics often coexist, making the symptom sorting all the more tricky, even for professionals.

“The symptoms of the four most prevalent mental-health conditions (ADHD, anxiety, bipolar disorder and depression) are not always easy to tease apart, especially in children,”

See this is what I’m talking about. Four different ‘disorders’ each with four different recommended biochemical treatments ranging from medical methamphetamines to the pharamacological equivalent of ecstacy. But they all look the same?

As many as two-thirds of depressed children also suffer from other oftentimes look-alike disorders. Untangling these so-called comorbidities hits a snag on the chicken-and-egg quandary: Which came first and is one the cause, effect, neither or both of the other?

And here Ms. Wasowicz hits the core of the issue; the real reason I won’t shut up. Comorbidities really crack me up. They talk about the comorbidity of depression and chronic illness a lot. Which is exactly what I’ve been trying to say. Depression is caused by thoughts. If you’re chronically ill, easy to think bad thoughts. Ergo, easy to get depressed. Not hard to understand. Knowing that, which is better? Drugs, or attempting to talk with this clearly distressed person who’s not in the best of health about their fears and their qualms?

Inconsistencies like this are why I think many psychiatric disorders should probably be thought of as ‘psychiatric injury’ instead. More often than not, there is an initial insult. The irritability, change in sleeping patterns, defiance, all of them are merely part of a response. Certain sets of symptoms are gathered together into neat little bundled and called ‘disorders’ or ‘disease’. These symptoms are then treated. Now, even before I got to med school I learned that it’s important to treat the root cause of a disease rather than merely the symptoms.

It’s important to note that since there is little to no causative evidence that ‘anxiety’ causes ‘anxiety-type symptoms’ or ‘depression’ causes ‘depression-type symptoms’. Which means when we can’t tell the difference between the two (as was discussed more heavily in the article), we decide which is which based on what medication they respond to. Which sounds eerily similar to what goes on in the recreational drug world. People all have ‘their drug’, something that just makes them go ‘click’, something that they just feel completes them. You’ll meet hyperactive people who use marijuana to calm them down. Or similar people who use meth to get even more hyper. Or you might a calm person who does downers because ‘that’s their thing’. On the other hand, he might turn into a totally different person on PCP, and that might be what he looks for. In other words. Similar personalities, different drug/responses desired.

One of the worst thing a surgical oncologist can do is not cut deep enough. Leaving behind a part of the tumor is usually pretty bad news for the breast cancer patient, indicating a likelihood of metastases and lower survival down the road. Similarly, I continue to fear that we don’t go deep enough when rooting out the causes of psychiatric problems. It’s easy to say ‘He looks anxious. Let’s call it Generalized Anxiety Disorder and figure out which street drug works best.’ It’s a lot harder to say ‘I wonder why he’s so anxious; let’s find out, and if he needs something to keep him calm meanwhile, we’ll put him on something temporarily.

I walk with a pronounced limp a fair amount of the time. If the doctors looked at my leg the same way psychiatrists treat the mind, this is roughly what would have happened:
“Doctor, I’m limping.”
“You have Generalized Limping Disorder. It’s a serious medical condition caused by the fact that your leg hurts.”
“So you’re telling me I’m limping?”
“Yes, but more officially.”
“Ok, so what can we do about it.”
“Well, here’s some Oxycontin”
“What about fixing the limp.”
“Nawwww. You’ll feel all happy and loopy on the opiates.”
“Ok”

Now, what the doctor should have done is try to fix my limp first and only if he couldn’t should he have told me to drug myself to my eyeballs.

I’m going to limit my typical tirade against anthropocentrism to three sentences for the sake of brevity and boredom prevention: Human brains did not evolve in a vacuum; as neuroanatomists have noted for close to 200 years, there are scarcely any differences in kind between the monkey brain and the human brain, merely differences in degree. People act surprised at the fact that other animals have emotions and the ability to infer. Which is why psych is such a radioactive pile of cow dung; it has a flawed view of just how deep the roots of our cognitive and emotional attributes go and why they came to be in the first place.

Ok, done. And yeah, I guess I cheated by using semicolons, making it five sentences not 3. But my blog. My bandwidth. Deal.

This is not a problem I have. Luckily for me, I wasn’t raised in an epistemological framework of unjustified humanism (whether religious or atheistic in nature), but rather was taught to appreciate the commonalities of all living things. Especially monkeys. Not only that but I’ve had a lot of face time with them. I’ve been tricked, outsmarted, beaten, berated, bitten, and generally abused by several species of monkeys originating from three different continents. I have no doubts as to their intelligence or as to the fact that they think just like we do, just in a less sophisticated manner.

A new study from Harvard researcher Dr. Marc Hauser highlights the ability of monkeys to make inferences about situations they’ve never encountered before.

Monkeys keep turning out to be smarter than people think they are. Researchers have shown that they can count to four and are aware of differences between languages like Dutch and Japanese, even though they don’t known what is being said. Now, Harvard psychologists find that monkeys can draw correct conclusions about novel situations. For example, shown a white towel that turns blue, a blue knife, and a glass of blue paint, they can figure out that the paint not the knife is responsible for the change in color.

“Our studies reveal a striking continuity between humans and monkeys in their capacity to draw causal inferences without the help of familiarity with the events or situation,” says Marc Hauser, a Harvard professor of psychology. “This ability highlights the richness of the monkey mind in terms of its understanding of the material world.”

Thank you, Dr. Hauser. And I mean that wholeheartedly. Both scientists and the public need to understand that there isn’t very much that makes humans unique, not because I’m one of those ‘human rights for great apes’ freaks, but simply because we can’t develop a conception of who we really are unless we understand just how we’re related to others.

Anyway, moving on to the experiment itself:

Next, they saw the glass of water and two halves of an apple. Following this, a knife was lowered, and two apple halves seemingly became a whole apple.

To a human, even an infant who had never seen such things before, the last two apparent happenings would never really happen. Can monkeys infer the same outcomes? Evidently, the answer is “yes.” They looked longer when a glass of water appeared to cut the apple than when a knife seemed to do the same. The longer look signaled disbelief.

Surprisingly, they didn’t fail. Without ever having seen a glass of water and two apple halves, or a blue knife and blue and white towels, the monkeys inferred that water cannot cut fruit and knives can’t change the color of towels.

And that’s the key here, just by looking at the objects, the monkeys were able to figure out what their actions were. Inference at its finest.

The experiments, then, answer a key question about human versus monkey intelligence. Is the capability for figuring out what is possible and not possible when you see something for the first time uniquely human? For Hauser, Spaulding, and a lot of scientists who read their report in the May 2 issue of the Proceedings of the National Academy of Sciences, the answer is a resounding “No.”

“Humans are not alone in their capacity to draw causal inferences from limited experiences,” the Harvard researchers write. “This capacity is part of the evolved psychology of rhesus monkeys and most likely other animals as well.”

Which really says it all, I’d head to the article itself since it ends with a great David Hume-bashing ending. I’m not much of a fan of philosophers either (although I’m a fan of philosophizing), like the psych establishment, they seem to have an allergy to the real world.

The saddest thing about this whole business is that people like Dr. Hauser have to go out and prove something that should simply be assumed based on parsimony.

I’ll end this by saying that, as I’ve mentioned before in my psych rantings, unless we understand the selective forces that led to the differentiation of the primate brain from those of other mammals, and the forces that led to the gigantic increase in encephalization between hominins and other primates, we won’t really understand what the brain was designed to do. And if we don’t understand that how the hell can we know when something is actually wrong with it?

Introduction
What a lot of people forget or just don’t understand is that unlike the traditional ‘computer/problem-solver/integrator’ analogy, the brain is highly context-dependent. The way it reacts to the outside world, and in fact the way it perceives it, is highly dependent on both exteroceptive (the world outside) situations and interoceptive(mood, motivation, etc) responses. This is a function of the limbic system. Which is one of the most fascinating parts of the brain.

It’s one of the weaknesses of most facets of psych that they don’t take into account how the wiring and reactions of the limbic system can radically change the way we think, without us even knowing about it. I’m not going to get hugely detailed today because I have a final in four hours, and because that would bore everyone, including me.

Instead, I’ll give a quick and dirty overview and integrate it with a story about my ancient dog that illustrates my main point dramatically.

Neuroanatomy of the Limbic System
First, a few pictures.

(From the wiki page I linked to earlier–Limbic System in red)
This is a real simplistic image, but it allows us to consider the gross brain anatomy and introduce a couple of evolutionary considerations.

The yellow, blue, and green areas collectively make up the brainstem. Each of them has a different function: the yellow and blue areas are called the medulla oblongata and the pons, respectively. The green is called the cerebellum. The yellow and blue areas are arranged basically like the spinal cord on steroids, and handle a lot of the basic aspects of physiological maintenance. They do the breathing and the intestinal movement and the heart and all that. You can actually cut off or destroy most of the brain structures above them and still have a live animal…just one that can’t do anything (essentially a coma). The green area is completely different from these guys. It handles coordination and making sure your movements are smooth, certain, and accurate. People with strokes often have this area affected, which is why they might shake when they move (intention tremor), have trouble walking (ataxia), or be unable to adjust their movements in the middle of an action. The brainstem is about as basic as a brain can get: You can live with it, but not really do much. Some of the non-vertebrate chordates seem to just have a brainstem and nothing above it.

The tan part of the brain that’s surrounded by the red limbic system is what’s called the diencephalon or sometimes the basal ganglia. This area of the brain serves as a relay station between the tan stuff outside (the cortex–stuff that does the ‘thinking’) and the ‘lower stuff’ below. Basically, it filters and gets sensory information to the right place to perceive it; it also modifies the info just a bit. And after the cortex is done sensing, integrating, and responding, it takes the cortex’s signal, processes it again, and sends it to the right places in the brainstem and spinal cord to get the motor response we want.

The basal ganglia are pretty complex and can do a little behaving of their own. ‘Motor programs’ such as throwing a punch or walking are found there. It also helps with keeping your head on straight. Two degenerative diseases that affect the basal ganglia are Huntington’s and Parkinson’s. Huntington’s preferentially attacks a basal ganglia nucleus called the caudate, which is important for cognition. This is why Huntington’s patients develop dementia in addition to the chorea (involuntary movements). Parkinson’s, on the other hand, attacks the Substantia Nigra, which help in the initiation and cessation of movement. This is why Parkinson’s patients shake when they’re still, but have a hard time moving on purpose; it’s like a faintly heard radio station. The static is almost as loud as the signal.

The limbic system is one of the phylogenetically oldest parts of the cerebral cortex; even the way it’s constructed at a cellular level is more primitive than the rest of the cortex (but more complex than lower structures). The oldest part of the limbic system is called paleocortex or archicortex, while the newer parts are called allocortex. All vertebrates have well-developed limbic lobes, but many don’t have much–if any–of the cortex surrounding it (the outer tan stuff). This is why goldfish seem so stupid. And why rats are less complex than cats, which are less complex than monkeys. Less of what’s called neocortex.

Archicortex has 3 layers of neurons that interact with each other in a complex network. Allocortex has 3-5 layers that can be kind of indistinct. And neocortex has 6 well-defined layers. Your emotions start in the paleocortex, move through the allocortex and then on into the neocortex. We’ll look at that in detail after a couple more pictures…

Here’s a schematic of how these structures talk to each other:

(click for larger)

And here are a couple of drawings:

(click for larger)

(click for larger)

This last one is probably the best. It not only shows the structures but how they connect.

(clicky)

Stuff comes from the sensory cortices (the unshaded cortical parts toward the back and sides of the brain) into the Hippocampus (the archicortex) and Amygdala. Sensory information travels to the hippocampus and amygdala through the parahippocampal cortex (allocortex)The hippocampus is the organizer for sensing and remembering details about the outside world (exteroceptive information) while the amygdala handles emotional context (interoceptive information).

Together, they send information to the anterior cingulate gyrus (which is part of the neocortex) through the thalamus which is part of the relay system we talked about earlier. The cingulate gyrus then projects back to the hippocampus and amygdala through the parahippocampal cortex. Making Papez Circuit.

Confusing, but what it all boils down to is that the hippocampus and amygdala are what help us store memory, recognize similar situations, and, in the case of the amygdala, tell the brain how to feel about that. The emotional side of things is what we’re most concerned with today, so we’ll talk about the amygdala a bit more. The anterior cingulate cortex is what turns the amygdala’s emotional response into a guiding behavior for the frontal cortex (the part that does the thinking). The anterior cingulate is important in motivation; lesions to it result in people that understand that something scary is happening, but don’t respond to it. The amygdala also projects to the nucleus accumbens. If you’ve ever read about the neurobiology of addiction you’ve probably heard of this structure. It’s the one that dopamine activates. It’s our ‘reward center’. So together the areas the amygdala projects to provide motivation (anterior cingulate) and reward (nucleus accumbens). One encourages you to do something, the other one congratulates you on achieving it.

These areas in turn project to the frontal cortex, the area we think of as the seat of cognition, personality, and consciousness. In other words, any time you think about anything, your conscious thoughts are being unconsciously modified by the limbic system. This is evolutionarily important because it allows the brain to be efficient and speedy. It makes sure you’re more motivated to do things that’ll help you avoid dying or help you make more babies. It rewards you for doing something that doesn’t get you killed or helps you so you’ll do it next time.

Instead of spending equal time dealing with things in the environment, it lets you ignore crap like dirt and leaves and focus on the jaguar approaching you and the pretty little thing that just smiled at you. But, of course, it does all this without actually letting you know.

The Story
My dog has been going through a rough patch. Breathing heavy, coughing up a little phlegm. Didn’t touch her food all day yesterday. But she ate everything else she was given; fruits, pudding, bread, whatever. Mom was freaking out. Dad was worried. I was at school taking a test and knew nothing of her going off her feed. So I get home, see the full bowl, and then I started freaking out. Called mom. She told me the dog had something to eat.

So I figured she had a viral infection. Would explain the phlegm and the thirstiness and the heavy breathing. And if you’ve ever had a lingering respiratory viral infection (like RSV), you might have noticed a change in your sense of smell, even if your nose wasn’t plugged up (anosmia). We have really bad noses but really good tongues. Dogs are the reverse. Flavor is mainly to do with your nose, believe it or not. So with her nose all blocked up, that food wouldn’t mean much to her.

Little brown pellets are just little brown pellets. They go through the hippocampal (exteroceptive) system but completely fail to activate the amygdala. The amygdala doesn’t tickle the cingulate, so the frontal cortex doesn’t care too much either. So my dog has no interest in a food that to her aging eyes looks just like gravel. That slightly off-putting odor, on the other hand, sends her into a frenzy. She remembers eating it with fondness as the amygdala grabs interoceptive memories of her nucleus accumbens rewarding her for eating. Her cingulate gyrus motivates her to go right after that food. The motivational memory was tied to the smell, and only the smell.

But that doesn’t explain the fact she’d eat her various ‘treats’. Well, actually it does. To a dog, when their master gives them something from his hand, it’s literally a reward. And that nucleus accumbens fires right up. So Shelly has generalized taking food from my hand to mean she’s going to be rewarded when the food hits her taste buds. Her amygdala and hippocampus together recognize me holding something in my hand and holding it out to her as food in my hand. Her amygdala adds the memory of the ‘reward’. It tells the cingulate gyrus which promptly kicks her frontal cortex in the pants, sending her questing after the tidbit. Of course, in her senility, usually she misses and chews on my finger first.

We’d tried everything to get her to eat. Brought the bowl to her, held her upside down and stuck her nose in it, threw it at her. At one point I was considering chewing on it like you do with a baby to convince them that Gerber’s isn’t as nasty as it looks.

I was explaining the reward and motivation thing to my little bro, when he said “Doofus, then hold her dog food in your hand like it’s a treat. She’ll start eating it then and probably keep eating.” Sure enough, it worked. Once I’d gotten her to take the ‘treat’ from my hand, the taste memories kept her motivated.

Final Thoughts
Same object, different responses. Not because my dog’s thoughts changed but because which thoughts she was enabled to perceive were different. The subconscious mind is some powerful stuff, and while we do have some control over it, we only get that way by understanding the way our brains work in the first place. The challenge of psych and mental health research in the coming decades is to understand how to work with these subconscious processes as much as any conscious ones. Cognitive Behavioral Therapy is all fine and good, but if the problem isn’t necessarily cognitive (as limbic system could be argued to be), it won’t have much of an effect.

Continuing my commentary on UPI’s ADHD series with the newest installment…

“The main point is that stimulants alone are typically not adequate, given their lack of carry-over effects once stopped, their inability to teach parents and teachers and children new skills, and the fact that combining medication with empirically supported behavioral treatments typically yields the best chance of normalization,” said Stephen Hinshaw, professor and chair of psychology at the University of California, Berkeley, and principal investigator on the Multimodal Treatment Study of Children with ADHD.

Sounds about right. Even the most selective of psychiatric meds can’t help but take a brute force approach. Worst case scenario is that they act on all neurons that respond to a specific neurotransmitter, in this instance noradrenergic and dopaminergic circuits. The more selective stuff acts only on neurons with a specific receptor sub-type. An example is found in the treatment of Parkinson’s Disease (think Michael J. Fox or Mohammed Ali) and Schizophrenia. Both involve problems with dopaminergic circuits, but they differ in the type of dopamine receptors in each. Schizophrenia treatments involve pharmacological agents which act on the D1 receptor while Parkinson’s drugs work on the D2 receptors.

The problem occurs in that receptor sub-types are shared amongst a large variety of circuits with many different functions. Many antipsychotics used in the treatment of schizophrenia have the side effect of causing random chewing motions of the mouth (Tardive Dyskinesia). This occurs because although D1 receptors are involved in the malfunctioning circuits that cause hallucinations, they’re also involved in the basal ganglia motor system. Because the drugs act on both of those circuits, the hallucinations are controlled, but the crazy mouth happens too.

ADHD drugs don’t even pretend to be selective, they just take a bigger hammer to the locus coeruleus (norepinephrine) and ventral tegmentum (dopamine) and jack up the levels. Such a gross intervention lacks the finesse and the selectivity of dealing directly with such issues as internalization of behavioral norms and academic success. I doubt that any drug could be.

Indeed, in a survey, 98 percent of specialists viewed multimodal therapy as most effective, but only 34 percent said they use it in all patients, reported Alistair Sinclair, analyst at the London-based market research firm Datamonitor, which conducted the study.

So they know about the importance of behavioral therapy, but they fail to push it. Of course, part of this lies in the fact that most cases of ADHD are treated without referral to specialists. All too often the buck stops at the pediatrician. Which is a problem, because while a pediatrician is trained in all sorts of pathophysiological processes, he’s not trained to understand the softer side of therapy and cognitive insults resulting in behavioral problems.

“Thirty years of research show ADHD drugs used alone do not help children avoid long-term outcomes that are a hallmark of the disorder — substance abuse, domestic problems, school dropout, delinquency and criminal behaviors,” said William Pelham Jr., University of New York at Buffalo distinguished professor of psychology.

Given a fair shake, his extensive research shows, behavioral therapy could cut the need for chemicals by an attention-grabbing 75 percent, he said.

I daresay it could be decreased even further. Which should always be the goal when we take such ham-fisted methods to an object as delicate, plastic, and complicated as the brain. He continues:

“The vast majority of ADHD children are treated with medication as first-line treatment by their physicians,” Pelham said. “Yet … there have been many studies of this over the past 30 years, and not one has found beneficial long-term effects of stimulants.”

“Unfortunately … many parents of ADHD children are not made aware that there is a well-established, evidence-based alternative to medication — behavior therapy,” he added. “Instead of immediately prescribing the drugs, physicians should be recommending to parents a sequential approach — behavior therapy first, and then add medication if needed.”

Which is exactly why I’m in med school instead of playing with South American monkeys…and getting paid to do it. It’s almost criminal to treat child behavioral problems the way we do. I don’t think anyone could disagree with the premise that the fewer chemicals in our bodies the better and the fewer drugs messing with our brains the better, yet medicate first and therapy maybe remains the dominant approach.

There needs to be a greater reliance on mental health professionals, particularly ones who practice behavioral therapy methods, in child and adolescent mental health. Pills remain nothing more than symptomatic treatments, ones which lack the finesse to deal with complicated behavioral issues.

Continuing my commentary on the excellent ADHD series UPI’s running on Sciencedaily, I’ll be taking a look at the newest article today.

Because I’m a demagogue, I have to draw attention to the 3rd sentence:

The treatment criteria call for moderate to severe symptoms that both parents and teachers agree disrupt home life and impair school performance.

And, because I won’t let go, I’m going to point out again that ADHD is always viewed through its impact on the teacher and the parent, rather than the child. While I’m not stupid enough to think that a 6 or 7 year old kid can tell you exactly what’s going on in their head, I’d still say that their internal state is at least somewhat important if we’re interested in their mental health.

Respected professional journals are devoid of evidence that would convict doctors of the massive overmedicating charged by skeptics, these specialists assert. If anything, they see a criminal neglect of youngsters who struggle needlessly when quick and easy help awaits in a capsule.

Antipsychotics, tricyclics, stimulants, antileptics, all drugs that have been used to treate ADHD. None have been shown to directly affect the source of the behavioral problem in the first place. The former two often causing devastating flattening of emotional behavior. And tricyclics, originally an anti-depressant now deemed too high in side effects for use in adult depression. Given what’s known about these pills, and what’s not known about how they work, some might charge that the criminal neglect lies in trying to distill the treatment of a complex psychological phenomenon down to a single little pill.

The Multimodal Treatment Study of Children with ADHD, or MTA, funded by the National Institute of Mental Health, indicated pharmaceuticals trump non-drug options for speedily alleviating the core symptoms of hyperactivity, impulsiveness, inattention and aggression. But it acknowledged more than a pill is needed to address such overarching problems as arrested academic achievement, poor social skills or conflict at home or school.

Yup, psychoactive drugs are good at forcing gross behavior into the mold one wants (i.e. symptom treatment). What they’re not so good at is attacking the underlying cognitive and emotional sources of the behavior (you know, causes).

Those challenges appeared better served with a combined approach that supplemented medication with teacher consultations, 27 group and eight individual behavioral training sessions for parents and an eight-week intensive summer program aimed at boosting the child’s social, sports and scholastic skills.

Huh, I never thought that actually going after the behavior itself would be effective.

And, as always, the early gains of medication-based therapy tend to disappear over time. Because, as I said, the drugs crudely force your mind into a mold by playing with serotonin, norepinephrine, and dopamine. They don’t do much more than that. Behavioral training, on the other hand, gets to use the brain’s greatest strength; its plasticity. Which is why generally within a year or two, the behavioral kids accelerate right past the drug kids. One group has learned to deal with the way their heads work. The other has just had it covered up.

linky

This series on ADHD with periodic installments at Science Daily is a really fine piece of work, exposing the lack of understanding of ADHD treatment of the very doctors that prescribe them, and the seeming unwillingness of them to deepen their knowledge or address the problems with the science. Here are some of my comments on earlier installments.

on to the article:

Why, many wonder, do stimulants settle down children who already appear to be overstimulated? And why do prone-to-abuse Schedule II controlled substances not only not get hyperactive children hooked but also apparently lessen their risk of future addictions, as most studies suggest and most mainstream practitioners contend?

Here’s a hint, because they’re not really overstimulated. They’re actually understimulated. Basic ecologically-valid cognitive neuroscience here. Which is why it’s so funny that they don’t get it.

As for addiction, it’s a well known phenomenon that the slower and more controlled the release of the drug is, the less likely it is to addict. Some researchers try to argue that the decreased incidence of drug addiction among children on these drugs is proof of their beneficial effect. This is completely unsubstantiated; a chronic pain patient on controlled release Morphine is less likely to become addicted than a chronic pain patient undergoing no pain treatment. This isn’t because of some beneficial psychological effect, but simply because you tend to self medicate with the street drug version ; which because of the rush is much more addictive. It’s simply because the doctor gets to the patient before the drug dealer does.

Researchers say the compounds appear to help suppress certain behaviors by altering one or more of three chemical messengers in the brain, the neurotransmitters dopamine, norepinephrine and serotonin, which the prevailing, though far from proven, theory implicates in ADHD comportment. In a counterintuitive twist, the chemical change somehow leads to improved self-control — provided the dose is right, investigators say.

Too much drug, and the hyperactivity revs up into even higher gear, while attention span sputters.

In one of the first studies to probe the mystery in humans, government researchers observed in lab experiments how the stimulant Ritalin boosts levels of dopamine, the brain chemical associated with feelings of reward and pleasure, stimulating attention and motivational circuits that fire up the ability to focus and complete tasks.

And it’s not counterintuitive at all. As anyone with a basic neurobiology background could tell you, memory and attention are intimately connected with emotion, drive, and reward as even they themselves state. As one of my neuro profs pointed out TODAY, one of the things that makes 1st year medical school so hard compared to later years is that there’s less of a connection to patients, less of an emotional involvement, and seemingly less goal-driven. Which is why it’s so funny that they don’t put two and two together. These kids aren’t getting motivational stimuli from the modern classroom. Hence the low dopamine and inattention. As always, one should apply the Monkey Rule. Bad for monkeys, bad for children. Can you imagine a monkey paying much attention to the teacher in a classroom? No, total lack of interesting phenomena. Same with children. Yet, instead of fixing this lack of motivational stimuli, instead they titrate up the dopamine levels in the brain directly.

These circuits do not work at full capacity in those with ADHD, who stray off focus with the slightest distraction, the controversial theory goes. By normalizing the chemical levels, Ritalin should get them back on the attention track, scientists speculate.

Or, you know, it could simply be that these circuits never get stimulated in the first place.

As always, the tireless Dr. Baughman offers his contrary opinion (I’m a fan if you hadn’t figured out by now):

“There is no psychoactive drug that does not injure the brain short- and long-term and impair perception, learning and adaptation. So a drug abolishes ADHD behaviors, conduct disorder behaviors, oppositional defiant disorder behaviors. They do nothing but abolish,” neurologist Dr. Fred Baughman, a long-time critic of the use of psychiatric drugs in children, wrote in an April 18 infomail sent to his Website subscribers. “When is the child to learn to control these behaviors with the normal brain God gave him?”

Are there children that truly have a brain pathology and need medication? Probably. I’ve never met an ‘ADHD’ kid who fit that bill though. The challenge of psychiatrists is to explain why they use one treatment for ‘gifted’ kids and one for ‘ADHD’ kids.

The ‘gifted phenotype’ is virtually inseparable from ADHD in terms of classroom behavior. But ‘gifted’ kids have an IQ of over 120. Despite showing a similar lack of excitement in the dopamine pathways, it’s taken for granted that these kids have a fully functioning dopamine reward system; it’s just not being stimulated.

Conventional wisdoom then proceeds to pull a 180 on ‘ADHD’ children, saying that their dopamine reward system is broken. Of course, they don’t test this, they can’t show a pathology, they can’t show any difference between these children and ‘gifted’ kids except IQ. Which, as far as I know, hasn’t been shown to correlate directly to attention. There are many kids with an IQ of over 120 that don’t display the ‘gifted phenotype’.

Holes abound everywhere, holes they haven’t been made accountable to fill. Illogical assumptions are made, and are allowed to form the foundation for current psychiatric theory. Brain chemicals are clamped at certain levels, abolishing the basic plasticity that gives us personality, individuality, and flexibility. Those who don’t act as teachers, parents, and society would wish them too are simply prescribed into submission. Those who don’t feel what they want to feel simply prescribe themselves into artifical moods.

Linky

New research has found that women report more pain throughout their lifetime. Compared to men, women feel pain in more areas of their body and for longer durations.

“The bottom line seems to be that women are suffering more than men,” said Ed Keogh, a psychologist from the Pain Management Unit at the University of Bath.

You’d think a post on gender differences in pain should be in either general medicine or under science. NOPE! Because in my non-PC and completely unprovable opinion, this has nothing to do with pain perception or intensity, but pain REPORTING. A horse of an entirely different color.

First off, there’s the whole ‘We withstand the pain of childbirth, so we have to have a higher pain tolerance than men’ line of BS that we’ve heard for years. And if my adrenaline level were high enough, I could literally have my arm blown off and not even whimper. But I probably couldn’t take a saw to it and cut it off right now before I passed out from the pain. There is all sorts of hormonal and neural activity during childbirth (and adrenaline rushes) that doesn’t correlate well to everyday life.

Besides, can anyone (female readers be honest) recall a female who withstood pain better than men in general? If it doesn’t make sense, it probably ain’t right. And this study verified that yes, men do have a greater pain tolerance and threshold than women:

In another set of experiments, volunteers were asked to put their arms in an ice water bath. Men were found to have higher pain thresholds (the point where they began to feel pain), as well as higher pain tolerances (the point where the pain became too much).

There are no doubt some differences due to hormonal fluctuations and sex differences in brain wiring:

“There is evidence for hormones, like estrogen and testosterone, affecting a person’s pain experience,” Keogh told LiveScience in a telephone interview.

Women report varying pain experiences throughout their menstrual cycle, when estrogen levels vary widely. Moreover, pregnant women — who often have elevated estrogen levels — can tolerate the intense physical pain of childbirth.

Of course one can’t deny the cultural and psychological aspects of gender roles. Men must be stoic. Women are emotional:

“Social and psychological factors cannot be ignored,” Keogh said. “We have found that women will focus on the emotional response to stress.”

In contrast, men typically think only of the sensation itself, which may explain their higher thresholds and tolerances.

“Women who concentrate on the emotional aspects of their pain may actually experience more pain as a result, possibly because the emotions associated with pain are negative,” Keogh said.

From my own experience both in general social settings and in more clinical settings (not near as much of the latter, I admit), women tend to report and to exaggerate their level of pain more than men. I guess you could call that ‘focusing on the emotional aspects of pain’, personally I call it attention whoring.

Chronic pain is something I know a bit about. Due to nerve damage and the resultant muscle atrophy and joint damage, I’ve experienced more than my fair share of pain; a good deal more than most–if not all–of my readers. One thing you learn about higher levels of pain, especially when it lasts for an appreciable amount of time, is that it tends to manifest itself in certain physical and psychologic signs. I’ve never met a person who this wasn’t true in.

Pain is usually reported on a scale of 1-10 in clinical settings. I spend my time between 4 and 7 day to day, and sometimes up around 8. After nearly 10 years, no one can tell I’m in pain at around 4-6. At around 6 my back goes rigid and I start clenching and unclenching my fists. Around 7 and above I get cranky. Real cranky. And this is in a very controlled, very adapted, very idiotic individual. In most people, you’re going to see much greater signs.

When I’m shadowing or volunteering in clinical settings, I often see women come in and report relatively new pain at around the 7 or 8 level. The first time you feel a 7 or 8, you’re going to *know* it. And so will everyone else. Clenched jaws, clenched fists, rigid back, cranky and snappish as a 15 year old chihuahua (and let me tell you from personal experience, it doesn’t get much more cranky than that). You are not going to walk with a loose comfortable gait, spring up onto the exam table and say hi to the doc with a smile. But that’s what I tend to see in these women.

Un-PC? yeah. Judgmental? yeah. Right? I’d put money on it.

Normally, livescience is pretty good. This article, however, is execrable.

Part of it is the author’s subtle but obvious bias toward the “everything else makes me fat except the fork full of food heading toward my mouth” school of thought. Part of it is the disinformation, oversimplification, and embellishment of the researchers they quoted.

Quick genetics lesson. Genes don’t always perfectly correlate to the phenotype they code for. In addition, much of the time they don’t directly code for a specific phenotype but indirectly infleunce it. There are two terms in particular we need to pay attention to whenever we discuss how genes influence a particular physical characteristic:

Heritability - Heritability is simply the proportio of total (phenotypic) variation that is due to genetic variation. Phenotype is influenced by both genotype and environmental factors. It’s important to note that heritability doesn’t actually measure how much a trait is influenced by genetics and environment in the individual , merely how much variation in the population is affected by each.

Penetrance - This has to do with how strong the correlation is between the presence of the gene itself and the trait it supposedly ‘codes for’. In a highly penetrant gene, you’re pretty much going to develop the trait regardless. An example is Huntington’s. In a gene with low penetrance, on the other hand, even though you have that gene that ‘codes for’ it, you may or may not actually develop the physical characteristic or symptom.

Heritability is thus a population-wide characteristic that cannot be readily applied to the individual, while penetrance is a measure of genetic influence on phenotype at the individual level.

K, genetics lesson is over. You typically see heritability of about 25-50% in the studies I’m acquainted with. After looking through the actual scientific paper, I noted they gave no data on the magnitude of the effects of these genes on body shape and body fat level. Also, they focused on gene expression rather than presence or absence of a certain allele. So they’re not even looking at genetic differences, per se. Genetic expression changes all the time in response to environmental factors; it’s practically a necessity to life that expression changes. In other words, not much substantive about the size of the impact of these genes, the causative nature of these genes, or the degree of environmental lability was given in the article. Now on to a play by play of the live science article/interview.

But without looking at you, Kahn can examine a sample of your genes and tell you if you’re shaped like an hourglass or a pear and whether you have huge hips or a beer belly.

“By looking at your genes, we can tell how fat you are and how your body fat will be distributed,” Kahn said yesterday.

You probably know someone who’s been heavy most of their life, but proceeded to lose a lot of weight based on hard work alone. I know several myself. Or, if you’re a night owl, just channel flip until you get to one of those infomercials for an exercise program. According to Kahn, those people don’t actually exist. Which I find amusing.

It’s pretty easy to see that both fat distribution and total body fat levels run in families, but the idea that ‘fat genes’ have total penetrance is absurd. As I’ve mentioned before, basic thermodynamics says otherwise. Fat gain and loss intimately depends on a human’s interaction with his environment. It is therefore impossible to imply that fat and obesity are genetic. The genes can influence that interaction, but they cannot supercede it.

Three genes—named Tbx15, Gpc4, and HoxA5—express themselves so distinctly that the differences can be used to predict a person’s body mass index (BMI) and waist-to-hip ratio.

“This finding suggests that the expression of these genes could be related to the pathogenesis [production and development] of obesity,” said Joslin researcher Stephane Gesta.

Two outrageous statements here. Because, as i said, genes can influence the interaction between you and the food you eat, genotype can be used with some predictive value. However it will not be a one-to-one correlation, because, as I said, ultimately it’s a matter of caloric intake as much as it is of activity and expenditure.

The second statement about obesity having a pathogenesis is even more outrageous. Obesity is a normal physiological and thermodynamic response to consuming more calories than you expend; excess energy is stored as fat, the more excess you have, the fatter you get. Obesity can result in pathogenic process, but that’s a secondary problem. Athletes develop joint problems, especially if their training involves weight work. Due to their larger musculature and the greater forces they put on their joints, cartilage and capsules can deteriorate faster. Like obesity and related health problems, there’s a strong correlation. But is becoming stronger a pathologic process? No, it’s a normal physiological and histological response to environmental stimuli. Pathogenesis in fatties and muscleheads is secondary to their fat content and their muscularity.

The study raises huge questions: Does body shape predict obesity, or is it a result of obesity?

“While we don’t know yet whether this genetic activity is a cause or an effect of obesity,” Gesta said, “these data do suggest that different forms of obesity could be a developmental problem that begins very early in life.”

Again, these genes begin their influence very early in life. Anyone would have to be stupid not to see it. But the developmental problem is behavioral. These kids have less leeway in how much they can eat and what they can eat. So do we give them a pill so they can eat as much candy and drink as much soda and supersize their value meals? Or do we teach them how to control their weight by not being idiots?

And an even bigger one: Can you alter the potentially deadly fate your body shape might suggest is in store?

“Now that’s the big question,” Kahn said. “While we now can predict the fat pattern, we have no magic bullet to alter the outcome. But with these new findings, we have identified potential targets for perhaps one day changing body shape. We don’t have drugs to alter the pattern now, but perhaps in the future we will.”

Now this is the most ludicrous statement of the entire deal. These people act as if naturally large people have never lost weight. I’m literally at a loss for words at this point. Not because I don’t know how to reply, but because the only reply I should use at this point are profanities and the casting of aspersions on their ancestry, intelligence, morality, and personal philosophy.

I’m outtie.

I’m more interested in psychological and psychiatric therapy than I am in theory (since that’s what I’m in school to do), so I’ll restrict my discussion of this largely to that context.

Have you ever been in a situation where there was just soo many ways to attack a position that you didn’t know where to start? Kind of like your first visit to Disneyland where you spent so much time trying to decide what to ride, that you wasted too much time to actually do any of the rides? Well, that’s kind of how I feel about psych. There are just so many objections to the current state of affairs that I never know which one to bring up first; and even worse, I’ll sometimes drop one halfway through to move on to the next one. The last time I attempted to put all my thoughts on psych into a single coherent series of essays, I ended up with a laughable result (which you can see in the earliest days of this blog). But, I’m going to try again.

The problem with psych is that it operates in a vacuum.

What I mean by this is that often times psychological theory seems to be pulled out of thin air, with little regard for other disciplines that also study the brain and behavior. A perfect example of this is Maslow’s Heirarchy. Personal experience, as well as stories handed down through the ages would seem to contradict Maslow’s supposition; self-actualization tends to be driven by a desire to achieve such things as esteem, belonging/love, and safety. Indeed, those that have all 4 of the ‘lower’ needs often show very little in the way of self-actualization (think trust-fund kiddies, etc).

As you peruse the vast array of psychological schools, you see they are founded on everything from ‘progressivism’ (Critical Psychology) to, well, nothing (Radical Behaviorism). Which brings me to my main contention: Psychology has failed to harmonize itself with what is known about the origin and development of brain and behavior.

While perusing Moti Ben-Ari’s excellent Just A Theory: Exploring The Nature Of Science, I caught a diagram he’d based off of the famous The Structure of Scientific Revolutions by Thomas Kuhn. Ben-Ari’s work is an excellent treatise on how science is done. Something that all psychologists and psychiatrists would do well to read. Anyway, here’s the diagram (click to see a larger one).

Maslow’s heirarchy, Piaget’s theory of child development, the psychiatric ‘chemical imbalance’ theory of depression(click on my psych or medicine categories to see more of my rants about the unscientific nature of psych), all of these are still at the pre-science stage. Their original paradigm has been assaulted by anomalies regarding the purpose of the brain (they evolved for a reason that probably had nothing to do with helping us to ‘achieve happiness and harmony’), the environment the brain operates best in (the traditional classroom is not an environment in which we’d expect what when all is said is done is basically a hairless monkey to thrive in), as well as the constancy and adaptability of the brain (unlike your computer’s circuit board, the brain regularly and constantly rewires itself).

Only problem is, these blatant anomalies have failed to result in a crisis. It’s as if all this evidence simply didn’t exist in the world of psychoogical theory and therapy. So what we’re continually stuck with is a pre-science paradigm that–because it has insulated itself from the fields which speak to the biological origins and nature of the brain and behavior–will not acknowledge a need to develop a new paradigm. Operating in a vacuum.

All theories are based on assumptions. These assumptions are usually based on observation of some sort. Over time, as our perception increases in accuracy and complexity, the observations themselves change. And with that comes a change in assumption…which will either lead to refinement or destruction of the old theory. The long-held theory that the sun revolved around the earth made sense given our observation that the sun seemed to go from east to west from dusk until dawn, only to end up on the east at dawn the next day. There was no reason to suspect that the earth either rotated on its axis or revolved around anything. With the dawn of modern astronomy, it became clear that the Earth was rotating, and–given the precession of the stars–was orbiting the sun as well. Which led to Copernicus’ famous pronouncement that the planets orbited the sun…in circular orbits. Keppler and his lapdog, Brahe, using increasingly accurate astronomical data, found that rather than being perfectly circular, their orbits were elliptical (basically take two ends of a circle and pull on them). The new observations led to new facts (elliptical orbits) which changed the assumptions and modified the theory rather than abolished it.

The psych establishment has consistently failed to take into account the new observations, assumptions, and theories developed through bioanthropology (paleoanthropology + primatology), behavioral ecology, and neurobiology; in the remainder of this initial essay, I’ll try to briefly discuss some of the more glaring omissions from psychological theory.

Darwinism:
1. The variability of traits in populations - Before (and sadly even after) Darwin there remained the idea of the ‘type specimen’ for a species of animal. If the ‘type’ happened to have mottled orange and black fur, then the ’species’ had mottled orange and black fur. Individuals who had more orange or more black were ‘imperfect’. As Darwin postulated (which makes more sense), there is actually a ‘range of normal’; rather than a species standing 27″ at the shoulder it would be characterized by the range of 24-29″. Psych currently has little or nothing in the way of established guidelines to determine what lies in the normal range and what lies outside it; the current trend seems to be that if a teacher/parent/lover makes the decision that your behavior is ‘abnormal’ then it is, and that if you don’t feel as good as you want, then you’re ‘abnormal’. (Are socially anxious people really that abherrant? Or do they merely lie at one end of ‘normal’ in a social anxiety spectrum?) Are we doing the mental health equivalent of declaring that being a 5′6″ tall male is a disease?

2. The sheer pervasivenes of ‘mental illness’ in the states must give one pause. The lifetime incidence of psychiatric illness is round about 47% if we listen to the dominant perspective. That’s sicker than dalmatians for crying out loud (for those who’ve never known one, they’re some of the most inbred, problem-filled dogs in the world due to pedigree/breeder issues). How did we get that sick? In the evolutionary struggle, those traits which make one individual less able to survive and reproduce than others will usually result in that individual’s elimination. By all accounts, depression, anxiety, and the like are not fun and substantially affect one’s ability to act in a normal fashion. They can’t have been good things to have for a hunter gatherer living in a Puma filled jungle. If depression, OCD, Bipolar, any of those ‘fairly common’ disorders are idiopathic–not due to outside factors–in nature, then how did they become so high in frequency, given their devastating effects? While natural selection can overlook more ‘minor’ faults (like the presence of an appendix, or flat feet), such large effects in such large portions of the population would not likely last. We are left with the proposition that in all but a handful of cases (I’ve only read about one family in eastern europe that is absolutely 100% depressed due to a serotonin receptor defect), these diseases are either developmental in nature, or are not diseases at all but *injuries* (I’ll come back to that later). And, while susceptibility has been shown to be heritable, see point number 1.

Bioanthropology:
1. Big brains evolved long before modern society did. Fully anatomically modern humans were around between 160,000 and 200,000 years ago. This means that the human brain was not designed to operate in modern society. And this is an important point. While it may function well enough, there will inevitably be friction when a brain designed to interact with 50-100 people intimately is suddenly plunged into a world where only the most reclusive interact with that many, to mention just one of the original ‘design parameters’ at odds with our current situation.

Why this is important is because of the ready use of the word ‘adaptive’ and ‘maladaptive’ to describe behavior in a modern setting by mental health professionals. They show a willingness to declare that a normal human behavior is ‘maladaptive’ in a certain setting and therefore must be changed. This is equivalent to saying that the response of high blood pressure, atherosclerosis, and heart disease to a junk-food-filled modern life is ‘maladaptive’ and therefore the physiological response should be changed. Yet, few doctors would say that nothing is wrong with eating copious amounts of big macs and whoppers. The way we’ve constructed our environment should be under scrutiny, but rarely finds itself there.

2. As TH Huxley–Darwin’s famous ‘bulldog’–was known to remark, he was unable to find a difference in the gross brain anatomy of humans and other primates; finding differences of degree, rather than kind. Aside from language centers, (which some argue chimps have as well), Huxley’s contention remains largely true today, at much smaller levels of resolution than were available to him. There is no part of the ‘emotional’ and ‘learning’ systems of the human brain that isn’t present in apes, monkeys, and indeed most social mammals. Studies of these parts in humans then must be grounded in their origination and purpose in ‘lower’ animals.

The conception of ‘Attention’ is one of the most lucid examples of the differences between psychological schools and evolutionary schools. Attention in animals is goal-directed. Perceive a stimulus, identify the stimulus, categorize the stimulus, act in response to the stimulus. If the stimulus is a blade of grass, it’s irrelevant. If it’s a banana, make screeching noises and run up the tree to grab it before everyone else. If it’s a leopard, make screeching noises and band together to ‘mob’ it by throwing sticks and stones until it leaves for less annoying prey. Compare this to children, who are told they are ’sick’ and then given meth in pill form if they can’t hold their attention on a non-goal-oriented stimulus. Sitting in lecture in med school, it’s hard to find anyone who can sit still or pay attention for an entire hour; and yet we expect that from our children?

Neurobiology:
1. Unlike most of the organs in our body, the brain regularly and dramatically reorganizes and rewires itself in response to outside stimulus. Most other tissues simply respond. About the only tissue that even comes close is muscle tissue. In response to type and amount (or lack thereof) of exercise, muscles can increase the size of their fibers, the metabolic type of fibers (anaerobic or aerobic), the emphasis on structural type (slow-twitch and fast-twitch), and the size of attachments to bone. The brain can and does all that regularly (see Hebbian and Anti-Hebbian synapses), but it can also change how it connects to other cells in the same lobe and other parts of the brain entirely. This would be like your muscles able to change which bones and ligaments they attach to from exercise alone.

However, the brain is largely treated as a computer. The PC on which the ’software of your mind’ is run. Plasticity and Hebbian synapses are never mentioned in the psych literature. No mention of the fact that the brain functions on a positive feedback system rather than a negative feedback system (again unlike most other tissues). Indeed the way we approach treatment to issues with the brain is much as we’d approach treating a broken negative feedback system. The brain is both software and hardware.

2. Although there is much we do not know about brain circuitry, we do know enough to begin to form a paradigm of brain function. We do know which parts of the brain do what, in a general fashion. And we know how they connect to each other, for the most part. Tying back in to my example of attention, the current psych perspective on learning and attention can be shown to be flawed through basic neurobiology as well. In most mammals, the ‘attention areas’ of the brain are connected to the emotional centers of the brain. Furthermore, in all ‘higher’ primates (humans included), the attention areas are also hardwired into the visual centers. The result is that attention is inextricably linked with emotion, in addition to which one’s attention will automatically and without conscious will be redirected to new visual stimuli. The human brain is not an attention maintaining machine, but an emotional-context-dependent goal-oriented attention switching machine.

3. Neurotransmitters, Pathways, and Treatment. As I pointed out in my earlier link, even the way we treat depression doesn’t harmonize with what is happening. In the very simple circuit I illustrated in that post, we have a ‘presynaptic’ nerve and a ‘postsynaptic’ nerve. The ‘presynaptic’ nerve fires in response to the external and internal situation (roughly speaking, firing=situation good, not firing=situation bad). The postsynaptic nerve responds to this by inducing a mood change through firing in response. This is an extreme oversimplification, but it’s a fairly accurate one. So what we have is:

situation good–>presynaptic response–>postsynaptic response–>feel good.
situation bad–>no presynaptic response–>no postsynaptic response–>feel like crap.

We medicate by changing the behavior of the postsyanptic cell. Making it fire no matter what the presynaptic cell is doing. Because the postsynaptic cell still responds just fine, this means the problem wasn’t with the postsynaptic in the first place. The problem was either in our perception of the situation, or in the presynaptic cell. Both of which continue to be ignored by most researchers, due to the fact that depression is ‘clearly idiopathic’. It fixes the symptom, but completely ignores the cause.

Putting It All Together
What we’re left with are a series of facts that the psych establishment has more or less ignored completely. They give us a clearer and more grounded picture of how the mind came to be and what it was designed to do. With this information we can proceed on a clearer footing, both in successful treatment of mental health problems (by an accurate assessment of symptom versus cause) and avoidance (by determining the ways in which the modern environment doesn’t harmonize so well with the big monkey brain on our shoulders).

The human brain is simultaneously more limited and more plastic than the psych establishment has given it credit for. The goals it was designed to reach, the way it was designed to achieve those goals, and the environment in which it was designed to function cannot be inferred by looking at humans in the modern context as it bears no relation on our origin. Only by looking at the evolution of the brain and behavior can we understand how to effectively treat the human brain.

Most importantly we need to redefine mental health problems in a more concrete heirarchy. Being a mere student myself, I have no business weighing in quite this far into the discussion, but since this is just a blog I’d establish the following three categories and definitions:

1. ‘Idiopathic Illness’–This would be the bonafide, headscratching ‘we have no clue what’s going on here’ kinda thing. Schizophrenia, that Eastern European family I mentioned, some forms of bipolar, and the like.
2. ‘ Illness’–Mental illness as a result of a definable environmental or developmental insult. In some cases it’s an event. In others it’s not learning to think in a certain way. Depending on the age of the person and how long/severe their mental health problems were, these may or may not be reversible.
3. ‘Mental Injury’–This category is the novel one, and I could see it encompassing the majority of people who have depressive episodes, anxiety problems, body image disorders, and the like. As I mentioned earlier, the only tissue that is all that similar to the brain are muscles. And muscles can get injured, partially because they, like the nervous system, also in some ways operate on a positive feedback mechanism. In other cases they get injured because we abuse them in ways they weren’t meant to be used (my mom is glaring at me and my weights when I say this one). The longer you don’t lift weights the harder it is when you start again. The bigger you get, the faster you run, the more awkward a position you get into, the more likely you are to get hurt once you leave the design parameters of the human body. It can be much the same case for humans. The horrors of war and post traumatic stress. Peer ridicule, desire to belong, and starvinve oneself. Or the basic neurobiological principle that the more you think sad thoughts the harder it is not to think sad thoughts (Hebbian synapse). With these injuries a combination of medication and therapy (depending on severity one emphasized more than other) could be used to get people back on their feet.

Conclusion:
I’m no Thomas Szasz. And I’m certainly no Cosmides or Tooby (wh0 in my opinion make the mistake of thinking that science can say MORE than it really can). And I don’t believe that people with the ’softer’ mental health problems are ‘weak’. But I don’t think they’re diseased either. There’s little evidence to support that contention. And as a person who’s suffered more than his fair share of physical ailments, there is nothing worse than a doctor who tells you that you won’t ever be fixed and will need to keep taking this medicine for the rest of your life to feel normal.

I prefer to see these mental health ailments as injuries because we’ve not shown an irreversibility that I consider the hallmark of an illness. Although some claim otherwise, my searches through everything from Ovid to Google Scholar do seem to indicate that cognitive behavioral therapy and interpersonal therapy are as or more effective than drugs. And like I said, the drugs do have a purpose, but I’d contend that purpose is to alleviate symptoms long enough to get the work of ‘fixing’ them done.

Currently it seems that every differentiation from the norm, every abherrant behavior, is an illness or a disorder. That pills are the only ‘treatment’ in sight. And that apparently 47% of us have a brain disease of one sort of the other. This is a perspective that makes little sense given the reality of our origins and the flexibility of the brain. By being honest about what is known about the brain and what really is illness and what isn’t, we can look for the origins of mental health problems and ruthlessly eliminate them. I will be happy man on the day when as few of my patients as possible are on long-term psychoactive medication, none are in my office because of mismatch between man and environment, and most come in eager to work through their injuries, aware that with a little hard work we’ll end our relationship with them free of trouble and stronger people besides.

God, sometimes ‘educators’ and ‘mental health professionals’ can be so blind I’m not sure how they function. One of my criticisms of the validity of ADHD has long been that a human child and a traditional classroom environment couldn’t be stranger bedfellows. Can you really think of any place more ill-suited to a child’s temperament? Hell, even now in medical school, us twenty-somethings can barely stand to sit still for an hour, listening to a droning and boring lecturer. And yet we medicate children for that very inability.

Putting an animal in an environment it wasn’t really meant for tends to result in some strange behavior. If you’ve ever been around caged monkeys, or an inside dog its first time in a national park, you’ll know what I’m talking about. I’ve long held that ADHD behaviors are a combination of 1) A defect of the classroom and 2) A lack of discipline. Because that’s how ADHD tends to be diagnosed. In the classroom. Indeed, in ‘gifted’ kids, who act almost identical to ADHD kids (but have a high IQ), this is exactly the rationale given; the classroom is ill-suited to a ‘gifted’ child’s learning style and temperament. Personally I don’t see how learning style and temperament correlate to IQ so solidly that we can say that ADHD kids don’t simply share these atributes with gifted kids.

Anyway, on to the article.

The fidgety boys and girls in Phil Rynearson’s classroom get up and move around whenever they want, and that’s just fine with him. In fact, stretching, swaying and even balancing on big wobbly exercise balls are the point of this experimental classroom.

One of the reasons they’re trying this out is to actually curb obesity. Which would probably help, honestly. General activity level is a good correlate of Basal Metabolic Rate. While these kids’ fidgeting, swaying, and hopping probably burns minimal calories as a form of exercise it will probably go a long way to helping them operate at a higher burn rate even at rest.

But the interesting thing here is just how similar this is to the Montessori system. Some call that system ‘anarchy’, and a ’structure-less free for all’. Far from it, it allows the child to work in a way that suits them. It’s one of the most effective schooling programs in the world, in my opinion. And if it is at all possible, it’s the route my kids’ll go.

The data aren’t in yet. But anecdotally, Rynearson and Superintendent Jerry Williams say the fourth- and fifth-graders are more focused on the curriculum than their peers in a comparison group in an ordinary classroom. And there are fewer distractions than in the traditional setup — where a lot of time is spent trying to get children to sit still.
“Sitting isn’t bad,” Rynearson said. “But I think kids need to move.”

Funny, for all the crap that more traditional-minded ‘educators’ spew about Montessori, this is exactly what one would predict if they opened their eyes. It’s exactly what you see in pre-schoolers and early grade schoolers in Montessori. So why not later on?

The students had mixed views of the experiment. Stephanie Mueller said she liked working on the computers, especially being able to repeat parts of lessons. And the freedom to move is “better than sitting down all day,” she said.

Heh. Expected by anyone with a brain.

Williams, the superintendent, has already been converted to the new concept and thinks it could be expanded, with or without the computers and iPods. “I would love to have this move from a single classroom to the whole school,” he said.

Superintendent Williams. Mr. Rynearson. I could kiss you. And no, not in a Brokeback way (the name Cowboy is in my Blog title, and I haven’t made one Brokeback joke yet, so deal). It’s people like you that can save our kids.

Until learning environments actually suited to humans are more universally instituted, we have no business talking about ADHD, whatsoever. Humans were designed to operate in a much more fluid, much more dynamic environment than the classroom. We evolved from monkeys, hyper, intelligent, curious, monkeys. Could you imagine a monkey in a classroom doing well? Nope, neither can I. If we’d evolved from cows, stupid, slow, stationary, cows, we might not be having this ‘ADHD epidemic’.

As time goes on, the medical profession advises people on their lifestyles more and more everyday. Pets relieve stress and extend your lifespan. Just 20 minutes of walking a day can make you healthier. Reduce your cholesterol. And my favorite; if you’re a trucker, take out your wallet so your spine doesn’t get crooked. We still have anti-anxiety medication, and we still have LDL-lowering drugs, and we can treat that arthritis, but we certainly don’t ignore the environmental component.

We understand that the human body isn’t necessarily designed to take the environment and influences we put it through. We need to extend that perspective to the human mind.

I’ve been following ScienceDaily’s series on ADHD for a while now. The articles have been as fair to my side of the debate as one could possibly hope and they’ve never hesitated to show the holes in both sides of the ADHD treatment argument. The newest article is hands down my favorite. Honest and clear.

In discussing ADHD treatments, consider some straight talk about the disorder:

– Diagnosis is in the eyes of the beholder, there being no biological diagnostic test.

– There are compelling clues but no patented proofs of the basis for the disorder.

– There is no cure.

– Treatment can control behavior, but there is little evidence it can increase knowledge or improve academic skills or achievement.

– The condition is chronic, likely to last years, perhaps decades, with the majority of children affected to some degree into adolescence and even adulthood.

– Most children improve with age, showing fewer symptoms and problems by their early 20s, whether or not they receive treatment.

– There is a dearth of sound scientific evidence of the effects of psychotropic drugs on growing brains and bodies over the long haul.

– Every chemical treatment, even when properly prescribed, can have unwanted and oftentimes unforeseen effects.

– Inappropriate administration of medication, either for the wrong child or at the wrong dose, can have additional, devastating, even deadly, consequences.

– All treatments come with caveats.

– Most psychiatric drugs are not approved by the Food and Drug Administration for younger age groups, and, like the majority of medicines for minors, are used “off-label,” or at the doctor’s discretion.

Well written. All I have to add is that we haven’t shown that ADHD type behaviors are anything more than simply one end of a personality spectrum. Ms. Wasowicz, excellent stuff.

…the annual number of prescriptions written for ADHD over the nine years mushroomed by a factor of 5, capping at 11 million for methylphenidate and 6 million and counting for amphetamines.

An estimated 80 percent of the total, or some 14 million, were for children, with 40 percent of these for youngsters 3 to 9. In addition, doctors made out 4,000 orders for stimulants for tykes 2 and under.

Critical of such trends, the DEA has made a point of noting most of these drugs are not approved for use in children under 6 and none for toddlers under 3 because their safety and effectiveness have not been established in those age groups.

These are basically street drugs. Stimulants are known to affect animal development at the neurological level in virtually every kind of multi-celled organism. Childrens’ brains grow and continue to form new synapses until they’re my age and older. Stimulants should thus be considered guilty until proven innocent as far as their effects on developing brains go. Indeed, Fred Baughman, MD has argued that extant research shows that use of stimulant ADHD meds for as little as a year can shrink the frontal lobe significantly. The frontal lobe would be what we think of as the seat of personality and consciousness, and to a degree, intelligence.

The preponderance of mainstream research suggests psychiatric drugs, if properly administered and monitored, are safe, at least in the short term, and effective, at least for clamping down on the core symptoms of ADHD, but there is little hard-core evidence they upgrade a child’s scholastic skills.

These kids are more sedate, but they aren’t learning any better. Anecdotal evidence of this can be found at nearly any school and any community as concerned teachers and educators talk about how the drugs destroy the ’spark’ that once drove some of their brightest, but least controlled, students.

It sure as hell seems to be that these ADHD meds basically function like a frontal lobotomy (and given Baughman’s very valid contention, they may be precisely doing just that). You’re a little bit less erratic. But you’re also a lot less you. Before we go shoving methylphenidate or amphetamines down these kids throats, it might be advantageous to try to see if they can learn self-control on their own. I did (more or less). And I kept my spark.

A new study finds that depression in their mother can often trigger depression in the child.

Houston, we have a problem. If it’s a biochemical disease, it shouldn’t be triggered by mere thoughts and behaviors. Yet, that clearly seems to be what we find:

The study results indicate that for children of depressed mothers, that trigger is sometimes their mothers’ illness acting up, said lead author Myrna Weissman, a researcher at Columbia University and New York Psychiatric Institute.

Sounds about right. Mommy, the central figure in your life, is acting a little sad. That sadness is going to affect you just a bit as well. Of course, mommy’s ‘chemical imbalance’ can’t induce your own chemicals to go off-kilter directly, now can they? Nope. Here we have thoughts influencing the biochemical picture. Just as you’d expect.

Effective treatment for mothers could mean their children might avoid the need for prescription antidepressants, the researchers said.

Since we know that the mothers’ depression is making the kids depressed, why would we use a biochemical treatment in the first place? The biochemicals aren’t the issue here; the home environment and the emotional state of both mother and child are. Health professionals shouldn’t be ameliorating symptoms, they should be aggressively and doggedly rooting out the cause of the symptoms.

Heh, they brought in ADHD, without me even asking for that talking point:

Dr. Peter Robbins, a Fairfax, Va., psychiatrist, said he’s seen similar results in his pediatric practice, and not just with depression.

For example, children with attention deficit/hyperactivity disorder often have similarly afflicted parents. Getting treatment for the parents yields improvement in the children’s symptoms, he said.

Again, if ADHD and Depression are solely the result of organic brain pathology, then we wouldn’t expect these results. If the parents are leading more controlled lives, staying on task, and being better organized, this is percolating down to the kids. This is thought and action in the model (parent) being reflected in the imitator (child). The fact that thought and action have such a profound effect on behavior–and, in depression at least, can be the inducer of psychological problems in others–mean that we can’t look at the brain as the source of the pathology. Instead changes in the brain should be seen as manifestations of these problems. Psychoactive drugs can change the way the brain works, and change the way input is mediated by the brain (making it mimic normal), but they won’t actually get to what caused the change in brain function in the first place.

Sorry about the sarcasm, but it really cheeses me off when the establishment contradicts common sense (and a good deal of neurobiology) by resisting efforts to tell the truth about psychiatric medication and the sometimes dubious claims about the reality and prevalence of various disorders. The latest brouhaha (spelling?) would be over the move to put warnings about the possibility of cardiovascular and psychosis-like side effects with the use of stimulant meds like Ritalin, Adderall, etc. Since many of these drugs are almost indistinguishable from street stimulants like crystal meth (which has long been known to have those side effects), should we be surprised? I mean really, if we’re going to present a coherent front, EVERY downside of stimulants we mention in anti-drug campaigns should be common knowledge to those children and their parents who are offered stimulant medication.

Some doctors, on the other hand, are predictably resenting these moves. They claim that putting such warnings might make parents less likely to ‘treat the disorder’. Of course, they’ve done a horrible job of proving it’s a disorder. Caring educators, parents, and friends continue to mention how those who are put on the drug may be more tractable but often lose their creative spark. The efficacy of ADHD drugs is usually measured by external observers; is the child more like a cow chewing cud in the classroom? Is he easier for mommy to control? And, occasionally, are his grades better? Of course, good grades in elementary school have little to do with later performance, learning, or creativity. For more on my rantings and views on ADHD see here, and here.

Anyway, time for some quoting:

Adding black-box warnings to some or all the drugs, which also include Adderall and Strattera, could cause more harm than good, some experts told the panel.

“I suggest confusion, polarizing viewpoints, initial press hysteria. But then what?” asked Julie Zito, a University of Maryland associate professor in pharmacy and psychiatry.

“What? Allow the minions to be fully informed about the drugs we tell them to take?” What the hell are medical health professionals? Seriously. To think we have a right to restrict information on adverse side-effects from our patients and their parents? Disgusting. I intend to look upon my patients (or their parents) as thinking individuals. To discuss with them how a drug works, and how it can backfire. I trust their rationality and intend to help them make their decision.

Psychiatrists and mental health advocates said leaving the disease untreated could rival the risks the drugs may pose.

“It is important to not let the discussion of ADHD medications overshadow the public health crisis of untreated mental health disorders in children,” said Cynthia Wainscott of the National Mental Health Association. Her 16-year-old granddaughter has ADHD.

“Take speed because your teacher doesn’t want to deal you and your parents won’t force you to develop a work ethic,” is what I’m reading. People with ‘ADHD symptoms’ go on to be very productive individuals without becoming meth-heads. I know this because I pretty much fit the DSM-IV guidelines 100%. Many high achievers do. We learn a work ethic and self control. Does the job just fine. As Thom Hartmann as argued, we wouldnt’ have Edison, Einstein, or da Vinci if ADHD medication were in place back then. These guys haven’t even proven ADHD is a disorder. And they certainly haven’t proven that behavioral controls are good enough. And all right-thinking individuals with knowledge of physiology, brain plasticity, and child psychology should be able to agree that the fewer drugs (especially controlled substances) you need to function, the better.

Jacqueline Bessner of Ishpeming, Mich., said her daughter, Leanne, 15, hanged herself last year two months after starting treatment with Concerta. Bessner said more black-box warnings would be useless without increased counseling and monitoring of patients.

“It’s being handed out like it’s candy,” Bessner said of ADHD drugs. “It’s too easily accessible.”

My heart goes out to Mrs. Bessner, it really does. I can’t fault her for her daughter going on ADHD meds when it’s forced down their throats by ‘educators’ and ‘professionals’. People like Mrs. Bessner and her daughter are why I’m going into psych. The specialty just seems to dependent on disinformation, propaganda, and manipulation, as some of these quotes (and in my earlier two blogposts I linked) show.

And a doozie:

FDA staff said they were struck by reports of several children under age 10 who were taking the drugs and mistakenly thought they saw or felt bugs, snakes and worms crawling on them. The hallucinations and other episodes most often occurred in patients with no known risks factors for such behavior, FDA staff said.

Heh. This should be familiar to anyone who’s more than a little steeped in pop culture. “Fear and Loathing”, “Requiem for a Dream”, need I go on?

Here’s an op/ed that takes a middle of the road stance. In response to the fact that most often parents are told by teachers that they suspect ADHD, the author offers the following:

This raises suspicions: Are some teachers using ADHD to control unruly students, particularly boys, who are naturally more rambunctious? Are parents seeking an edge for unfocused children who are struggling academically? Are time-pressed doctors handing out prescriptions based on little more than a 15-minute chat and a teacher’s note?

Excellent. External sources rather than internal are the way we measure ADHD. Which of course calls into question the motivation of that external observer. But of course, we can’t question that ADHD is real so the author turns right around with:

There’s also a risk in letting fears stop parents from giving their children medicine that could turn their lives around. About 70% of patients see improvement after taking the drugs, AAP notes. Children who go untreated for ADHD are more likely to use illicit drugs, drop out of school and have other problems.

You generally don’t ask a 10 year old kid if they feel like they concentrate better or if they’re being less ‘disruptive’. You ask their teachers and their parents. What do they mean by improvement? Tractability shouldn’t count. I find it also humorous that they point out that kids untreated for ‘ADHD’ are more likely to use illicit drugs. As I’ve said before, does it really matter? Either way they’re chemically dependent.

Doctors have yet to prove that ‘ADHD’ is anything more than a personality type. A personality type that doesn’t fit in that well in the modern classroom, true. But the ‘gifted’ phenotype (basically ADHD behavior with a high IQ…I was changed from ADHD to ‘Gifted’ after I became involved in competitive math and science) doesn’t fit in the modern classroom all that well. We accept this in ‘gifted’ kids because they’re smart (and my high school administrators and teachers ignored and put up with a lot of antics for precisely that reason) while we drug ADHD kids because they’re ‘normal’. You don’t drug up a kid because the modern classroom is broken. My grades in elementary school might’ve been better. And I probably would’ve been less of a behavioral problem in high school. And probably wouldn’t have slacked off in college as much as I did. But I would wager everything in my bank account–well over 10,000 dollars–that I would not be the overachiever I am if they’d drugged me up. The early-life benefits aren’t worth the loss of later achievement that these drugs would bring. Instead we should teach these kids how to control that impulsiveness, how to make it through that hour of class time before you can get up, how to bring just enough discipline into your life to make it through the suppressive school environment before your own personality is allowed to flourish.

As if amphetamines and drugs not too different from ecstasy weren’t bad enough, now we’re giving anti-psychotics to kids who aren’t psychotic in the first place.

4% of all kids are on anti-psychotics. FOUR PERCENT. That is MULTIPLES of the incidence of psychosis among children. But it’s ok because “attention deficit disorder is sometimes accompanied by temper outbursts and other disruptive behavior. As a result, some doctors prescribe anti-psychotics to these children to calm them down — a strategy some doctors and parents say works.” What really angers me is that we still haven’t even done a good job of proving ADHD is real(as I discuss in this earlier post).

People don’t like hyper kids, so they drug them up. Of course it gets rid of the temper tantrums. Anti-psychotics work a lot like horse tranquilizers. Some doctors are raising concerns, pointing to the coincident arrival of heavily marketed anti-psychotics like Risperidol.

Dr. David Fassler, a University of Vermont psychiatry professor, said more research is needed before anti-psychotics should be considered standard treatment for attention deficit disorders in children.

“Given the frequency with which these medications are being used, there’s no question that we need additional studies on both safety and efficacy in pediatric populations,” Fassler said.

But forgetting about safety and efficacy, what about appropriateness? Just because these drugs control the kids, are they a good thing? No one has even thought to ask the kids apparently. Personally, I can say my own growth and development as a person had very little to do with the schooling side of things, despite the fact that many of my friends describe me as ‘over-educated’. If they’d put me on ritalin and risperidol, I might not have had the behavioral issues I had earlier (which basically amounted to being bored out of my skull), and I may have had a slightly stronger GPA. But I wouldn’t have thought the thoughts I’ve thunk, wouldn’t have pondered the things I’ve pondered, woudln’t have written the things I’ve written.

And well, nothing’s worth taking that away from me. Nothing is worth taking these kids’ brains away from them.

If this is for the children, why do all these drugs seem to only involve making things easier on parents and teachers?

I’ll go ahead and say no. My stance on this is a thoroughly researched and well-articulated one. But, it’s also evolved over 4 years and hundreds upon hundreds of research articles. It’s also thoroughly personal. I was told I was ‘ADHD’ for nigh on a decade…until I got involved in math and science competitions and it became apparent that I wasn’t ‘diseased’. I was, in fact ‘gifted’; my brain just didn’t like the classroom environment and thrived in looser confines. As far as I can figure out, the only difference between these ‘diseased’ kids and ‘gifted’ kids like me is IQ. In fact, if you look into the diagnostic criteria for the differential between gifted phenotype and ADHD, IQ is a primary determinant.

Now, I’m a big fan of Occam’s Razor. It is, after all, one of the most powerful tools in both philosophy and science. So we’ve got two groups of kids; the only readily discernible difference being their IQ. So it occurs to me that maybe the only real difference at all is their IQ. Maybe ADHD kids would thrive in the same environment I did; in a less structured, goal-oriented setting that didn’t require I behave like a lobotomized basset hound.

Add to that another crucial argument. Humans did not evolve in the modern world. We’re descended from monkeys, more or less. And, as many neuroanatomists since well before Darwin have remarked; there is scarcely a qualitative difference between our brains and theirs. For the most part we’re looking at a monkey brain with an expanded frontal lobe (seat of consciousness/learning/etc). Can you imagine a setting less ideal for a monkey than a classroom? Thought so.

I’m sure I’m going to catch a lot of flak from status-quo doctors for my arguments (as usual). But just as in the whole depression mess, if you gave me a theory that wasn’t so full of holes it looked like swiss cheese, I might be a little more inclined to accept your contentions. Might.

I chanced on a really good spiel about the ADHD controversy on ScienceDaily today that I’d encourage everyone to read. I’m going to go through some of the quotes and show you the differences in language and tone between the guys I side with and the guys I think are so full of crap that some ex-lax is in order.

First up, the status quo:

“Instead of a culture where we say we have the wealth and resources to identify people with mental illness and offer them treatment, we say instead mental illness is bad, but treatment is worse, so we’ll stigmatize both treatment and mental illness and incorporate the dysfunction associated with that into our definition of normal,” said Dr. John Walkup, director of child and adolescent psychiatry at Johns Hopkins University.
“That’s very sad for a progressive country,” he added. “You live with lots of dysfunctional people and say bad things happen to people, and we can’t do much about it.”

This is a deliberate mischaracterization–bordering on slander–of the position men such as Fred Baughman and Thom Hartmann hold. (NOTE–I don’t entirely agree with Dr. Hartmann’s categorization of ADHD as a ‘hunterer/gatherer’ type behavior. But we do agree on the fact that ADHD represents what would be seen as adaptive behavior in a non-modern context). And I’m trying to stay apolitical, so I won’t even touch the ‘progressive country’ comment.

The position of skeptics isn’t that ‘treatment is bad’ but that if we’re going to use a biochemical treatment, we should show a biochemical cause. The establishment hasn’t yet, and probably won’t (I believe). Dr. Hartmann, far from stigmatizing ADHD holds that ADHD characteristics are what enabled men such as Thomas Edison and Einstein to achieve what they did. All we are saying is that before we give these kids amphetamines (Adderall) or other stimulants (Ritalin), we should probably have a stronger scientific footing to do so. Symptom and disease can be two different things. Covering up the symptom is not the same as treating the disease. And that assumes it’s actually a disease. We counter the notion that humans should fit precisely into one mold. We believe that ‘normal’ for humans encompasses a wide range of behavioral attributes, learning methods, and personality quirks, and that the current ‘disorder mania’ of psych has resulted in the active suppression of individuality. Hard-to-teach and hard-to-control have more to do with the parent and the teacher than the child. In fact, they’re defined by how the caretaker looks at the child. Which means we’re not being child-centric at all. Just making life easier.

And then the skeptics speak, the words of Dr. Frank Baughman (who I DO agree with almost in toto) below:

“They made a list of the most common symptoms of emotional discomfiture of children; those which bother teachers and parents most, and — in a stroke that could not be more devoid of science or Hippocratic motive — termed them a ‘disease,’” he said.

“Twenty-five years of research … has failed to validate ADD/ADHD as a disease, and yet, the ‘epidemic’ has grown from half-million in 1985 to between 6 million to 7 million today!”

Remember I mentioned the disease mania earlier? 25 years ago they claimed it was a disorder. Without any neurobiological proof. The timeline does help explain why this 22 year old has been plagued with accusations of disease for most of his life.

The establishment will try to derail us by placing us with the likes of Tom Cruise, whose spastic interviews caused quite a bit of uproar a few months ago. They do us a dishonesty. What if, for instance, creationists used the argument that since Hitler and Marx both used evolutionary theory to justify their philosophies, that accepting evolution means accepting Nazism or Communism? Simply because I and Tom Cruise sort-of share an opinion about a subject doesn’t mean we arrived at that opinion using the same methods.

After the typical ’scientific’ uproar that Tom Cruise was full of crap (and he was for the most part), came the admission that even madmen can stumble upon a kernel of truth every now and then:

The profession’s blanket censure of Cruise was not unanimous. In a “Today” follow-up, Harvard University psychiatrist Dr. Joseph Glenmullen conceded a few points to the Hollywood heartthrob, namely, that psychiatric drugs can mask the real problem, be overprescribed and aim to fix an unproven chemical imbalance in the brain.

Which is what I’ve been saying since I was a teenager; psych meds are more like painkillers than they are physical therapy targeting the source of the pain; ameliorating the symptom vs. attacking the cause.

I’ve never actually met anyone on antidepressants who wasn’t depressed for a reason. And I’ve met a lot of them. Even helped a few of them work through their depression to the point that they’re reasonably content individuals free of prozac or other drugs. Sometimes it was an event, sometimes the lens through which they viewed the world was just a bit ‘out of round’.

I’ll end here out of concern for length, and because I believe I’ve addressed the important points. As I said before, look at the language of those who support the status quo.

–A doubter says “show me the proof.”
–They answer “We all say there’s proof.”
–”That’s not the same as proof.”
–”But we all have fancy letters after our names!”
–”Do we not? Address the holes.”
–”You evil bastards! We’re doing this for the children.”
–”So are we.”

And so it goes on and on.

We’re all familiar with Mr. Cruise’s remarks on the subject; and many of us have dismissed him as a lunatic. I won’t argue that he’s fallen off the deep end, but even the most delusional sometimes stumble onto a kernel of truth.

The chemical imbalance theory is a tautology; a prime example of circular reasoning:

In logic, begging the question is the term for a type of fallacy occurring in deductive reasoning in which the proposition to be proved is assumed implicitly or explicitly in one of the premises.–Wiki

So here’s the statement: Depression is caused by a chemical imbalance of serotonin (chronically low levels).

The problem: Low levels of serotonin and depression are the same thing. The above theory would be much like claiming that the sky is blue because light of shorter wavelength is scattered most by the atmosphere. Yes, it’s a true statement. But it says nothing substantive because it’s merely the same observation from two perspectives (eye and spectrometer). Scattered light in shorter wavelengths looks blue to our eyes. The answer to that question would have to go slightly deeper, saying that shorter wavelength light is scattered much more than longer wavelength light by atmospheric gases. Because shorter wavelength light appears blue to our eyes, the sky thus appears blue.

Low levels of serotonin and a depressed mood are the same thing; neurochemical and behavioral perspectives of the same brain event. I’ll refer back to the picture of serotonergic nerves masterfully executed in MSPaint that you first saw in this post on how SSRI’s work (and why I’m not a fan):

The presynaptic cells are what make and release the serotonin (called the Raphe nuclei). The postsynaptic cells are the ones that are affected by the released serotonin. It’s known that activation of the postsynaptic nerves by serotonin is what makes you feel good, and that when these postsynaptic nerves are not firing, you feel depressed. This is why SSRI’s, which don’t affect cells of the Raphe Nuclei themselves, have a positive effect on mood.

Postsynaptic activity is thus a correlate of mood. Because postsynaptic activity is a function of the available serotonin levels, of course low levels of free serotonin will be seen as depression. One implies the other. Ergo, nothing was said.

Low levels of serotonin thus don’t cause depression, they are depression. Thus Tom Cruise was more or less on the ball when he said that, “There is no such thing as a chemical imbalance in a body.”

No one has, in fact, proven that there is an organic cause of low serotonin levels (i.e. a chemical imbalance) in the brains of depressed people, except for one tiny family in eastern europe with a genetic defect that hampers the activity of their serotonergic (presynaptic, Raphe Nuclei) neurons.

There is thus no evidence that depression is neurological in its cause instead of psychological (although it does present with neurologic symptoms both in the short term and chronologically). Considering how much money is going into depression research, my money is that, in the majority of cases, chronic depression is rooted in maladaptive thought patterns.

It’s times like this I want to beat my head into a concrete wall until my brain oozes out my ears. What the heck is the point of being a biological anthropologist trying to understand the roots of human behavior in our animal brethren when articles like this, based on research papers like this keep trying to insist that certain behaviors are uniquely human…when they’re not.

I don’t mean to say the research itself is worthless, it provides an interesting example of a behavior seen throughout the animal kingdom, and has important implications for the role of alpha males and other dominant individuals in the day-to-day lives of juveniles. It’s just that the research is framed in a way that’s a little misdirecting. But I’m going to untwist my panties long enough to talk about the substantive aspects of the study.

Toddlers’ endearing desire to help out actually signals fairly sophisticated brain development, and is a trait of interest to anthropologists trying to tease out the evolutionary roots of altruism and cooperation.

Good sentence, good goal. Infant interactions with non-kin adults is actually an area of research I hope to hit sometime in my career, although not with humans.

And — this is key — the toddlers didn’t bother to offer help when he deliberately pulled a book off the stack or threw a pin to the floor, Warneken, of Germany’s Max Planck Institute of Evolutionary Anthropology, reports Thursday in the journal Science.

Also great find. It shows that these 18 month olds are thinking in terms of intentionality, an important concept in the development and evolution of the mind. They’re able to tell the difference between when the researcher throws down a book (wanting it to be on the floor, or at least willing it), and when the researcher drops the book on accident (not wanting that outcome). When the researcher fails in his goal, only then does the infant help out. In other words, these infants arent’ simply taking an interest in the object because it moved or becfause it caught their interest. They’re putting themselves, in a sense, in the mind of the researcher. A lot of animals can’t do that. Some say only humans can do that. I challenge them to get off their asses and work with some of the more intelligent social mammals.

They then contrasted this with juvenile chimps, who didn’t help out as readily:

Would 3- and 4-year-old chimpanzees find and hand over objects that a familiar human “lost”? The chimps frequently did help out if all that was required was reaching for a dropped object — but not nearly as readily as the toddlers had helped, and not if the aid was more complicated, such as if it required reaching inside a box.

So at least they admit that other primates show the same tendencies, but they’re careful to mention that they don’t seem to have as much of a drive to do so. This represents the substantive and incontrovertible part of the study, but they don’t stop here, and soon turn to hand-waving, psychobabble, and diminution of the cooperative ability of other social mammals.

No other animal is as altruistic as humans are. We donate to charity, recycle for the environment, give up a prime subway seat to the elderly — tasks that seldom bring a tangible return beyond a sense of gratification.

Heh, praise for the wonderfully selfless human race commences. Of course, since we admit that we do get a return in sense of gratification, we’ve already admitted it’s not selfless. That gratification is the proximate reason we are altruistic. Doing something for someone else feels good, both through the internal warm fuzzy feeling and the reinforcing external input of praise. There’s a lot more to the story than just those benefits though, although I dont’ have space or patience to get into it here.

To be altruistic, babies must have the cognitive ability to understand other people’s goals plus possess what Warneken calls “pro-social motivation,” a desire to be part of their community.

And again we’re talking proximate causes here. Pro-social motivation isn’t in itself an evolutionary (or ultimate) cause as to why animals help each other out. An evolutionary reason *might* be that a cooperative group is necessary for the success of the hunt (as in wolves). And pro-social tendencies are a proximate enforcer helping to maintain that cohesion.

Other animals are skilled at cooperating, too, but most often do so for a goal, such as banding together to chase down food or protect against predators. But primate specialists offer numerous examples of apes, in particular, displaying more humanlike helpfulness, such as the gorilla who rescued a 3-year-old boy who fell into her zoo enclosure.

But observations don’t explain what motivated the animals.

This is where the bias really becomes evident. If it’s not goal-directed cooperation, it’s humanlike. I find this funny since human helpfulness is very erratic unless it’s goal-directed. Much like apes, monkeys, wolves, and dolphins. The other thing we notice is that they restrict their talk of non-goal-directed cooperation to apes. Funny thing is, I don’t think of apes when I think of incidents like that. I think of dolphins, I think of capuchin monkeys, I think of wolves, not apes. And there’s a reason for that to come later.

The other thing is that, as they say, simple observation doesn’t explain what motivates these numerous animal examples. Which is also true of human observation. Why exactly can we talk about pro-social tendencies in humans but not in animals when the only things we observe are the same? As I discuss in Baboons Need Friends Too, just because we can’t talk about proximate mechanisms when doing ‘real science’ doesn’t mean our study subjects don’t have them. So here’s my thing, if a human behavior researcher is going to talk about proximate mechanisms in human babies who can’t even talk, I’ll talk about proximate mechanisms in other mammals.

In the gorilla example, do you know what I think motivated her to save the kid? She thought to herself “Oh crap, a baby’s in trouble, I better do something.” Just like humans do every time we see a little kid wander toward a pool, a stairwell, or into the street. Our kid or not. Being social mammals, we possess empathy; this empathy causes us to feel an internalized fear that something might happen to that infant. So we help it. This also explains why a pride of lions once saved a teenage girl from rapists, why dolphins regularly save swimmers, and why 8lb male capuchin monkeys are known to kill restrictors if they threaten un-related infants.

Discussion:
Wasn’t a good place to put these comments so I’ll just throw em down here, just like you would on a real research paper when you’ve got something good to say but nowhere to say it.

One more criticism of this study is the choice of chimps, and the emphasis on ape behavior. The contrasting of humans with apes is in part valid and invalid. The use of apes when studying the evolution of humans is always valid in that they are our closest relatives, and thus understanding the path which led to humans must be looked at in terms of how we developed relative to the rest of Hominoidea.

It is invalid when we assume that anything humans do that other apes don’t do must be unique. Social animals, and especially social mammals, have a continuum of group types and behaviors, ranging all the way from foxes who spend most of their year alone, only to find the same old mate and keep house for a few weeks, to elephant herds, where females spend their entire lives together, to spider monkey societies which coalesce and disperse as resources and weather permit. In other words, even if we’re the only ape species which displays a certain type of social behavior (such as pro-social tendencies), this doesn’t mean we’re the only social mammal to do so, or that the circumstances behind that evolution are unique.

Basically, looking at other apes can tell us about the differences between their and our evolutionary paths. But looking at animals that display a behavior similar to the one we’re looking at in ourselves can tell us why there were differences in our evolutionary paths.

This is an exceptionally glaring mistake in this study because, by and large, apes aren’t that social compared to other primates. Gibbons are socially monogamous; a male, a female, and a couple kids. Orangs are solitary, with one male’s territory covering 3 or 4 females’ territories, with little time spent together. Gorillas are largely polygynous, with one male a few females, and a few kids. Chimps have bigger groups, but the females within the groups don’t tend to interact too much, and the males spend as much time beating the crap out of each other as they do anything else.

Humans in hunter gatherer settings (and many claim back through H. erectus) have had group sizes around 50 people for a very long time. Much larger than any other Hominoid, but right in line with many many species of monkey, both catarrhine and platyrrhine (Old World and New World respectively). So if we’re talking about social phenomena, it might be a better idea to look for similarities in animals with similar social constructs. I’d recommend capuchins and pigtail macaques immediately. I’ve spent a lot of time with both in a captive setting, and have read extensive amounts of research on pro-social tendencies in both, and know they posess both in great amounts.

Finally, and most importantly, capuchin adult-infant interactions, like those of humans, go beyond simple tolerance to mutual ‘enjoyment’ (for lack of a better word). Capuchin infants actively seek out big adult males, much as babies are drawn to big human males.

On to altruism, this study has proven nothing about altruism. Pro-social tendencies including unrepaid helpfulness in pigtail macaques and capuchins have been shown to confer benefits upon the individuals displaying them. An indirect or ‘invisible’ gain is still a gain. It would be better to say that the behavior of helpfulness may be an important phenomenon in group-living mammals that isn’t adequately explained either by the theory of reciprocal altruism or kin selection theory.

It’s interesting to see just how early pro-social tendencies can develop, and how early an understanding of intentionality can develop in the human infant, but other than that, this study says nothing about this somehow being a uniquely human trait.

As always, I recall a story from the upanishads in which a student asks his teacher how he should treat the animals, to which the reply was simply “Well, how would you treat a child? For what is the difference between a monkey and a child?”

Wow, maternal SSRI use is linked to withdrawal symptoms in neonates. Really?

I am so stunned and amazed by this discovery that I’m speechless. *sarcasm alert*

It’s a well known fact that one of the best outcomes possible in an addict’s pregnancy is that the child is born with withdrawal symptoms. ER did an episode where they performed emergency detox on a kid a few years ago. One of these drugs that causes withdrawal is cocaine. Which happens to have some similarities to SSRI’s, MAOI’s, and many other drugs used for things like depression and anxiety.

A basic lesson here: A lot of us think of nerves as something like electrical circuits sending signals to each other and different parts of the body. This is only partially correct. An individual neuron does act a lot like that. But nerves connect to each other using chemicals like norepinephrine (similar in structure to adrenaline), serotonin, or dopamine. There is a presynaptic neuron and a postsynaptic neuron:

Figure 1: Synapse

The little round shapes are the neurotransmitters. When the electrical signal reaches the end of the presynaptic nerve, it causes neurotransmitter to be released. The neurotransmitter moves across that gap (the synapse) and touches the postsynaptic nerve. When it touches, the postsynaptic nerve is induced to fire and continue the electrical signal.

Normally, almost immediately after the postsynaptic nerve fires, the presynaptic sucks that neurotransmitter back up like a hoover. If the stuff stuck around, the postsynaptic nerve might fire when the presynaptic nerve didn’t. Like a short-circuit almost.

Now here’s a picture of the same synapse, only with a Reuptake Inhibiting Drug involved this time:

Figure 2: Synapse with Reuptake Inhibitor

Notice that now the presynaptic nerve can’t suck the neurotransmitter back up. The drug blocks re-uptake. Cocaine is a Dopamine Reuptake Inhibitor. It works by preventing your nerves from reabsorbing (and thus ending the effects of) dopamine. This is what gets you high…the increased amount of free dopamine. When you take the cocaine away, the dopamine gets reabsorbed, thus lowering the amount of free dopamine. For an addict, even though they still have normal amounts of dopamine in their synapses, they feel like they have less, since they were used to the higher amount. So they feel bad. Readers may have experienced caffeine or nicotine withdrawal, or if they have had surgery or really bad musculoskeletal injuries, they may have had problems getting off the narcotics they were given.

But dopamine isn’t the only neurotransmitter whose levels are jacked up by recreational drugs. Opiates and heroin have a powerful effect on both dopamine and serotonin. MDMA (ecstasy) is well known as a powerful stimulatory agent on serotonergic cells (those that release serotonin). SSRI’s act in a similar fashion to X on the same neurotransmitter, albeit at a reduced level. MAOI’s act on dopamine and serotonin, just like opiates.

So why is the medical establishment ’surprised’ at this new finding? Well, I’ve got a couple ideas why.

1. For various reasons, doctors don’t like to move without empirical evidence. As a dabbler in ‘real’ research (and future doctor), I understand this completely. Science depends on real data. Science-based fields, such as Medicine and Engineering, depend on the application of science. Thus doctors are tied to it. However, while science is ultimately rooted in empiricism, this overlooks one of the great strengths of scientific theory: that it is predictive.

2. Schooling. A doctor first gets a 4 year undergraduate degree. Then a 4 year MD. Then, if they want to become a psychiatrist, they get 4-5 years of residency before they’re treated as full doctors. That’s 12-14 years of post-secondary education and training. However, only a single semester-length class in neurophysiology and neuroanatomy is required. 13 years. One relatively broad class which spends comparatively little time on topics of interest such as ‘higher’ functioning, long-term potentiation, and the self-ordering properties of the brain. This likely won’t change in my lifetime, no matter how much of a ruckus is made, so I won’t bother.

3. Well, this is a slightly tin-foil hat idea. I once accused the mental health professions of having Munchausen’s By Proxy. Wiki it. I’m still half serious about it. But while it may be true that institutions and organizations act this way, I’m still just idealistic enough (somehow) to believe that most mental health professionals have the well-being of their patients at heart. Since I will one day be one of them, I feel it important to give them the benefit of the doubt
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Antidepressants are a topic near and dear to my heart, so I’ll be returning to it at a later point. I just wanted to make the point today that most of the medications for the ’softer’ psychiatric illnesses are basically no different from recreational drugs in function, and sometimes not even in form (Adderall doesn’t even try to pretend to be anything but a member of the amphetamine chemical family). Since they look like them chemically, and act like them functionally, it should be no surprise that they won’t escape at least some of the detrimental properties of recreational drugs.

As a gun rights activist, I’m a staunch believer in the ’slippery slope’ phenomenon. They start with ‘reasonable’ bans and curtailments (and they usually are at least somewhat reasonable on the face of it). Then the restrictions continue to get worse. Eventually, as in England which saw up to a 50% rise in gun crimes last year, despite a total ban, they stop using logic to defend the practice whatsoever.

The slippery slope phenomenon is one of my greatest fears about our permissive, even encouraging, attitude toward psychiatric medication for people with mood problems. Relacore was originally marketed to help reduce belly fat (another use for pills I look down on). However, recently they’ve begun to market it based upon a beneficial side-effect: mood enhancement. Their most recent advertisements make no bones about this, propounding its value as a ‘Feel Good Pill’ first, and a belly fat reducer second.

Intractable depression with no known behavioral cause used to be treated with MAOI’s and SSRI’s. Nowadays, known cause and grief beyond a certain length are calls to prescribe these pills. And now we have pharmaceutical companies promoting OTC drugs that do the same damn thing.

Why is this a problem?
Cocaine: Dopamine Reuptake Inhibitor
Prozac: Serotonin Reputake Inhibitor

Cocaine=bad. Prozac=good. This was somewhat tenable in the days where antidepressant prescriptions were rare and often temporary. As the criteria for candidates for these drugs grow wider and wider, as the people who take them become more and more ‘normal’, this distinction between a recreational thin white line and a ‘medically necessary’ little blue pill becomes artificial. And now, with the apparently societally acceptable use of OTC mood enhancers, this distinction has quite literally become a gently sloping line, from self-medication with illegal drugs to self-medication with legal OTCs, to a doctor prescribing you a drug because you’ve wasted your life and hate yourself. In short, abovetheinfluence.com, the oh-so-memorable “This is your brain…” commercials, and the anti-drug program just got anally raped, without lube.

Now, as a libertarian-leaning conservative, I actually have no problems with legalization of cocaine, or the fact that Relacore is advertised pretty much as a legal recreational drug. What I have a problem with is the self-delusions that Relacore and the profligate SSRI prescriptions allow.

As it becomes more and more ok to take mood enhancers when you’re feeling ‘blue’, it becomes more and more ok not to root out the cause of those thought patterns in the first place. Someone with low self-esteem takes a pill. They feel better. But it didn’t actually fix the self-esteem or the cognitive dissonances that caused it. They can’t cope with the loss of a family member, so they take the drug. They never move past their grief.

As a medical student I’m well aware that the goal of a doctor is first to cure a disease. As a realist, and a chronic nerve injury sufferer, I’m well aware that not all diseases can be cured. All doctors can do with me is alleviate the symptoms: cervical traction, antileptics, and (god forbid) hardcore pain medication down the line. Depression, anxiety, and similar mental problems aren’t the same way. Behavioral therapy is highly effective. Actually moreso than medication, according to many.

Indeed, while doctors point to ‘chemical imbalance’s, and this new protein p11 (I’ll link with my thoughts on this protein later). that’s all the rage, they haven’t actually proven that these are causes rather than symptoms of depression. Indeed, since basic neurbiology established well before I was born that modulator proteins (like p11) and chemical titers change very easily in the brain, most of these studies prove next to nothing. To draw an analogy, so far what they’ve shown is like saying that people who don’t exercise have poor cardiovascular health. Wow. Shocker.

Occam’s Razor tells us that if rates of depression in the population are as high as they are, and we have yet to find a true causative biological source (a gene, or a developmental insult, would be favorite), then what we are seeing isnt’ so much a disease as an adaptation to something…probably a mode of thought. If so, as health professionals it is our job to seek out what is causing this depression. And, in the absence of a causative factor, we must assume it is thought.

We would be remiss in our duties if we simply treated an obese patient’s knee problems with Hyalgan and pain relievers while ignoring the influence of his weight on wear and tear in the joint. We would be failing our patient if we treated their severe sunburn but didn’t caution them against the dangers of tanning. We would be doing them a horrible disservice if we merely prescribed lipitor without at least attempting to change our patients’ lifestyles.

When a doctor can fix a cause of a disease, they owe it to themself and their patient to go after that cause even as they manage their symptoms. With our permissive stance toward mood enhancers of all stripes, and our veritable endorsement of pills before psychotherapy as treatment for BEHAVIORAL problems, we forsake our jobs and our oaths. And more importantly, we forsake the mental health and personal growth of our patients.