It is encouraging that more and more people – psychiatrists, patients, and researchers – are opposing drug treatments for depression, anxiety, and ADHD. But this is only half the battle. To oppose the level that psychiatry, my field, has sunk to comes with the obligation to right the ship. It is essential, and of paramount importance, to restore psychiatry to its proper place, where patients are well treated. In the history of psychiatry, the quest used to be to devote all of one’s thought and study about the real sources of human suffering, and submit it, with humility, in the service of the patient’s authority, rather than ask patients to submit themselves to psychiatric authority – as taught by psychiatrists such as D.W. Winnicott, and the ‘Object Relations’ school of Ronald Fairbairn, and finally the illuminating teachings of Harry Stack Sullivan on Schizophrenia as practiced at Chestnut Lodge. Unfortunately, this has all too often gotten lost, due to ego, money, and power.
It doesn’t have to be this way. But where do we turn? Obviously we need to recover from practices that violate the fundamental principle of “Do No Harm.” But over and above that, we have to constructively treat and heal the ‘pains’ of our patients.
The sad thing is that we already have everything we need: the lost art and science of psychotherapy. Don’t get me wrong, there certainly has been a lot of bad therapy over the years – all kinds of schools, theories, fads etc. My own roots were in psychoanalytic psychotherapy. But it was beset by considerable problems. Its practice suffered from dogmatic theories and miscast beliefs, which worked to the detriment of the responsiveness of our patients. I moved on to develop the Psychotherapy of Character.
As opposed to the fraudulent ‘chemical imbalance’ theory of ‘biological’ psychiatry, psychotherapy not only effectively treats us but it is consonant with the way psychiatric symptoms actually develop in the first place. The wisdom, the art, the science, the neuroscience of psychotherapy respects the complexities of the human condition. It addresses the workings of the brain, and in precisely the way our consciousness forms in the first place. Patients mourn the traumas of life in the human context of safe boundaries and genuine emotional holding and relationship with the therapist. Our consciousness is organized as a play in the theater of the brain – with a cast of characters, relatedness between them, scenarios, plots, landscapes, and set designs.
We write our plays throughout our development, as the actualities of others’ responsiveness, deprivation, and abuse impacts the unique constellation of our temperaments. (See – “A Unified Field Theory of Consciousness – A New Paradigm”) Once established we play out our scenarios over and over again. We are prisoners of a drama we can’t even see. Psychotherapy is a kind of living theater that gives form – and access – to our invisible internal play. Therapy serves to deactivate a problematic and damaged play, and allows us to write and inhabit a new one that heals symptomatic suffering and fosters authenticity and the capacity to love.
To become a psychotherapist takes many years of disciplined work. One learns, fundamentally, by paying attention to our patients. There needs to be years of apprentice-like learning that requires careful supervision. One needs to know oneself, so that our own plays don’t interfere with our patients’. This requires therapy for ourselves. Psychotherapy is not a ‘we-they’ enterprise. A therapist cannot consider himself superior or better than his patient. We are all fellow-travelers in the human condition. Only mutual respect can foster the mourning of our problematic plays and recovery from suffering.
Why would someone come into my office to be a patient in psychotherapy? Why would he decide to subject himself to the inconvenience, the considerable expense, the uncertainties, and the discomfort of confiding in a stranger, while contending with stigma and shame?
A patient comes to a psychiatrist for relief from his suffering. The word ‘patient’ itself comes from patiens — “enduring pain and suffering.” Human suffering takes many forms. People may feel unhappy, lonely, angry, or sad. They may have symptoms: obsession, compulsion, anxiety, so-called depression, panics, phobias, paranoia, delusions. People have characterological behaviors that get them into trouble—drinking, drugs, gambling, eating (anorexia, bulimia, overeating, bingeing), sexual perversions, impulsivity, rages, emotional isolation, narcissism, echoism, sadism, masochism, low self-esteem, and psychotic and manic states. They may have crises in their lives: divorce, death, loss, illness, rejections, failures, disappointments, traumas of all kinds, and post-traumas.
Suffering does not exist in a vacuum. It flows from our damaged plays of consciousness. Since there are built-in fault lines to every problematic play, the way we break down follows along those fault lines. The way a person breaks down reflects the way he is constructed. Suffering is the manifestation of something having gone wrong in his characterological play.
To attend to a patient’s suffering, we must explore his inner play. This exploration is the journey of psychotherapy. It proceeds through a responsive conversation between therapist and patient. What transpires is far more than the cognitive content of the words. It is the exploration of a patient’s invisible, unique inner drama. However, the transformative process in therapy, ultimately, does not turn on this exploration, per se. It follows from the responsive engagement between us. Emotional holding allows one to digest and mourn the internal play. And finally, it is responsiveness and holding with the patient’s Authentic Being that fosters the writing of a new play, grounded in authenticity and love. A therapist does not heal his patient. He does not have such a power. He facilitates the processes that do it all on their own. When a patient writes his own new play, which flows from his authenticity, it is his own. It may be very different from his therapist’s political, religious, or scientific beliefs. This is as it should be.
We all have the regular human struggles in our lives. Nobody—neither patient nor therapist—is spared his fair share of tragedy and suffering in life. Having sufficiently dealt with his own characterological world in no way means the therapist is better than his patients or a kind of superior being. It allows him, however, to have enough internal and external resources to deal with his own ongoing life issues, so they don’t interfere with his clarity and genuine availability to his patients. Even if he does get temporarily reactive and lost in his own play, he can quickly recover.
Being a therapist goes against the natural human inclination to avoid discomfort. It means a therapist has to allow himself to sit with the full range of human darkness, as well as human virtue, in himself. Consequently, I know in myself the worst and the best of the whole range of human impulses. This is not always easy. People tend to want to see themselves as good and to see badness as located outside themselves. A therapist is willing to resonate with the full range of his patient’s characterological dramas, while possessing the facility to retain his grounding in his own authentic self.
All humans are capable of the full range of human possibility. Our persona imagination encompasses the full scope and is resonant with even the greatest extremes. The range of personae runs the gamut from Gandhi to Jeffrey Dahmer. We all carve out our unique character plays from the collision of our temperament with our developmental experience. In this sense, we all come to our characterological positions honestly. If I felt a resonance with Jeffrey Dahmer, this does not mean I would cannibalize someone. But it is in my image-ination potential and in yours. No character personae are outside the great human drama. Being human encompasses them all. With a sufficient anchor in his authentic self, the therapist accepts that all potential persona identities and motives are in us but not of us.
Patients always know, no matter what, that something is amiss in them. Otherwise they wouldn’t be there. Keep in mind that psychotherapy is an exploration of the patient’s characterological world and the forces that brought it about. Even a depraved characterological identity does not encompass the Authentic-Being of the patient. The point of the therapy is recovery from a problematic character identification. The problematic character identification is in the patient, but it is not reflective of the patient’s Authentic-Being or potentially recovered self.
Respect for the patient means respecting his boundaries. Exploitation means violating the boundaries. There should never be any exploitation in therapy. The list of exploitations isn’t long: sexual, sadistic, power, financial, ego aggrandizement for the therapist, or having the patient serve the therapist’s emotional needs. Both parties are sitting in their seats and do not engage in any action — impulsive, or premeditated. All exploration is properly on the screen of the living theater in the office. Violation of boundaries always leads to sadistic aggression and violence. The therapist’s provision is much like that of a good parent — with boundaries and good-enough loving. I reiterate “good enough” because – as in child raising – there is no such thing as perfect responsiveness in therapy.
And finally, confidentiality is of the highest order. Confidentiality is the boundary that keeps a safe circle around the therapy. This means it is safe for the patient to say anything without reference to any consequences in the outside world. The only usage and value of what is talked about is in the service of the therapy itself. Confidentiality ensures that the content of the therapy will not be used for any advantage or disadvantage for either the patient or the therapist outside the therapy.
Therapy from the beginning to the end is a responsive engagement between my patient and me. A new patient comes to my office because he is suffering. I need to hear the nature of his suffering. I need to know something about his circumstances. And I need to get a preliminary sense of his characterological world and how it got to be the way it is. The first few sessions will be focused on this discovery. This is the evaluation. I am evaluating the nature of his situation in order to be in a position to address what would be involved in dealing with it. New patients often think when I use this word that I am evaluating them in relation to a judgment about their worth and value, or evaluating whether I would accept them into therapy or reject them. This is not the case. I am, in a preliminary way, getting to know them. Likewise, they are evaluating me based their impression of me. They are, in a preliminary way, getting to know me. We are on equal footing, and all the processes that will ensue are purely human.
There are no formulas at the beginning of therapy or at any point during the therapy. As I open the door for the first time, I am open to the various impacts this new person makes on me: his appearance, his style of dress, the manner of his greeting, his response as I usher him to his chair. I do not study these things. I simply notice their impact on me. As I ask what brings him to my office, he tells me the specifics of his suffering. I listen to the content, and I feel the emotional impacts of his presence. I am responsive to whatever presents itself. I may continue the discussion of his “problem,” or I may shift my response to the state of feeling that is present or the state of feeling that is conspicuously absent. If the person is reticent, I may be active in my engagement and actively responsive to what is presented. If the person floods the discussion, I may interrupt. If the person is tangential, I may refocus. If the person tells me his story, I may quietly listen. From the beginning, therapy is a responsive engagement.
The culmination of the evaluation usually results in the first connection between patient and therapist. Just to have someone hear the pain of the suffering without ridicule or diminishment is a form of emotional holding. This is amplified when there is shame involved. The initial symptom is always a veil for a deeper pain. When this is touched upon and addressed in the evaluation sessions, the patient is reached in his real pain. He feels understood and listened to.
Even when some temporary relief takes place during the evaluation, as is often the case, this is not the treatment, and it is short-lived. This is the just the prelude. The evaluation isn’t much different from the false intimacy of two people sitting next to each other on a long train ride. One may confide very private stuff to this stranger. The conversation feels very intimate, but it is an anonymous false intimacy, predicated on never seeing this person again.
The beginning of therapy is but an introduction to a stranger, making a first and an essential emotional contact. But we will see each other again. We will deepen our exploration. We will move toward a trusting closeness, which is not anonymous. Real trust always has to be earned. And as always happens, the patient’s internal dramas and cast of characters will make their presence felt. In order to find our way, we always have to slog through the characterological dramas. They always come alive in the office. This is the hard part. In order to reach the patient’s Authentic Being, we have to grapple with this odyssey. It is only as this takes place that real trust can emerge.
Of course one does not at all need to be a doctor to be a therapist. There are some advantages, mostly learning how taking responsibility in life and death situations changes a person. Knowledge of the body, consciousness, and physical ailments can be very useful during the therapy. The downside of doctors is that many are sadly not geared to be responsive, with respectful relationships. We need to offer real psychotherapy on a very broad scale. The need is enormous. We need therapists of all persuasions – psychologists, social workers, and others to develop into really great therapists. We need everybody who is dedicated to a revival of this lost art, in every discipline that seeks to practice it. The secret truth is that recovery from symptoms is not that hard. It is incredibly satisfying to help people recover from their suffering, and fulfill their best selves.
I was a psychotherapy client for a long time, due to a variety of issues which I wanted to untangle and get clarity on. I moved a few times over the years, and was also in the system for a while, so I’ve sat with quite a few therapists in my lifetime. I had trained as a psychotherapist, myself, but now I work with clients in a different way, that is not psychotherapy, which has been working well for me and clients.
You’re right, there are some who are competent and some who are not. More than ‘are we a match?’ I think a client can assess competence by how well we feel listened to and engaged with. I have to say, there are some really negative thinkers and cynics sitting in a therapist’s chair, which does concern me. Not all can claim self-awareness and ownership. I’ve heard a lot of projections flung at clients, and that always made me cringe in the worst way.
To some degree, it was helpful to talk about confusing issues and get clarity, outside feedback, another perspective, etc. After a while, I was done with talking and turned to different schools of thought altogether to continue my evolution. So I terminated my psychotherapy once and for all and moved on.
A side effect of chronic psychotherapy, I discovered, was that my brain had gotten so in the habit of processing and analyzing, that I could not stop it from ruminating. I could get no peace of mind, no matter what I did. I could not get my mind to relax, it just wanted to talk and talk and talk away at me, and I could not find my center. It was energy-draining and extremely distracting.
That’s where meditation and Qi Gong really served me, to heal from what I started calling ‘therapy brain.’ Psychotherapy had left me completely ungrounded.
I just wanted to express this as a consideration when working with a client. I always include meditation in my sessions with clients. I find that it really grounds the session and creates an innate feeling of safety and focus. I also do at least a 30 minute meditation to ground and center before working with a client.
I think there are a lot of vital elements missing in the education of counseling psychology, regarding the energy of dialogue. To me, that is significant. I learned vital tools for counseling outside of this field.
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Psychotherapy is one potentially appropriate method of care among many. There is no one size fits all solution to every human beings emotional distress. Learning to live well involves many different pieces that vary from individual to individual as well as within the life of any single person. In other words what we needs changes as we ourselves change and grow.
What works for me or you or that person over there may not work for anyone else…or some bits and pieces of it may and others not.
As soon as we believe or assume we know what is right for others (or everyone) we are flirting with coerciveness.
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Very well put, Monica. In our daughter’s case, psychotherapy was the stepping stone to drugs, when the therapist, though well meaning and caring, said “she is not responding to therapy and needs psychiatric medications.” An adverse reaction to antidepressants led to a bogus bipolar label and ultimately a multi-year struggle to withdraw from the “cocktail of medications.” We tried multiple therapists, and none of them could help when the withdrawal went badly. Today, our daughter is doing very well and is free of meds with the exception of a very small dose of 1 medication that we hope to be done with at year-end. What did help? Orthomolecular (nutrient) therapy and energy healing.
As you say, people and their healing paths are different and insisting on a single modality smacks of coerciveness. Not only that, psychotherapy has not been universally effective for severe cases (some people spent decades at the Chestnut Lodge without recovering) and overselling therapy may propel some people toward drugs.
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I think therapists should not automatically assume, “Patients always know, no matter what, that something is amiss in them. Otherwise they wouldn’t be there.” Especially if this assumption implies to the therapist that, “We are prisoners of a drama we can’t even see.”
When I went to a psychologist, I was actually dealing with ADRs and withdrawal effects of drugs, not some sort of invisible drama. Well, I was also in denial of the abuse of my child, and dealing with interpersonal problems with the alleged child abusers, plus disgust at 9/11. The stress of these real life issues are likely what worsened the ADRs and withdrawal symptoms of the drugs.
My point is that sometimes a person’s problems are actually real. And I truly hope the psychiatric industry will some day get out of the business of defaming people with “mental illnesses” to cover up easily recognized iatrogenesis and child abuse.
I understand that addressing the sexual abuse of a three year old child is difficult for psychiatrists and psychologists. But given the fact that the most common attribute of schizophrenics is not a “genetic” one, but rather that 85% of schizophrenics had dealt with “adverse childhood experiences.” It seems quite obvious to me that the psychiatric industry has a real problem with covering up child abuse, by misdiagnosing victims with “major mental illnesses.”
I’m quite certain most mental distress has to do with real life concerns, not mythological “plays” we write in our head. Those are just good makings for novels.
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Agreed. Psychotherapy is essentially based on the same concept as psychiatry: fixing what’s “wrong” with the person. Well, in 99% of the cases, even if there’s something “wrong” with someone it does not occur in vacuum. Craziness of all sorts is a product of being in impossible life situations and feeling trapped. Psychotherapy does not cure real life problems, in fact it often makes it worse because it forces the victim to start thinking “what did I do wrong”?
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Trauma does create dramas that get played out over and over again, no doubt. Some of those dramas are exactly what is happening right now…learning to recognize all of that is very helpful actually. All human beings are subject to replay of early child programming to some extent as well…it’s just how we’re wired…those things can be recognized via many different modalities as well.
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True, dramas (or belief systems) are created throughout life, but that does not mean the “plays” are always bad, need psychotherapy, or need correction – which Robert seems to be assuming to be true when a patient comes to him. I’m quite certain I’m not alone in going to a therapist at the only time in my life I had dealt with real life problems. And sometimes we just need to be reminded of the beauty of our dreams and intuitions, and helped with our real life problems.
My unfortunate experience, and the wisdom I learned via it, is that the “evidenced based” medical community, which according to my medical records doesn’t believe in either the spiritual or the arts, which basically means they don’t believe in human intuition whatsoever. And thus also seemingly doesn’t subscribe to the long held wisdom that medicine is an art, not an “evidence based” science. Is that now the theories of “evidence based” medicine are being exposed more and more today as nothing more than “profit driven medicine.”
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And fraudulent “science.”
And I brought this up because I watched a documentary tonight, “Alive Inside: A Story of Music and Memory.” It’s on Netflicks. And the abuse and neglect of the elderly is very similar to the abuse of the so called “mentally ill.” This documentary points out that bringing an art form within humanity, back into the “evidence based” only medical community, helps people actually heal. And we now have the baby boomers worrying about their end years.
Perhaps, since EBM is now being proven to be nothing but profit based medicine, and not beneficially to actual humans. Now would be a good time to start incorporating the ancient wisdom that medicine is an art, again. And that respect for the arts, intuition, and actual patient concerns may actually be wise again?
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“It is no measure of health to be well adjusted to a profoundly sick society.” – Jiddu Krishnamurti
Sometimes the crazy person is the only reasonable one (or maybe even most often). Yet they are the ones who need “fixing”. It’s all sick and perverted.
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Thank you for your article. I understand your stance and how very supportive and caring you must be in your practices. but I do have a question for you. There are so very many info sites on the fraudulent practices of some psychiatrists, not to mention their “money line” associations with Big Pharma. A lot of what I read on this is from doctors, such as yourself and other professionals. If their unethical behavior and practices are so well known by so many, then why can’t something be done about it? Why is it that so much is said and written on the subject, but nothing changes?
Why are highly regarded psychiatrists such as Dr Joseph Biederman, who hails from your neck of the woods, still allowed to practice after being found guilty of taking $1.6 million from Janssen Pharmaceuticals? This doctor clearly broke the law, but the slap on the wrist he received is so outrageous! Is it so important that he continue to be the “cash cow” for Harvard Univ. etc, that his totally unethical behavior goes ignored? I am rather outraged at this, and I find it even more outrageous that he can get away with it. God only knows what else he has done that we don’t know about. If you read Biederman’s deposition from the J&J hearing, you will see that he basically takes no responsibility for his actions. You would think that someone who is so highly regarded would be more ethical. I guess I must be living in a dream world. Can you please shed any light on how there is so much that has been said on this, but nothing gets done.
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I am as much, if not more, troubled by this situation as you are. Not only is there a tremendous amount of corruption, but a lot of power to go along with it.
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I have often thought what it must be like to be a medical professional and have to be aware of the corruption that takes place. It is very upsetting to think that people, who just want to talk to someone, just have a normal conversation with someone about what is bothering them, are afraid to do so without the threat of getting locked up in a spin bin or put on an entire cocktail of very dangerous drugs.
How do you stay above it all? And what would you suggest as something a person like myself could do to make people more aware of what is going on so that we can have a change?
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My major focus is my dedication to my patients. So first and foremost I keep my head down and do the work. I hope I can contribute some by writing.
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Would you actually do something substantial for your patient? Help him/her to find work? Pay their bills? Find a lawyer they can trust to prosecute their abusers?
Psychiatry in my experience is close to useless. No amount of talking heals the injustice of the world or the pain of human condition. It’s all words in the wind and false promise.
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Dr. Berezin,
I totally understand and thanks for answering me. I appreciate that you are contributing by writing the truth. To those of us who are not in your field, we have many questions and I know that you will be truthful in your responses.
One thing I have always been interested in is how different disorders are created. Is there anything you can tell me about the creation of child bipolar disorder? I would be interested in knowing if it was simply concocted, a play on DSM definitions while matching ADHD and bipolar symptoms or some form of real science? I believe I read that Dr. Biederman is taking the credit for that one.
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In my understanding there is no such thing as child manic-depression. There is no science to it. Dr. Biederman and friends extrapolated that since someone becomes manic-depressive later in life than it must start in childhood. So put the child on drugs. There’s no basis for this whatsoever. The last thing a child needs to be on are psychoactive drugs. And in my understanding ADHD is a made up ‘condition’ to be treated with, of all things, amphetamines. Yes there are some children who are active and can spin out of control, but this is not a disease. In a subsequent post I will address how temperament and child rearing generates so called psychiatric conditions. I don’t believe in these medicalized diagnoses as if that defines who a person is. It’s not. Sometimes, its useful to characterize the nature of someone’s struggle in the service of being thoughtful about how to approach them.
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Well, maybe psychotherapy is less damaging than psychiatry’s drugs and shocks but it’s not so great either.
“Once established we play out our scenarios over and over again. We are prisoners of a drama we can’t even see. Psychotherapy is a kind of living theater that gives form – and access – to our invisible internal play.”
Or it tricks the person into think one or the other way about him/herself, sometimes maliciously, sometimes because of the psychotherapist’s cluelessness. It’s not that unconscious does not exist but I find all the techniques and guardians of them dangerous. People’s psyches are so easily manipulated, false memories can be created and people can be led to believe things about themselves and others that are not true. I’d never trust any paid “professional” to be the judge of my inner world – I can do that myself if I need to.
“I am, in a preliminary way, getting to know them. Likewise, they are evaluating me based their impression of me. They are, in a preliminary way, getting to know me. We are on equal footing, and all the processes that will ensue are purely human.”
No, you’re not on equal footing. You’re not sharing your life history and problems with the “client” (what an awful word that is). The sheer concept of “boundaries” is such a sick perversion of the idea of interpersonal relationship that it makes cringe every time I hear it. Either you’re in it together with the other person or not. There’s no such thing as a “boundary” in a loving relationship – when it’s there then the relationship is sick.
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Dear B,
I can definitely see why you feel the way you do. To put your trust in others and get screwed in the end never feels good, does it?
I think that it is necessary to point out that everyone is responsible for their own condition. How you got there, what you did on your journey, has everything to do with you. Sure, you can say that it’s everybody else’s fault that I am the way I am, but when you come down to it, it all started with you.
You may not be able to fix everything that happened to you in the past, but the future is still there for you. If you don’t like the doctor you’re going to, then go to someone else. Do your homework. If you find that a doctor is not acting in your best interests, then file a complaint on him. As a start you can do this with tour local police dept. Or get online and find out how you can do this with your local medical association. The more knowledge you have on how things are supposed to go, the more power you will have.
No one ever said that the road was going to be easy, but it is definitely worth it when you can sanely come out the other end. The most important thing a person can have for himself is the ability to be.
You have a right to be. And with that right comes the responsibility to do what is ethical, moral and in
your best interests. I’m not saying you don’t have a right to express yourself, not at all. But you seem like a caring, genuinely “I want to get better” person.
You have a lot of knowledge on what is wrong with psychiatry/psychology, so use what you know to make changes. You definitely will feel better when you help others. And that does not cost a cent. Good luck to you.
Fluffy48
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“I think that it is necessary to point out that everyone is responsible for their own condition.”
I disagree. This kind of thinking is a part of the today’s cruel spirit of the day when it’s everyone by and for him/herself. You are responsible for yourself but you are also responsible for others around you and vice versa. If you harm someone and this person ends up being “screwed up” on a personal level (whatever diagnostic label it’s going to get) it is also your fault and your responsibility not only or maybe not at all this person’s. Part of what is wrong with psychiatry and today’s society as a whole is that we place the blame always within an individual. Sometimes it may be true but most often it is not. We are connected and we are a part of society and if you tell a victim “you’re responsible for how you feel and behave even if this is a result of trauma” is re-victmisation. There’s a reason why “psych” professions are best friends of abusers – they concentrate on the victim and what she/he should and should not do rather than persuing justice and some real action to help, prevent and punish.
I know that there are some people who claim they are being helped by psychologists and I don’t want to make blanket statements (which to be fair I maybe kind of did in the post you’re referring to) but I feel like we are missing something from that picture.
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“Do your homework. If you find that a doctor is not acting in your best interests, then file a complaint on him. As a start you can do this with tour local police dept. Or get online and find out how you can do this with your local medical association. The more knowledge you have on how things are supposed to go, the more power you will have.”
The moment you’re psychologically able to go through that fun process you’re describing you probably don’t need a shrink anyway. Actually doing some of these things requires very thick skin and a lot of perseverance. Remember we are talking about people in the middle of a serious crisis, sometimes extreme distress and they are the most vulnerable to abuse.
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Dr Berezin,
Thank you so much. I look forward to your future posts very much. You’re right, there is so much that makes up why a person is like they are, and everybody deserves the dignity that goes with that. I am especially looking forward to the information on kids, as they are our future and right now, their future does not look so bright. I am sure that if you asked the little guys who are getting all the mind blowing psych drugs if they really want to take them, not one child would say yes. It’s pretty sad.
Keep on writing…you are reaching many.
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I agree with you, B. There is no such thing as a professional “fix” in life. People who believe this are sadly lacking in insight. Others can help, but, when they make their money claiming to be authorities on human problems, they often lose their humanity in getting the paycheque.
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New York Times
“A recent groundbreaking brain-imaging study found that children with attention-deficit hyperactivity disorder experience a development delay with a distinct biological basis. Investigators at the National Institute of Mental Health discovered that areas of the brain’s cortex undergo a thinning maturation process about three years later in children with A.D.H.D. than in those without the condition. Areas that integrate sensory information with executive functions like focused attention, remembering things from moment to moment and controlling movement — functions that are often compromised in people with A.D.H.D. — showed the longest lag time.
The results of the study support the belief that A.D.H.D. is a delay in a normal pattern of development, rather than a deficit that completely derails development — a longstanding debate in A.D.H.D. research. Yet despite M.R.I. images showing biological brain differences in children with A.D.H.D., news of the findings immediately tapped into a wellspring of skepticism about the legitimacy of the condition. Web sites were inundated with postings that A.D.H.D. is “just a delay,” that kids diagnosed with the condition are actually “normal” after all, that it’s perverse to medicate children for something that “most” will outgrow.
Estimated to affect millions of Americans — 3 percent to 7 percent of children and more than 4 percent of adults — A.D.H.D. has traveled an extraordinary arc of clinical and public opinion over the last four decades. What began as a relatively unknown disorder became broadly recognized as one of the most common psychiatric problems in children and an increasingly major consideration in adult psychiatric diagnoses as well.
Yet even as a mountain of research confirms the disorder’s biological and genetic basis, the impulse to deny A.D.H.D.’s legitimacy persists. “It’s always generated by this underlying skepticism, this feeling that, ‘Come on, all these kids need is a kick in the pants; this is just an excuse for being lazy,’ ” said Dr. Edward M. Hallowell, author of the popular “Driven to Distraction” series of books on A.D.H.D. “Twenty-five years since I first learned about this condition, the subtext is still always there, and it’s always on the part of the people who know none of the science.”
“Dr. Philip Shaw, the National Institute of Mental Health psychiatrist who led the imaging study, was surprised and dismayed to see the results taken up to bolster that brand of doubt. “The findings, if anything, are very good evidence of yet another major biological difference between kids with A.D.H.D. and typically developing children,” he said. “The study was very much a question about the biology of A.D.H.D., and I think the findings certainly would feed into the idea of A.D.H.D. as being a very real problem with a very clear biological basis.
The notion of a delay also seems to have sown confusion about how often children actually outgrow A.D.H.D. In fact, the disorder persists into adulthood in a majority of cases, with hyperactivity and impulsivity generally waning while inattentiveness persists. The actual figures are widely debated, depending upon how restrictively A.D.H.D. symptoms in adults are defined.
About a fifth of young adults still meet the strictest diagnostic criteria for A.D.H.D., Dr. Shaw said. But if you take a slightly broader definition, “about two-thirds to half of people still have a lot of problems stemming from their childhood A.D.H.D.,” he said, adding: “We were only looking at one of the first milestones of brain development. There are others to come, further down the line. And we know from a lot of other studies that teens with A.D.H.D. have very real differences in both brain function and structure.”
Russell A. Barkley, author of “A.D.H.D. in Adults: What the Science Says,” believes that persistence may be even more common. “Between 14 and 35 percent of children will technically outgrow the disorder, falling within the normal range of behavior and impairments as adults,” Dr. Barkley said. “We have many studies showing the functional deficits in A.D.H.D. well into adulthood.”
Dr. Shaw plans to continue imaging studies on both younger and older children. For now, he stresses that his findings mean children with A.D.H.D. face real challenges. “Just by underpinning that there is a very real biological difference, I hope it would add to the argument that kids with A.D.H.D. do often need adaptations to their learning environment to give them as good a chance as possible,” he said. “The priority still remains making sure your kid gets the best possible treatment and can realize their potential.” Publish date: 3/12/08
After struggling for decades to try to survive in the real world of modern, technically advanced U.S. of A., the pieces of the puzzle finally come together with a diagnosis of and treatment for a disabling condition unbeknownst to you. “My gosh, you mean all this time this A.D.D. thing for kids, I’ve got? Impossible! But, I have all the characteristics. How can this be?” But sort of like the theory of quantum mechanics, it passes every test, it explains every thing that’s been inexplicable, up ’til now.”
Wouldn’t you know, even as the reality of this damnable disorder really begins to sinks in, out there on the distant horizon a very vocal, but small minority, clamors unceasingly shouting at you at the top of their lungs that there is no such thing. You’ve got something that doesn’t exist.
Lo and behold, you’ve been duped again. You are using a fictitious label to feel better. It gives you an excuse. It offers a cheap explanation why you have been such a doofus all your life. You like that, don’t you? Just blame everything on some poorly conceived ploy to make psychiatrists and the drug companies rich. Every study, every double blind, controlled test, every observed experiment, every SPECT scan, every PET scan, each MRI, is bull. Every doctor prescribing the cocaine to you is a drug dealer, a thug and crook. (All meds used to treat it are just some form of speed) Not one piece of real scientific data supports this crazy, concocted crap. You are a fan of those charlatans. You are just like them.
But, I can read a book.
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This barrage of accusations, the contempt for this breakthrough diagnosis and treatment, the cutting insults, feels like a tsunami without warning breaking over my self-esteem and new life of possibilities in churning waves of hatred. And medical experts lead the way.
Somehow, I have become the enemy. My doctors are compared to Nazi war criminals who use me and everyone else they can for their selfish gain. If that isn’t bad enough, it turns out that as a duped believer in the myth of junk science, I too am just as guilty. I’m a Nazi. We abuse others. We sell drugs. My team, it turns out, is a cartel, a real cartel.
We are from that school of medicine that cut off brains for bucks. When drugs came along, we saw the money making potential, so we dropped the lobotomy business and started pushing drugs. Now, I and my partners drug little kids. We make them docile puppets; we make them behave and all the bad parents and nasty teachers love us. We want to stifle creativity. We sell the idea that drugs are all you need.
Meanwhile, unaware how diabolical I’ve become, for the first time in my life, I follow what the newsman reports. I hear every word he said. For three minutes.
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Blakeacake, I can understand how disorienting and off-putting these conversations might feel for you. After all, you’re encountering a new and unfamiliar perspective that calls into question everything you know. Meanwhile you’re trying to share your own perspective, but it isn’t a new one for the people you’re conversing with — they’re already familiar with it, and have strenuously rejected it.
If you’re interested in learning more about this new perspective, my advice would be to seek sources of information that state the case in a calm and objective manner, rather than attempting to sing the praises of psych diagnosis and drugging to people who have been harmed by diagnosis and drugging. One place to start would be right here on this site, in our archives: http://www.madinamerica.com/news-archives/all/adhd/
We also have a new search function: http://www.madinamerica.com/?s=adhd
Best of luck to you. And ps: please make sure that the email address you’ve signed up to the site with is a valid one (I attempted to contact you about a moderation issue and the email bounced).
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I can understand how disorienting and off-putting these conversations might feel for you. After all, you’re encountering a new and unfamiliar perspective that calls into question everything you know.
I am familiar with their perspective.
Meanwhile you’re trying to share your own perspective, but it isn’t a new one for the people you’re conversing with — they’re already familiar with it, and have strenuously rejected it.
Are you sure all the other participants reject my perspective? Is it a requirement for posting that you must agree with me? If so, I wasn’t aware of it and I apologize. Maybe it would make sense to reconsider what I am saying. Science is always about learning more.
I am calm and objective. If my experience has been different than most, are you suggesting it is better not to express it? I haven’t been presented with a reason to reject as unscientific even one of my opinions, yet, though I ask for proof that others are right or that I am. The oft repeated refrain that junk science is my foundation, I have not concluded the same about anyone else.
Would you prefer that I stop sharing my opinions?
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Blakeacake, you’re certainly free to share your opinions (as long as they’re within our posting guidelines for the site). I was pointing you toward resources where you might find the proof you say you’re looking for, and suggesting that that might be a more productive use of your time than trying to demand proof from people who may not be interested in (or have the patience for) engaging with you.
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blakeacake, would you mind using quotation marks when you’re quoting someone else’s comment? It’s totally disorienting when you mix together your opinions with previous posts.
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I appreciate your comment. However, I am against psychiatric medictions, and psych diagnoses. I don’t use them. I certainly don’t sing their praises. I address my approach toward psychiatry to the best of my ability. I hope you will consider my offerings.
you may contact me at [email protected]
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Robert, I’m sorry, I should have put the name of who I was addressing my comment to — I was referring to the commenter Blakeacake singing their praises, not you! Much appreciation for your approach toward psychiatry. I’ll edit my comment so it’s more clear.
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Robert Berezin, MD
Psychiatrist and author of Psychotherapy of Character:
The Play of Consciousness in the Theater of the Brain
Robert Berezin says:
December 19, 2014 at 5:18 pm
“We may not be as far apart as it seems. I certainly judiciously use, anti-psychotics for schizophrenia and manic depression, both in the context of real psychotherapy. Where I absolutely disagree is that I find no place, and no use for antidepressants at all – either in manic-depression or any other depression. These patients can be reached in a real way in therapy, always. I continue to suggest my book to have a fuller context for my position. Then I’d be happy to discuss.”
Dr., did I misunderstand your comments here?
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Thank you, Emmaline. And I apologize for my contribution to the confusion.
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Pretty first name, Emmeline. Any relation to Margaret? She was an incredible person.
You said, “The arguments here are somewhat one-sided in the sense that what we’re trying to offer on this site is a counterbalance to the monolith of mainstream perspectives on psychiatry. That ground is more than sufficiently covered elsewhere — in fact it’s pretty much all you can find elsewhere — what we’re presenting is an alternate, more critical view.”
Ms. Mead, Have you read an article in a newspaper or seen on television a segment of a show or an entire program featuring the wonders of a drug that has helped turn around a failing student into a thriving, happy student?
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Ever? Has treatment for the disorder attracted one positive word or any acclamations from our media? Autism receives some serious attention. Dyslexia, too. They should. Freed from what feels like an unending, unknown, hellish nightmare of ADHD, this confounding, damnable disorder, through medication, its victims hear nothing, except, it doesn’t exist and we take speed.
Emmeline, (Love that name) said, “rather than attempting to sing the praises of psych diagnosis and drugging to people who have been harmed by diagnosis and drugging”
I sing the praises of a life set free from hell. I don’t care if taking pepper did the trick, and I don’t mind if an elevator operator convinced me to use it; it is being liberated from hell that makes me sing. Should I be silent? Should I refrain from telling my story? Is there room for truth? Formidable, entrenched powers crush a lot of folks. Many are overlooked. “It don’t count ‘less it sells” our modern day Bard wrote.
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I’m not sure what you’re getting at, and am not interested in getting embroiled in a debate with you, but to answer your question I don’t really watch television. I do read articles from a wide variety of sources, but am more likely to read those that take a more critical perspective than the “featuring the wonders of a drug” point of view you describe.
I read this today and found it quite interesting: http://www.theblaze.com/contributions/adhd-definitely-doesnt-exist-but-if-it-did-i-would-have-it/
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Great article Emmeline although unfortunately, alot of the commentators didn’t agree. 🙂
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You said you are offering a counterbalance to the, “monolith of mainstream perspectives on psychiatry. That ground is more than sufficiently covered elsewhere…”
What I want to convey is that some kids have benefited profoundly through the use of medication, but we don’t hear much about them or those kinds of success stories, anywhere. I think it needs to be said, unequivocally, some kids respond favorably to treatment for ADHD. Kids with ADHD make considerable advances on drugs. Don’t forget about them. Don’t let anything obscure your sight of the boy in the straw hat whose life turned around. Some have been given a real shot a living; something they stopped dreaming of, an honest-to-goodness life unimpeded by the inability to control distractions. (Can you try to imagine what that is like? Would you try?)
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@blakeacake,
Of course you can say whatever you believe , but when it contradicts facts that prevent harm to kids, you are bound to be challenged– especially by people who have put forth effort to obtain facts.
I see no one censoring your comments, or challenging your right to post them:
>>”What I want to convey is that some kids have benefited profoundly through the use of medication, but we don’t hear much about them or those kinds of success stories, anywhere. I think it needs to be said, unequivocally, some kids respond favorably to treatment for ADHD. Kids with ADHD make considerable advances on drugs.”<<
I contend that the risks of CNS stimulants to the brain, mind and body of a *kid* outweigh the questionable results you are calling *success stories*.
Kids don't need drugs to control distractions, and would never seek a solution for what amounts to the problems teachers and caregivers are having because they are forcing the *kid* to attend to something he is not interested in.
Obviously, you don't know much about kids– and seem really unconcerned about how your lack of information is a threat to their well being. At least this is what you are really conveying – in my professional opinion.
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blakeacake,
You don’t seem to understand that this is not a pro psych drug site. If you want psych med success stories, I would suggest you find another site to visit.
I think you know that already by the way but for various reasons, continue to post here. I have my suspicions about why you do but because I don’t want this comment to be deleted, I will keep them to myself.
Since you keep pushing folks here for statistics, I am going to make the same request. How many of those folks that you call a success story continue to succeed with meds long term which I will define as 5 years? Can you produce studies not written by drug companies or medical professionals connected to drug companies that prove your point?
By the way, when I asked you a similar type question before, you ignored me. So I am hoping you don’t do it again.
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