A New Paradigm for Psychiatry

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There is a New Paradigm for Psychiatry. It is the ‘Play of Consciousness,’ not molecular brain diseases.

Here’s a newsflash – the hope for a molecular-biochemical explanation for psychiatry is a false hope. Most of my field has come to expect and believe that we are on the verge of a new paradigm. This paradigm is based on the illusion that the workings of the brain on the molecular level has anything to do with psychiatric conditions. The proponents believe we are on the verge of proving that psychiatry is a brain disease no different from cancer or diabetes. But all that the research has come up with is – nothing. The reason why researchers have no proof that psychiatry is a molecular medical disease, is because it isn’t so. Psychiatry is not about brain diseases.

We have spent billions of dollars chasing this illusion, and we are planning to waste billions more. The sad paradox is this so-called scientific pursuit has all the markings of a religious belief, not science. A false theory has taken on the certainty of belief, despite the absence of any real evidence. Molecular theories and neurotransmitter theories have been disproven at every step. In real science one exception disproves the hypothesis. But not here. False speculative claims just keep multiplying and are taken as fact. It is believed that it is just a matter of tying up the loose ends. We are on the verge of a brave new world. Salvation is at hand. But the whole deal is built on a house of cards.

However, there is a paradigm that fully illuminates psychiatry. It is not only consonant with biology and neuroscience, but evolution itself. The problem with the fruitless quest of molecular psychiatry is that we are looking in the wrong place. Psychiatric conditions operate on a much higher level of brain function – by which the brain maps the adaptations of responsiveness, deprivation and abuse in the context of our temperament through our memory, creating the ‘Play of Consciousness.’

Don’t get me wrong. I love neuroscience and the study of the brain. I am in awe of Sebastian Seung’s Connectome project (see the NY Times article, “Sebastian Seung’s Quest to Map the Human Brain“), and my friend Matthew Faw’s exciting research on the hippocampus and consciousness. (see his video, “Consciousness is Memory”) However, there is also a tremendous amount of poor brain science masquerading as fact. Don’t believe everything you read.

Consciousness is Memory

We evolve as a species, and we evolve as individuals in relation to our salient environment. All throughout our development – the embryo, fetus, newborn, baby, toddler, child, and adolescent adapts to its emotional environment. There are only three relevant issues – responsiveness, emotional deprivation, and abuse. Each of us fields our experience through the unique constellation of our temperament. The four elements of temperament are Internalization/Externalization, Introversion/Extroversion, Active/Passive, and Participant/Observer. (See “The Nature-Nurture question – Nature. The role of nature comes from our genetic temperament.”)

Each one of us is absolutely unique. I may process by being an Internalizer, Extrovert, Active, and Participant. You may be an Externalizer, Introvert, Passive, and Observer. We are all somewhere on an axis of those dynamics. With each dynamic we can range from 90-10, 60-40, or be balanced. And one temperamental element may be stronger or weaker in its influence. Each of us then fields the unique actualities of responsiveness, deprivation, or abuse in our emotional environment through our temperament.

By six weeks old we begin to write a play in consciousness. Initially consciousness is too immature to create representational form. At that point we only have the ‘feeling of our being.’ By age three we mature into representational consciousness where we create a three dimensional drama with personas, feeling relationships between them, scenarios, plots, set designs, and landscapes. Once our play consolidates, the rest of our experience is always filtered through the existent play in consciousness, which influences our ongoing experience. As the twig is bent, so grows the tree. When we reach adulthood, we consolidate our character. Our characters are as unique as our fingerprints. No two snowflakes are alike, but we are all snowflakes.

Significant deprivation and abuse generates a current of anger and pain in our personality. This creates the whole host of potential psychiatric symptoms. I’ll give a few examples of how this works. But of course, personality is far more complicated than these shorthand examples. Abuse fosters an ‘attacker’ and an ‘attackee’, who relate by sadomasochism in one’s character play. Externalizers will project the ‘attackee’ persona back onto other people. They will be prone to blaming and fighting with others. Internalizers, on the other hand are prone to an internal war where the attacker attacks the attackee inside of him on an ongoing basis. This generates self hate, as opposed to the Externalizer’s “I hate you.” When symptoms develop Internalizers are prone to ‘depression.’

We can see here that some personalities will attack ‘out’ and others will attack ‘in’. The ongoing sado-masochistic war feeds on serotonin. When the war is chronic, the serotonin supply eventually gets overwhelmed, and symptoms develop. This should be a signal that the chronic internal war needs to be attended to and healed, so that the personality is no longer in a state of perpetual war. If one were to feed more serotonin into the system via drugs, this results in a hardening and numbing of the personality. This feeds and fosters the destructive internal war to continue, to escalate, and become more destructive. More damage will be done. The absence of conflict over a resulting selfishness, can sometimes make a person temporarily feel better. This is not a good thing. And eventually, it will make things worse. (Depression is not a biochemical disorder or disease).

Different personalities will translate the same attacker-attackee currents into other symptoms. For example, With a Passive temperament, one does not identify as possessing or dishing out aggression. Aggression is located in the other person. How does a passive temperament operate in the context of being a recipient of abuse? This individual does not identify as the possessor of aggression, but as the helpless one who is the object of aggression. He cannot protect himself from the steady state of sadistic attacks, which are too powerful and overwhelming anyway. This leaves him in the position of identifying as distressed and exposed, anticipating external attacks, with no possibility of protection. As the recipient of attacks, in this context, he is inclined toward masochism. But more importantly this defines the circumstances that generate anxiety. It derives from sadistic attack directed by the attacker toward the attackee, with insufficient and failed protection. And this position will express itself as anxiety later in life as a teenager and into adulthood. Anxiety is the inevitable expression of sadomasochistic attacks of the ‘play’ via a passive temperamental orientation. (Anxiety is not a biochemical disorder or disease).

On the other hand, if a person is active rather than passive in the context of a sadomasochistic play, he would generate the opposite scenario. He would identify with the active position of ‘dishing it out’, with the potential for sadism. He would be predisposed to become a bully, and make someone else anxious, as the unprotected object of his attack. (Bullying is not a biochemical disorder or disease.)

These are just a few examples as to how temperament creates symptoms. The entire array of psychiatric symptoms is generated by the way temperament fields responsiveness, deprivation and abuse. It’s far more complicated than this brief description. The pain of isolation from deprivation and the sado-masochistic currents from abuse generate the full scope of psychiatric issues. None of them are biochemical disorders or diseases. Life events happen that generate problematic adaptations that create suffering. All of our suffering 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 the characterological play.

The Play of Consciousness is the paradigm that encompasses all psychiatric conditions. This is the relevant story. Understanding brain mechanisms is exciting, but psychiatry does not operate on this level. When a new play is written in the brain, brain mechanisms follow, but they do not lead. By healing the character, the brain mechanism follow suit. I’ll repeat the list of the various forms of human suffering: People may feel unhappy, lonely, angry, or sad. They may have symptoms: obsessive, compulsive, anxiety, so-called depression, panics, phobias, paranoia, delusions. People have character 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. These all derive from the real paradigm, the ‘play of consciousness.’ As Shakespeare said, ‘The plays the thing’… not some imaginary neurotransmitter disease.

Mourning is the built-in natural biological process to deal with healing and recovery for all pains, loss, trauma, as well as death, in the human lexicon. The way to deal with suffering, in all its forms, is good psychotherapy. Therapy is a responsive relationship that fosters mourning the pain of past traumas, to write a new ‘play of consciousness’ which promotes authenticity and the capacity to love.

This new paradigm is a unified field theory of human consciousness, which includes psychiatry, neuroscience, dreams, myths, religion, and art—all elements of the same thing. It derives from and is consonant with our child rearing and culture. The “play” encompasses the ineffable human mysteries—birth, death, and the disparity between our ordinary sense of self and our intimation of a deeper authenticity. It includes as well the dark side of our nature. And finally, it holds the key to the nature of beliefs in general. Human consciousness and human nature are one and the same. The creation of our inner play by the brain is the consummation of our Darwinian human evolution.

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Mad in America hosts blogs by a diverse group of writers. These posts are designed to serve as a public forum for a discussion—broadly speaking—of psychiatry and its treatments. The opinions expressed are the writers’ own.

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132 COMMENTS

  1. I agree that only pseudoscience supports psychiatry and their concept of “mental distress” but take exception to abandoning science in favor of a philosophy of mind. Molecular neuroscience is absurd since molecular physiology is far too complex to explain any organ of the body; all other organs are only explained at the tissue level. Molecular physiology explains cellular physiology that explains tissues and tissue systems that explain organs. Since we have a basic understanding of neuron cells, we have all the information necessary to understand the brain. The problem is that scientists model the brain after computers that work on a principle of binary science and thereafter ignore binary neuroscience; this is illogical. The cerebral cortex is nervous tissue structured for thinking and the limbic system is nervous tissue structured for motivation; motivation directing thinking is binary neuroscience. Binary neuroscience explains all consciousness, cognition and behavior; mental distress is emotional distress- the natural, normal neurobiology of distressful experiences. Please consider Natural Psychology at NaturalPsychology.org.

    Best wishes, Steve

    PS- Any criticism of Natural Psychology is appreciated.

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      • Dr Berezin, if we remove all the brain tissue from the skull, depression will disappear; personality disorders, ADHD, bi-polar, anger, they won’t bother us a bit. Or say we remove all the neurotransmitters, same thing. Deprive our grey matter of oxygen for 8 minutes and mood disorders vanish.
        Logic tells me with the few neurons I have left, that the brain must have something to do with us, you know?

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      • Dr. Berezin, the 4 temperments you mention, from where do they come?

        “We evolve as a species, and we evolve as individuals in relation to our salient environment. All throughout our development – the embryo, fetus, newborn, baby, toddler, child, and adolescent adapts to its emotional environment. There are only three relevant issues – responsiveness, emotional deprivation, and abuse. Each of us fields our experience through the unique constellation of our temperament. The four elements of temperament are Internalization/Externalization, Introversion/Extroversion, Active/Passive, and Participant/Observer.”

        We must eat and breathe. Molecules must enter our bodies or our temperments disappear. Add toxic molecules to food and air and our temperments cease. The molecular level of brains is extraordinarily important.

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      • Physiologists understand organs like the heart and lungs at the tissue level. For instance, the heart nourishes the body by muscle tissue creating a pump with valves created by connective tissue; nourishment is carried throughout the body with pipes created by epithelial tissue. Consistently, the lungs create respiration (absorbing oxygen and dispelling carbon dioxide) with chambers made of epithelial tissue (that mediate between the environment and the body) and muscle tissue to force the exchange.

        Physiologists understand the general function of cells and how they create tissues (systems of cells). Cells are systems of molecules; it is true that we are far from understanding how cells function at the molecular level.

        Best wishes, Steve

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          • As I stated in my original comment, organs are only explained at the tissue level- with four kinds of body tissues. Nervous tissue is comprised of neuron cells and glial cells, and we understand the basic functions of each. Hence, we have all the information we need to understand the brain.

            Best wishes, Steve

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          • “Nervous tissue is comprised of neuron cells and glial cells, and we understand the basic functions of each. Hence, we have all the information we need to understand the brain.”
            No, not nearly. Do you know how many types of neurons and glial cells are there? I don’t and as far as I can tell nobody does. And that’s not mentioning other types of cells (endothelial cells, stem cells) which are present in the nervous system. We have some knowledge of how the tissues are built and how their function but not nearly enough to understand how they do it. Not with the simplest of them and brain is not simple. Plus tissues are not only about the building blocks but the dynamic physiological processes they undergo which we also hardly understand. It’s like saying: a car has a function of transporting stuff and has 4 wheels, the engine and a steering wheel so we understand how cars work. You need to get a bit more complicated than that when you want to really know how it does it, not to mention to repair it.

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  2. I just watched the evening news, first of which I consider hopelessly biased by corporate sponsors…most commercials are for drugs. The news presented is horrifying with little real analysis and even less to feel hopeful about in our world…We hear a one sided explanation with the conclusion that we need “a more aggressive response to the threat”…meaning we need to bomb our “enemies” so they quit killing us….I am feeling very hopeless about this whole picture, you could describe me as having any number of psychiatric symptoms…anxiety, depression, insomnia…yet, I refuse to believe that I have anything close to a brain disease…we have a world full of pain, confusion and what I consider delusional thinking and I am having a rather normal human reaction…

    Thank you for your article Robert! We need to inject some sanity into psychiatry…and hopefully our world. Instead of taking our “soma” let’s talk, listen and deal with the world’s pain and quit making it worse…

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    • The thing is that … OK … we basically assume these days that the brain is the mind. People can theorize about quantum mechanics and the brain being an antenna, souls or whatever, anything is possible I guess.

      Anyway, if the brain is the mind (or the mind is a slave to the brain or excluding any number of other possibilities here) then any behaviour or thoughts are a symptom of the brain working right ? So in that respect it’s hard to argue against this model, but like has been said are the ‘diseases’ really diseases !?!? I don’t think so.

      These days everyone is expected to be somewhat of a computer, somewhat of a robot in order to be successful. I don’t know. I think with a lot of these problems toxins, diet, lifestyle, outlook, shitty circumstances are the real explanation rather than brain diseases.

      I’m skeptical of the whole system as it currently stands and I’m skeptical of anyone who really thinks they have some sort of guru status when it comes to the human condition, time and time again the trait that seems to come through is arrogance or just plain craziness.

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  3. “Psychiatric conditions operate on a much higher level of brain function” …

    … only if illusion is classified as a “higher level of brain function.” In reality, there are no such thing as “psychiatric conditions,” except those that have been invented by psychiatrists. Wishing “diseases” and “mental illness” into existence may be “play of consciousness” for psychiatrists, but it is suffering and hell for those who are stigmatized and tortured. Psychiatry is and always has been based on lies. The paradigm shift that needs to take place is the shift away from lies, the shift towards truth. This is a shift that anyone can make by studying and understanding the history of psychiatry.

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  4. Dr Robert, I like your article.

    The dopamine idea (in my opinion) is wishful thinking, and it is simple minded.

    I know that lots of people, have made complete recovery in different ways. But nobody has ever made any real recovery with the dopamine approach.

    I don’t trust the so called neuroscience either. I think the way forward would be to concentrate on what’s already proven to work.

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  5. Dr. Berezin,
    If a person is terribly nearsighted and he cannot really function because his vision is so poor, but a pair of corrective lenses will bring the world into focus for him, is there any reason not to supply him with a nice pair of glasses?

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      • Suzanne, You are spot on!

        We had to retrieve our son from college, in a psychotic state, because of amphetamines that he had a prescription for because he was all of a sudden diagnosed with ADHD. After being his HS class valedictorian and getting into MIT I might add. Amphetamines steal away a persons confidence and that’s how it becomes your trap. 25% to 30% of kids in some schools are on some form of amphetamine. So addictive it is one of the single most destructive legal drugs on the market today. Way more to the story but I wish it were as simple as a new pair of eyeglasses.

        Thanks for posting this response.

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        • Warmac, I am SO sorry to learn of the harm done to your son in the name of ADHD “treatment.” I hope he is doing better now!

          My own son is dead, in large part because of the self-serving LIES promoted by American psychiatry. What if we form a nationwide organization for pissed off, whistle-blowing families who have been devasted by the false paradigm of psychiatry? What if a large group of pissed off parents like the Fees and like you and me got ORGANIZED?! Mental “illness” is not the problem – it’s the incompetent, life-detroying bio-psychiatric paradigm and its “treatments.” That is the problem.

          PS: I’d like to thank blakeacake for bringing us together here. Perhaps he/she will inadvertently serve as the catalyst to form a major backlash against dangerous psychiatric quackery.

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      • Very interesting. Glasses are fine. They are not dangerous. Without glasses the person is practically blind and cannot function, realistically. No question he needs and will benefit from a fine new pair, prescribed and fitted just for him. We don’t give it a second thought. Glasses are safe. He can’t see. Voila!

        Did you hear the breaking news? Pepper treats ADHD. It works great to focus one’s attention, like 20/20 focus. Stimulants are so yesterday. Pepper is here. Cheap, safe, plentiful and IT WORKS!

        One year later and no one discusses ADHD any longer. At least, no one bothers to challenge whether or not it “is”. (Bill Clinton now knows that is is is.) Take your pepper. Doesn’t bother me. It doesn’t matter if it’s real or not. It is those dangerous drugs we don’t like. Good riddance drugs.

        Hello Ms. Beachy, thank you for your response. Please share more! (I hope Dr. Berezin will join in.) I want to know your educated, sincere thoughts. Really.

        Would you give aspirin to someone with a headache even if aspirin really is more dangerous than amphetamine? I am a teetotaler. Don’t smoke or drink or do drugs, ever, at all. I would prefer pepper. Pepper doesn’t help. Should I stop my meds? Most of my life I could not function. Awakenings. Did you see it? True story. The L-Dopa drug restored life to a group of catatonic patients. Robin Williams and De Niro. I can relate.

        I don’t want to kill myself, especially now that I can read. I LOVE to read. I can watch documentaries and do Algebra II and cross word puzzles. People don’t laugh at me any more. (I’ve heard people whisper, saying how smart I am!) I want to live. I like being healthy. Should I stop?

        Here is Dr. Hallowell’s response to the December 9, 2012 New York Times article:

        “To the Editor:

        Bravo Dr. Sutherland! As a man who has both A.D.H.D. and dyslexia myself, and as a psychiatrist who’s been writing about and treating children and adults with this condition for over 30 years, I know of the rampant yet preventable damage wrong information about A.D.H.D. does to children and adults every day.

        The proper treatment of A.D.H.D. should always include education, a lifestyle review, coaching to develop organizational skills, and assessment of talents and strengths, not just a focus on what’s going wrong. The treatment also may, but need not, include medication. First used to treat what we now call A.D.H.D. in 1937, stimulant medications have stood the tests of time and scientific review. Medication should now be a welcomed option, but it usually is not, due to wild and toxic misconceptions.

        People often ask me, “Do you believe in Ritalin?” My reply is that it is not a religious principle. Yet, it is often discussed as if it were. Stimulant medications, like Ritalin and Adderall, are simply medications. When used properly, they can be a godsend, as effective in helping people who have A.D.H.D. as eyeglasses are in helping people who are near-sighted. If they do not help, or of they cause side effects, either the dosage should be changed or the medication should be discontinued. It should be as simple as that. Sadly, this sensible approach gets blown up routinely by the hyperbolic nonsense that appears too often even in responsible media. The SCIENCE IS CLEAR, used properly stimulant medication is safe, in many ways safer than aspirin, and provides the most effective short term aid we have to help people of all ages deal with the negative symptoms associated with A.D.H.D. Yet, rather than regard this medication as a helpful tool, most parents fear it, seeing it as a last resort. Stigma enshrouds stimulant medication like an impenetrable rind, preventing legions of children, as well as adults, from ever reaping the extraordinary benefits these safe and time-tested medications can provide.

        Happily, we have many other powerful tools in our toolbox we can use to help people develop the many talents that are wonderfully embedded in the mind of a person who has A.D.H.D. But it is foolish to disregard the science and subscribe to the superstitions that lead people to remove stimulant medication from that toolbox.”

        Thank you again for your response.

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        • Hey there blakeacake,
          You are so welcome! In answer to your question, yes, I am familiar with the film “Awakenings.” It was probably the most heart-wrenchingly sad movie I’ve ever seen. What a tragic story. Why do you think the “L-dopa drug restored life” to a group of catatonic patients? None of them were restored to life. Treatment was a tragic failure. Were you unable to attend to the entire movie? As I recall, the effects of the drug were temporary, and ALL the patients returned to a catatonic state. So sad.

          Good luck with your ADHD amphetamine addiction. I hope it doesn’t end up destroying you like it has so many others.

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        • “Would you give aspirin to someone with a headache even if aspirin really is more dangerous than amphetamine?”
          Seriously? How many people die on aspirin?
          Aspirin is only really dangerous for small kids, it can cause Reye’s Syndrome. That’s why you don’t give them to kids.
          Amphetamines are addictive, can cause cardiovascular events and psychosis. They are given to kids like candy.

          “we have many other powerful tools in our toolbox we can use to help people develop the many talents that are wonderfully embedded in the mind of a person who has A.D.H.D.”
          Not true. Existing studies show that there’s no long-term educational benefit to kids taking stimulants.

          Where did you take that bs from? Who is this Dr. Hallowell?

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          • Nor is there any long-term social or emotional benefit to stimulant use over time. I have no problem with individuals using stimulants if they know the risks and are willing and able to take responsibility for them. But forcing kids to take stimulants that don’t enhance their long-term benefit just because it makes them easier to deal with is just plain dumb.

            By the way, I don’t know if you are aware of this, but there was a great study back in the 80s showing that “ADHD” kids were indistinguishable from “normal” kids in an open classroom environment where they had more control of their time and activities. We had all our kids (two of which are classic “ADHD” types) enrolled in this type of schooling, and none took any medication and the two “ADHD” types both graduated HS with honors, and the youngest is currently enrolled at Evergreen State College. I don’t think they needed amphetamine “glasses.” They needed to learn in an environment that respected their personalities and learning styles. They got it, and they did just fine.

            Most “ADHD” is caused by schools.

            —- Steve

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        • blakeacake,

          You forgot to quote Dr. Hallowell’s 2013 article, conceding that perhaps his beliefs were unwise:

          “… in a recent interview, Dr. Hallowell said that the new C.D.C. data, combined with recent news reports of young people abusing stimulants, left him assessing his role.

          Whereas Dr. Hallowell for years would reassure skeptical parents by telling them that Adderall and other stimulants were “safer than aspirin,” he said last week, ‘I regret the analogy’ and he ‘won’t be saying that again.’”

          Here’s the entire article:

          http://www.nytimes.com/2013/04/01/health/more-diagnoses-of-hyperactivity-causing-concern.html?pagewanted=all

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  6. I think it’s important not to claim that the brain is *never* part of the problem. A traumatic brain injury can be a root cause, from an automobile accident, sports injury, concussion… or in the case of a veteran, from an explosive devices:

    http://www.brainlinemilitary.org/content/2010/12/blast-injuries-and-the-brain.html

    This is only *one* example of a physical, underlying reason a person may be suffering from a “mental illness.” I cannot wait until the day more doctors begin to acknowledge this.

    Duane

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      • Well, if your argument is for legalization of narcotics, then yes, it may be a good idea. Just don’t tell people that caffeine is treating a biochemical imbalance or that it will turn one;s kid into a little genius. No drug can do it.
        Alcohol, caffeine, marihuana, amphetamine etc. are all psychoactive drugs. They are used for fun and to ease pain and to get through difficulties. It’s OK for people to take them as long as they are adults and they know what they’re putting themselves into. But we don’t ask doctors to prescribe whiskey for social anxiety and we should not prescribe amphetamine as school aid.

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      • blakecake,

        I consider myself to be as critical of psychiatry as anyone on this site, but that criticism stops at the door of the profession, and I have no ill will toward anyone who has sought, or continues to seek conventional psychiatric treatment. My anger (and rage) is reserved toward those who cause suffering, not toward those experiencing it.

        It sounds like you’re a person who has done the best you can, with the information you had (continue to have) at hand, like every other person out there.

        You ask a good question – what is ADHD? Obviously, it depends who you ask. But if you asked me, it can be based on a number of physical possibilities: nutritional deficiencies, food allergies (sensitivities), and/or absorption difficulties. I think the symptoms of what is called “ADHD” are very real, and very few people know where to find non-drug treatment. Neurofeedback can be helpful, along with eliminating culprits in the diet; along with making sure certain nutrients are in the diet.

        In the event you are interested…
        There are some good links on my website, under the categories ‘Root Causes of Mental Illness’ and ‘Nutrition’. Also, under ‘Peer Support’, there is a link to Safe Harbor, an online support group. You may want to look at the work of Mary Ann Block, DO; Natasha Campbell-McBride, MD; and Kelly Brogan, MD (MIA blogger) on the site:

        http://discoverandrecover.wordpress.com

        I think the backlash you experienced on MIA is due to the personal experience many in this group have experienced – with psychiatric drugs, often by force.

        I don’t always fit in well with this group. My politics are hardly in keeping with most on this site, and I happen to believe that the *right kind* of medical intervention can go a long way in helping people overcome very serious underlying *physical* conditions that are called “mental illness.”

        In short, I agree, *something* is going on with “ADHD”, and suffering is very *real*. For whatever it’s worth, I know first-hand how it feels to be misunderstood on an online group. I hope you the best.

        Duane

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  7. Thank you Dr Berezin for this piece.
    I wish there were more psychiatrists who could accept that we are human beings, formed through not only our inherent and inherited characteristics, but also through our experiences, our loves, our traumas and our environments.

    Perhaps then, more would look to helping to heal our injuries, rather than striving to correct some mythical chemical imbalance, without which we would all meet some imagined, heterogenic, and psychiatrically-determined-but-forever-undefined and unattainable vision of “mental health”…or actually freedom from the multitude of “mental illnesses” defined in the DSM.

    I do feel concerrn, however, that you seem attached to some quite specific and potentially limiting paradigms which could lead you to have particular expectations regarding the progress and desired outcome of the therapeutic process. In this way, your approach could potenetially be construed as subtly (or not so subtly) coercive, and as creating people who please your definition of “well”.

    I suspect that one of psychiatry’s BIG issues is precisely that it seeks a “unified field theory of human consciousness”, but that human beings and their many consciousnesses are immesurably diverse and complex , so any unified theory is bound to be significantly insufficient.

    That said, I am enjoying your writings and your valuable contributions to MIA – it is great to see a field leader and senior academic come down on the side of humanity, rather than drugging and related pseudo-science so heavily pushed by mainstream psychiatry.

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  8. To be honest the point of the article seems very murky to me: is it that we all have different personalities which are shaped by our experiences therefore we respond differently to life’s stresses? If so I agree on a larger point.

    What I disagree with is putting this in a language of pseudo-neuroscience talking about depleted serotonin supplies and such. I also don’t necessarily like the model of “Internalization/Externalization, Introversion/Extroversion, Active/Passive, and Participant/Observer”. It reminds me of the Greek temperament types: https://en.wikipedia.org/wiki/Four_temperaments. Sure you can categorise people this way, you can even make it a bit more complicated by saying somebody is 10 on this axis and 90 on another but it’s still based on bs measures and gross oversimplifications and devoid of context or information about internal states.

    “These are just a few examples as to how temperament creates symptoms. (…) Life events happen that generate problematic adaptations that create suffering. All of our suffering flows from our damaged plays of consciousness.”
    People respond differently to abuse and I agree that the different “symptoms” are not sign of different underlying pathologies but rather responses to various crisis filtered through the individual personality. This is the point that psychiatry at large seems to miss completely so they create elaborate DSMs splitting the hair into thinner and thinner threads and and then try to treat these symptoms while the person goes bald.

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    • The main thing that bothers me about is it seems reductive but the author has explained this is because it’s a blog post, fair enough.

      Still I really don’t like thinking this way whether it’s true or not if i’m being honest.

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  9. “The reason why researchers have no proof that psychiatry is a molecular medical disease, is because it isn’t so.” Dr. Berezin

    Dr. Berezin are you able to confirm your statement above through science?

    “I certainly judiciously use, anti-psychotics for schizophrenia and manic depression, both in the context of real psychotherapy.” Dr. Berezin

    Robert Berezin, MD (MIA Author)
    on February 14, 2015 at 5:17 pm said:
    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]

    Dr., in light of your stance, I’m not clear why you would prescribe anti-psychotics for schizophrenia and manic depression?

    “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.”

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    • Science operates on the principal that an experiment has to verify the hypothesis, otherwise, it’s assumed to be false until proof arrives. Additionally, one contradictory finding can be sufficient to disprove a theory.

      Psychiatry operates on the principle that what it says is true until proven false by its opponents, and allows that one positive study is sufficient to negate any number of negative ones.

      If we are being scientific, your first question makes no sense. The real question is whether psychiatry has any proof that any “mental disorder” IS a molecular medical disease. In the absence of such proof, we have to assume that it is not. Such proof has been sought for years, but is not forthcoming, and every “proof” that’s been offered has been discredited. There is no currently supportable theory for the cause of ANY mental health disorder. And why would there be, when these “disorders” are decided on by committees of psychiatrists, many of whom sport long lists of conflicts of interest with pharmaceutical companies?

      Science is the ultimate form of skepticism. A real scientist doesn’t try to prove his theory correct, he does everything he can to prove it wrong. Only when it holds up to that kind of scrutiny is it accepted, and then only pending new data that may conflict with it. If psychiatry operated on that basis, there would be no psychiatry.

      —- Steve

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      • Steve,

        I think you can find some good science behind treatment of sleep apnea, and how allowing oxygen to go to the brain (rather than being obstructed) helps the *brain* heal – allowing an individual to overcome many forms of “mental illness” – depression, anxiety, agitation, mood swings. The *brain* needs oxygen: our mental health depends on it.

        There are some good *scientific* studies on various vitamins, ie, B-12 and D-3 for the treatment of depression; omega 3s and bipolar, etc, etc… Are these naturally-occurring elements, used as a form of treating a deficiency, similar to treating a “chemical imbalance?” I would say, maybe so.

        But if a person were to change their diet, and “treat” depression or bipolar with the right source of nutrients from foods, nobody on MIA would blink an eye. Maybe there is something to the “chemical imbalance” theory after all, considering what we are beginning to find out in the area of nutritional studies. Here are over 1,200 studies on nutrients for depression:

        http://vitasearch.dyndns.info/search?sort=date%3AD%3AL%3Ad1&output=xml_no_dtd&oe=UTF-8&ie=UTF-8&client=CP_frontend&proxystylesheet=CP_frontend&filter=0&getfields=*&q=depression&btnG=Search&site=Summaries

        I see your point, but disagree slightly. Because neurotransmission cannot be measured, the chemical imbalance theory is anyone’s guess. But our brains are connected to our bodies. Our guts have neurotransmitters, and much more serotonin than our brains. Hormonal imbalances have an effect on emotions, so does the thyroid, the adrenals… the chemistry of the body can get out of balance… but not the brain? That seems like a stretch.

        I believe imbalances can be corrected, without the use of toxic drugs. So I suppose you could say that I am not so much against the (anyone’s guess) “chemical imbalance” as I am against the toxic chemical “cure.”

        Be well,

        Duane

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        • Duane, have you seen information like this.. Newer research is even more impressive.

          Nihon Yakurigaku Zasshi. 1997 Jun;109(6):259-70.

          [Neurotransmission in human brains measured by positron emission tomography (PET)].

          [Article in Japanese]

          Yanai K1.

          Author information

          Abstract

          Various techniques have been developed to image human brain function in the past decade. X-ray computerized tomography and magnetic resonance imaging (MR) are used to evaluate brain structure. Recently, positron emission tomography (PET) and MR are often utilized to perform human brain mapping such as attention, cognition, language comprehension, and so on. PET also makes it possible to evaluate the states of various types of neurotransmission. These techniques cannot only be used to map “brain neurochemistry” in normal human brains, but they will also increase our knowledge by demonstrating neurochemical abnormalities in a wide range of neurological and psychiatric disorders or those that occur during normal aging. The PET techniques are applicable to the development of new drugs in the pharmaceutical industry. Using PET techniques of imaging neurotransmission, it is feasible to measure the release of neurotransmitter after activation of the CNS by various methods (ligand activation study). We have developed the methodology of using 11C-labeled antagonists for mapping functional histamine H1-receptors in human brain directly and noninvasively by PET. The present review article provides an outline of the conceptual and methodological progress over the past several years that has made it possible to visualize neurotransmission in human brains by PET.

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        • Duane, many thanks for your comments. I, too, am somewhat out of sync with the prevailing mindset at MIA. I disdain and oppose with everything in me the prevailing drug-based paradigm. At the same time, I am convinced that the idea that biology plays no role in mental distress will not stand the test of time. The evidence is all around us — including right on MIA — that vitamin/mineral deficiencies (or overloads) are implicated in mental illness. Orthomolecular (nutrient) therapy has done wonders for my child and made me a believer in nutrient therapy. Nutrients are the insulin for the brain; that is the right analogy.

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        • I don’t disagree with you, Duane. My issue is not that there are no cases where physiology causes what we think of as “mental disorders,” it’s only that we can’t say with any accuracy that based on BEHAVIOR or EMOTION or THOUGHT, we somehow KNOW there is a biological problem. A person with sleep apnea should be diagnosed and treated – for sleep apnea, not for some fictitious “bipolar disorder.” Same with B vitamin deficiencies. Psychiatrists almost never check for anything other than the “symptoms” that define the “disorder,” even when their own drugs are the cause of the “imbalance” they are now ostensibly treating.

          The biggest problem with the DSM is NOT the drugs – they are a consequence of the warped thinking behind it. The biggest problem (scientifically speaking) is the lumping together of people with a wide variety of conditions, some physiological and some psychological, and people with no condition at all, and claiming they all have the same “disorder,” when the only thing they have in common is a set of symptoms. It would be like treating everyone who has a rash in the same way – topical steroids for all, whether it’s poison ivy, measles, or syphilis. It prevents any actual research into the real causes such as the ones you are presenting.

          Hope that clarifies things. I don’t agree that therapy is the right thing for everyone. It depends on what problem you’re trying to solve. Real diagnosis means finding CAUSES, not simply categorizing things in ways that make someone’s product more marketable.

          Appreciate your comments, as always.

          — Steve

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    • There are times in the treatment of schizophrenia when a patient is horrendously terrified. I don’t impose med’s on anbody. Sometimes it helps to get back intactness. I give the control to my patient. The real work has nothing to do with med’s. It is the psychotherapy.

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      • “There are times in the treatment of schizophrenia when a patient is horrendously terrified. I don’t impose med’s on anbody. Sometimes it helps to get back intactness. I give the control to my patient. The real work has nothing to do with med’s. It is the psychotherapy.” Dr. B.

        Thanks, doctor, for your response. Meds help bring a very sick patient back to intactness where the real work can begin. (I think the meds do some important work, too. To assist the patient to the point where more work can be done, is critical.)

        How does the med do that? How is it possible? Do any medical principles, evidence, testing or theories indicate what it is specifically that that med does to recover intactness?

        I’d ask the same kinds of questions for your work with Manic-Depression when meds are applicable.

        Thanks Dr.

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  10. “Nor is there any long-term social or emotional benefit to stimulant use over time…” That is not true.

    “If we are being scientific, your first question makes no sense. The real question is whether psychiatry has any proof that any “mental disorder IS a molecular medical disease.”” Yet, there is no proof that it isn’t.

    DR. Berezin, if you read this and are so inclined, could you explain why you would you prescribe antipsychotics for S and MD?

    “By the way, I don’t know if you are aware of this, but there was a great study back in the 80s showing that “ADHD” kids were indistinguishable from “normal” kids in an open classroom environment where they had more control of their time and activities” Would you give the name of the study or other details? I’d like to see it. What is an open classroom? Their grades were just as good? Do you know how long it lasted? Thanks

    “While both of these impositions can yield some short-term benefits…” Dr. Wiener.

    Dr., based upon what information do you make this statement? Any ideas you could share with us why drugs and organization can yield short-term benefits?

    “In this treatment protocol, diagnosed individuals are remanded into treatment that mimics institutional care (i.e., others control their access to resources and their behavior is restrained with drugs).”
    How is their behavior restrained? by drugs? They are unable to move or speak? Again, why do you suppose there can short-term benefits in this type of setting?

    Dr., do you believe ADHD exists? Is there such a trait, characteristic, disorder, illness or whatever it should be called? Or is it just nonsense? Is there nothing to it? Are some people unable to concentrate consistently when they need to, no matter how hard they try to? Can that type of problem exist? Or, is it your opinion that attention is always under the control of the individual?

    I would appreciate your thoughts and those of any and all the MIA writers.

    Thanks

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    • You should re-read my post. Saying there is no proof that it isn’t a biological disorder is nonsense scientifically. If there’s no proof that it is and no proof that it isn’t, then scientifically, it isn’t. There may be evidence later to change that conclusion, but you can’t assume your hypothesis is true in the absence of evidence to the contrary. It’s kind of the most basic law of the scientific method.

      An open classroom is a classroom where there are activities available for children to engage in, but there is not a teacher in front directing everyone to do the same thing at the same time. Generally, there are work stations of some sort, with suggested or designated activities outlined, but within those guidelines, kids are encouraged to experiment more and learn from doing rather than from hearing. Additionally, kids aren’t usually kept to a rigid schedule – they can attend one activity for a short or long time and transition to another when they feel they are ready to do so. The investigator in the study in question believed that the constant starting and stopping at the teacher’s behest is part of what frustrated the “ADHD” kids in the regular classroom and led to their inappropriate behavior.

      I don’t have the reference ready to hand but will look it up tonight and hope I remember to get it to you tomorrow.

      I do think ADHD is a characteristic or trait that is at least partly inherited. But I don’t thinki it’s a disease. Human beings and other species survive on genetic diversity, as it allows adaptability to varying environments. In a hunter-gatherer society, the “ADHD” person would have been in high demand as a hunter or warrior, both occupations that allow lots of flexibility and have an element of risk and adventure. I think we end up creating problems for these kids when we put them in an environment that is unavoidably dull, especially if they have to take a lot of arbitrary orders. The difference in the open classroom shows that this characteristic behavioral pattern isn’t necessarily a detriment. It depends on the environment and the expectations. We don’t expect a geeky scholar type to be an excellent athlete. Why do we expect a creative and adventurous type to be an academic?

      — Steve

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  11. And to anyone who cares, how do you view and what is ADHD, exactly? Same questions as above. Is it fictitious? Real, but no big deal. Typical of boys, nothing serious. Nothing that requires or justifies the use of any stimulant, period. A phase. A set of traits? Not serious. Can be disabling. A function of willpower?

    I would appreciate your thoughts.

    Thanks

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  12. “I do think ADHD is a characteristic or trait that is at least partly inherited”

    Great. You gave a clear answer. It exists. IT EXISTS!

    Now what?

    Can we approach further discussion about it a step at a time?
    What if an open classroom has no positive influence on some kids who have it? IOW, do some experience its symptoms more extensively or more severely than others? If so, what do we do with those kids?

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    • “It’s alive! It’s alive! It’s alive!”

      How about we approach it one letter at a time, and concerning each specific case? Does this have anything to with attention, specifically a lack thereof, and leading to a surplus in activity, usually plain fidgety or nervousness, and does such constitute a “disorder”, I guess the way that mussed hair constitutes a “disorder”? Furthermore, is this “state” or “condition” of “disorder”, the way mussed hair is not, a legitimate concern for medicine? Likewise, is this not another instance of…’There must be fifty ways to’ pathologize childhood and adolescence coming from a medical pharmaceutical industry perspective. You say A. I say B. I don’t know why you say A. I say B.

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    • “It” exists, because “it” is a list of behaviors that make it inconvenient for these kids to function in a standard classroom environment. Being artistically talented exists, as does being athletically clumsy and being short or being fat. Fatness is a good example. Some people are more likely to be fat because of genetics. This can be enhanced or reduced by exercise, diet, and other environmental factors. Fatness is more common among poor people and among those who are abused as children, so there are clearly stress-related variables, but some people don’t get fat regardless of stress or diet.

      Does that make “fatness” a disease? Or is the genetic variation in body weight a natural distribution of genetic traits that might be beneficial to the species? Fat people, for instance, are more likely to survive a famine, while the skinny ones die off. On the other hand, the skinny ones are probably better runners and hunters, and the fat people might die without them.

      A wide range of genetic variables are important for species survival. Just because something is partly genetic doesn’t make it a disease. Read what I wrote about the open classroom. Why aren’t we creating classrooms that work for these kids, instead of forcing the “square peg” into the “round hole” of a standard classroom? It’s not the peg’s fault it’s square. It’s just a bad fit. We used just such a classroom with our youngest, who is classically ADHD (helped to create the school, actually), and he graduated with a 4.0, was all-state in soccer, and is attending college with over $20,000 in scholarships. Guess he turned out OK without “treatment,” didn’t he?

      —- Steve

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      • Great! & what is the function of a “kid”? Indulge me some in a juvenile philosophy lesson why don’t ya? Over eating disorder leads to obesity disorder, etc. We all have our “addictions”…Some of us are just young, and fidgety. I don’t see that as a good reason, because fidgety-ness may have an negative effect on grade-point averages, just as daydreaming might, for giving school children speed. Childhood may be abnormal, sure, but if it is, I say, let’s hear it for that kind of abnormality. Pumping it up with toxic chemicals has proven a dreadful disappointment. Look at the negative outcomes sometime, and I can imagine you might find better things to be doing with children.

        I say B. You say A. I don’t know why you say A. I say B.

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      • “It” exists, because “it” is a list of behaviors that make it inconvenient for these kids to function in a standard classroom environment.” Steve

        Thanks for this, Steve. I appreciate the opportunity to examine ADHD with you and Duane. I know I have much to learn.

        Responding to your opening statement, let me ask this. You say it exists because it is “inconvenient” for these kids to function in a standard school environment. What if it makes it impossible for some kids to function in a standard class or an open class (have you found that study you mentioned. I would like to see it)? What then? Is it possible some have it in a more severe form than others? Or that some people don’t have the intelligence/skills to compensate for it as well others do? Can you graduate from college with untreated ADHD and if so, is that proof everyone with it can do as well if they have the same strengths and interests, or may the traits be overpowering to some regardless how intelligent they may be?

        This is the one-step-at-a-time approach I prefer. Just trying to break things down to look carefully at the logic at each point of a discussion. So, I start with your first sentence, in this case, to try to parse it into precisely what we can deduce from it, if that is okay with you.

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        • I suppose you make my point for me to some degree. “ADHD” is not an entity, it’s a heterogeneous collection of people so labeled because of social expectations. (Notice that there is no “hypoactivity disorder?) This particular way of being can make it harder for a kid to succeed in the pathway our culture expects him/her to travel. For some of these kids, they are motivated and can use their intelligence and drive to come up with ways to overcome their difficulties in organization and focus. In other case, they don’t care about going to college and do other things instead. Why is that wrong? My brother, Jim, was a pretty classic ADHD case. Never liked school, always dabbling on the edge of trouble, liked riding motorcycles above the speed limit – definitely a risk-taker and not an academic type. My high school still had voc ed and he learned to be a mechanic – work with hands, lots of noise and moving parts and power, practical results he can put his hands on. He now owns a garage and earns three times what I do annually. He found his niche.

          Not everyone needs to go to college. It’s a cultural bias that is rampant in our schools (unless you’re black, of course, in which case, you’re not expected to do much but fail), but it is not based in reality. School as designed doesn’t work for some kids. That doesn’t make the kids “disorderd” or “disabled.” It suggests to me that the school, who is being paid to teach them, needs to take another approach.

          And while there may be an odd kid who can’t function in an open classroom setting, they appear to be extremely rare in the “ADHD” diagnosed population. This setting works for most of them with zero medication. So you can eliminate probably 95% or more “cases” of ADHD just by changing the educational approach. Seems worth a try, don’t you think?

          —– Steve

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          • “their difficulties in organization and focus” Steve

            I think that is a good partial definition of the traits that some people experience/have to such an extent that it interferes with their ability to progress through school and life.

            Some kids are motivated by and excel at football and cannot focus on what the coach says consistently. They are so big, strong, quick and aggressive, they can and do compensate. If the coach stops his lecture/teaching and asks him what he just said, he cannot answer. He wanted to pay attention. He tried to pay attention. His entire life revolved around his love for football. He had no idea what the coach was teaching, consistently.

            Graduating from college is a measure I think you raised. “For some of these kids, they are motivated and can use their intelligence and drive to come up with ways to overcome their difficulties in organization and focus. In other case, they don’t care about going to college and do other things instead. Why is that wrong? ” Nothing. I don’t think I said there was. In addition, if school is the only major life activity where the child is failing or struggling, he doesn’t have ADHD.

            If you can let me know how to find that study, that would be great.

            “And while there may be an odd kid who can’t function…” Can we discuss that odd kid that doesn’t do well even in an open classroom? What is it about that kid, in particular, that interferes with his ability to focus his attention?

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          • It exists, like unicorns exist. Another list of descriptive traits, specifically, one horned and horse, or horse-like, possibly magical, or impossibly.

            The people part I get. Usually young people, until recently, when the DSM allowed them past puberty, and now?….It’s “safe” to prescribe amphetamines to adults.

            I get your point though, I think, ADHD the acronym has four letters, and pity the poor kid who gets saddled with the wrong teacher. Ditto, parents. Ditto, counseling department.

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          • “Can we discuss that odd kid that doesn’t do well even in an open classroom?”
            Can we discuss kids which are born superheros and can fly? I mean you’re trying to discuss concepts that most of us don’t agree are true. How many kids diagnosed with ADHD ever have a chance to be in an open classroom?

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          • My point is that we should provide the kind of instruction that works for the kid involved, rather than trying to change the kid to fit our instructional style. If the coach lecturing his football player doesn’t work, he should take him aside and show him, or have another kid show him how. My youngest, Kevin, learns soccer mostly by watching videos and trying out the things he sees. Probably doesn’t get a lot from coach lectures. Oldest was even more that way, but both are absolutely amazing athletes and learn what they need to learn on the job. “Kinesthetic learners” is the term they use in education. Look it up.

            For the odd child who can’t make it in an open classroom, you come up with another plan that works for him. But don’t you think it would be marvelous if you could “heal” 95% of “ADHD” by simply reorganizing the classroom to a style that works for the child? The other 5% probably have more serious issues going on at home – abuse, neglect, domestic violence, or whatever else, and may need more specialized attention. So we provide it to them.

            Teachers are paid to be experts in teaching. They should know how to approach kids who learn differently. They should be able to recognize and build on strengths. They should know how to use positive behavior management to encourage success. It’s not my kid’s job to change his personality so the teacher’s job is easier. It’s the teacher’s job to find a way teach my kid.

            “ADHD” is just a way of describing a kid that is annoying for adults to deal with. While there COULD be something wrong (low iron, sleep apnea, thyroid issues, etc.) that is causing or contributing, just being active and impatient with boredom and having a hard time concentrating on someone else’s agenda is not a disease. Kids are all different. They’re supposed to be. That’s the challenge of being a teacher. If someone doesn’t like that, they should choose a different profession.

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  13. Dr. Berezin,

    I owe you an apology.

    You are new to this site, with less than a half-dozen blog posts. Yet, I was quick to jump… on what I consider a missing piece of the puzzle, namely the need to search for underlying medical conditions, rather than relying solely on psychotherapy.

    I don’t regret having stated my opinion, but I do feel badly about how it was stated. I should have thanked you for taking a strong stand against the current paradigm, and your work toward making safer, more effective options known, and available.

    I apologize for not doing so, and for mis-directing my anger toward conventional psychiatrists. Thank you for being part of MIA.

    Duane

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  14. Dr. Berezin, I am sure that you deplore the fact that all the hype for turning up the volume on psychiatry as medical investigation and turning the volume off on psychiatry as medicine just is what keeps the dollars pouring into research projects having little to do with treatments that will change lives as they could be changed by better attention to individual needs. Tricky research protocols also guarantee that psychiatrists have constant scientific-sounding messages for the press and their various pressure groups that offer “peer support”. So that there never has to be a conversation about over-diagnoses and the reluctance to walk through careful discussions of trauma, for instance. Or about whether and when and how (and how knowingly) American psychiatry has done more harm than good for patients.

    Psychiatry hides behind modern science to avoid any distraction from their focus on “major mental illnesses”, through pre-emption of “dangerous thoughts and behavior” by forced treatment modalities, and so never will have to answer for its entitlement as a real state monopoly with extra-judicial authority for bringing in the business and covering up “mistakes”…until it’s made to answer.

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    • Mistake in my big opening sentence… help editor, help….

      I do of course mean turning the volume on full blast (like Torrey and Nardo and Healy) that psychiatry just is doctoring, and turning it all the way down on the human relations capacity, upon which psychiatric diagnosis pivots. As in such evasions as saying that its just purely sympathy to practice by affirming sick-talk with people who want to call themselves ill (like Vivek Datta) and like to think they can get some supposed chemical imbalance treated, when they are in fact unhappy.

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  15. The following is an article which includes the issue of tracking/measuring neurotransmissions.

    “The JAMA study said that, compared with a group of healthy subjects, brain scans of 53 adults with ADHD revealed a flaw in the way they process dopamine, which among other things, alerts people to new information and helps them anticipate pleasure and rewards. Swanson speculated that people with ADHD may even have a net deficit of dopamine.”

    “Sept. 9 report in the Journal of the American Medical Association, based on a new study that indicates a striking difference in the brain’s motivational machinery in people with ADHD symptoms.”

    “This is another big piece in the puzzle saying that there is something there, that this is not simply a matter of anxious parents,” said James Swanson, a co-author of the report and a developmental psychologist based at the University of California at Irvine.

    The JAMA study said that, compared with a group of healthy subjects, brain scans of 53 adults with ADHD revealed a flaw in the way they process dopamine, which among other things, alerts people to new information and helps them anticipate pleasure and rewards. Swanson speculated that people with ADHD may even have a net deficit of dopamine.

    “The findings offer support for a long-held theory about why people with ADHD tend to be so easily distracted and bored — so hard to teach in school, so prone to end up in high-stimulus jobs such as in sales or the media, and so susceptible to gambling and drug abuse.”

    “Volkow’s team collected detailed images of participants’ brains with positron emission tomography, or PET, scans after injecting them with a radioactive chemical that binds to dopamine receptors and transporters, which take up and recycle dopamine as it moves between neurons. The imaging showed that, in people with ADHD, the receptors and transporters are significantly less abundant in mid-brain structures…”

    *Nora Volkow, is a research psychiatrist who is director of the National Institute on Drug Abuse

    “Stephen Hinshaw, chair of the psychology department at the University of California at Berkeley, praised the study as being “above and beyond the normal rank and file” of incremental progress in the quest to solidify the dynamics of ADHD.”

    Katherine Ellison
    Special to The Washington Post
    Tuesday, September 22, 2009

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    • Key proviso: these are AVERAGE findings on the group as a whole. It is not true that each individual with an “ADHD” diagnosis has this pattern, hence, we can’t assume that dopamine transmission issues are causal.

      Second proviso – no information on the medication status of the people being scanned. Using stimulants over the long term has long been known to reduce the density of dopamine receptors in the brain. This is observed with both amphetamine and cocaine abuse, and is called “neurological down-regulation.” It is responsible for the development of tolerance to a drug with regular use. Anyone who has used stimulants extensively over time, even at “therapeutic” dosages, would be expected to have a lower density of dopamine receptors. This is a meaningless experiment if it’s not done on drug-naive subjects.

      Additional point: If low levels of dopamine receptors really is the cause of all or even some cases of ADHD, prescribing stimulants appears to be long-term counterproductive, based on what I just said above about down-regulation. This may very well explain why stimulants seem to “work” in the short term but produce no better results in the long run – kids taking stimulants are going to have their dopamine receptor density REDUCED over time, rather than increased, as would seem to be indicated by the direction this study is suggesting.

      Bottom line: “Swanson SPECUTLATED that people with ADHD may even have a net deficit of dopamine.” This is speculation. It proves nothing. And honestly, even if it did, it does not suggest stimulant treatment as a long-term solution, because stimulant treatment will bring about a worsening of the supposed causal conditions.

      —- Steve

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    • Here’s a problem: dopamine in the brain is not associated exclusively with motivation but also with movement (there are some people who claim that the motivational function is actually an artifact of behavioural tasks that are design to uncover it). Therefore every measurement of dopaminergic activation can be caused by people having a different pattern of motor activity: if you suspect someone has “ADHD” they are hyperactive, fidgety, whatever you want to call it and so will have higher dopamine release. So essentially you are observing that people who tend to be more active and excitable have more motor excitation in their brains. Duh.

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      • Just a clarification: they talk about receptors and not dopamine itself. They do not even know which receptors (there are several) and they can have different effects – e.g. in Drosophila there are two and they act quite differently. But even assuming that their data shows there are fewer receptors in general hence lower dopamine binding this still does not mean it’s a pathology – as Steve pointed out it may be that these people have higher ligand levels so need fewer receptors. And the former can be an effect of having physical activity. Or it can be an artificial effect of drug use. Making imaging studies on subjects with unknown drug status is simply stupid (or manipulative).

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  16. “We fulfill our natures in relation to the quality of our nurture.” And our nature cannot be flawed? Antipsychotics return intactness to a deeply terrified schizophrenic. Thank goodness. How awesome it that? A person overwhelmed by fears is enabled to benefit from psychotherapy through the use of a drug. I take for granted, all too often, the advances we’ve made in modern medicine.

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    • “Antipsychotics return intactness to a deeply terrified schizophrenic.” This may be true, but it’s also true that antipsychotics cause anticholinergic intoxication, a syndrome that emulates the symptoms of schizophrenia. In other words, antipsychotics can cause a terrifying psychosis in a patient that has never been psychotic before. Drugs.com points this out:

      “MONITOR: Agents with anticholinergic properties (e.g., … neuroleptics …) may have additive effects when used in combination. Excessive parasympatholytic effects may result in … anticholinergic intoxication syndrome … Central symptoms may include memory loss, disorientation, incoherence, hallucinations, psychosis, delirium, hyperactivity, twitching or jerking movements, stereotypy, and seizures … Use of neuroleptics in combination with other neuroleptics or anticholinergic agents may increase the risk of tardive dyskinesia.”

      Personally, I experienced my first “psychosis” after being put on merely .5 mg of Risperdal (I was also on an anti-inflammatory). The bottom line reality is some people are ungodly allergic to the neuroleptics, my grandmother was also. But the majority within the psychiatric field misdiagnose the central symptoms of neuroleptic induced anticholinergic intoxication syndrome as “bipolar” or “schizophrenia.”

      Perhaps today’s psychiatric industry needs to learn that their “new wonder drugs” are just as toxic, or perhaps more toxic, than their old neuroleptics? When my grandmother was made sick with Stelazine, she was quickly taken off it and never took another psych med in her life. She died at the ripe old age of 94.

      Today’s psychiatrists feel the need to put a patient onto every single neuroleptic on the market prior to becoming too embarrassed to continue to force medicate a person who is allergic to all the neuroleptics because an oral surgeon, but not one psychiatrist, is smart enough to point out the reality that “antipsychotics don’t cure concerns of child abuse.”

      Thank you for this blog, Dr. Berezin, and please try to enlighten other psychiatrists to the reality that the neuroleptics can and do cause the symptoms of schizophrenia, via the central symptoms of anticholinergic intoxication syndrome.

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  17. Blakeacake, If you do a search of this site for anti psychotics, I think you’ll find a great deal of information regarding their documented harms and significant overuse.

    You seem happy to celebrate that, occasionally, someone is temporarily assisted by these drugs, while conveniently ignoring the masses of information regarding the harms done to hundreds of thousands of people, and the many, many millions of dollars drug companies have been made to pay out through lawsuits because of their misleading claims of efficacy, and dangerous strategies regarding off-label marketing.

    I happily admit to not knowing the exact figures, but how many people have to die from diabetes, heart disease, other metabolic disorders, premature deaths and a multitude of well-documented side-effects from these drugs for you to stop celebrating the odd case where you badger a doctor into confessing that they may occasionally be of assistance? Your celebratory stance seems to be more around your own “winning” than around the fact that a single person has been “helped” while many thousands more may well have been harmed.

    That single person who may be temporarily assisted could still be helped were the drugs’ prescription limited to very specific emergency situations such as that to which you allude, but the hundreds of thousands of others who are unnecessarily given them would not be harmed or killed were they tightly controlled.

    As for hard evidence that “Antipsychotics return intactness to a deeply terrified schizophrenic”. A cure? My golly…not even the pharmaceutical companies would dare to make such an outlandish and unrealistic claim!

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    • As for hard evidence that “Antipsychotics return intactness to a deeply terrified schizophrenic”. A cure? My golly…not even the pharmaceutical companies would dare to make such an outlandish and unrealistic claim!

      Antipsychotics return intactness to a deeply terrified schizophrenic, according to Dr. Berezin

      I quoted Dr. Berezin

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      • No, blakeacake, you are not quoting Dr. Berezin. You are sort of paraphrasing him and misrepresenting him in the process. Regarding the use of psychiatric drugs with a terrified schizophrenia patient, what Dr. Berezin actually stated was

        “Sometimes it helps to get back intactness.”

        He also stated that he never imposes meds on anybody and that the real work has nothing to do with meds.

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      • The only direct quote from Dr Berezin I can find like that says,
        “There are times in the treatment when a patient is horrensdously terrified. I don’t impose meds on anybody. Sometimes it helps to get back intactness. I give the control to my patient. The real work has nothing to do with meds. It is the psychotherapy.”

        Which you have paraphrased to indicate something that is qualitatively different.

        Dr Berezin’s article (first five paragraphs) makes it abundantly clear that he does not believe that drugs fix any chemical imbalance or induce a cure of any kind – that is your belief and you have stated it repeatedly, both in this thread and in others.

        Re-read the original article, which was focussed on a particular approach to psychotherapy. It might come in handy if your drugs turn on you, as they have turned on so many of us who are regulars and/or contributors here.

        That YOU believe the drugs help YOU does not make their usefulness a universal truth.

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  18. Ritalin, like all medications, can be useful when used properly and dangerous when used improperly. Why is it so difficult for so many people to hold to that middle ground?

    And yet difficult it is. Ritalin continues to be a political football, a hot-button issue almost on a par with abortion or capital punishment. One is pushed to be for it or against it, while the right and good position is to be for whatever will help a child lead a better life, as long as it is safe and it is legal.

    Used properly, Ritalin is safe, safer than aspirin. And it is legal, albeit highly regulated. As to its long-term use, apply common sense. Use it as long as it is helpful and causes no side effects. That may be for a day, or it may be for many years.
    Of course we need to address the complex issues that contribute to behavioral, emotional, and learning problems in children. I’ve written extensively about what I call “pseudo-ADHD,” children who look as if they had ADHD but in fact have an environmentally-induced syndrome caused by too much time spent on electronic connections and not enough time spent on human connections, i.e., family dinner, bedtime stories, walks in the park, playing outdoors with friends or relatives, time with pets, buddies, extended family, and other forms of non-electronic connection. Pseudo-ADHD is a real problem; the last thing a child with pseudo-ADHD needs is Ritalin.
    But that is not to say that no child needs Ritalin, nor that those who prescribe it are dimwits hoodwinked by drug companies to medicate children who do not need it. Sure, some doctors over-medicate, while other doctors never medicate because they “don’t believe in ADHD” and “don’t believe in Ritalin.”

    Above all, children need a loving, safe, and richly connected childhood. The long-term study that Dr. Sroufe cited in his opinion piece does indeed show that over time, medication becomes a less important force in a child’s improvement and that human connections become ever more powerful. It is good and heartening to know that human connection–i.e., love–works wonders over time. Love is our most powerful and under-prescribed “medication.” It’s free and infinite in supply, and doctors most definitely ought to prescribe it more!

    But that is not to say, as Dr. Sroufe does, that Ritalin has “gone wrong.” We may go wrong in how we use it, when we over-prescribe it, or when we use it as a substitute for love, guidance, and the human connection.

    But as long as we use it properly, it remains one of our most valuable–and tested–medications. Going all the way back to the first use of stimulants to treat what we now call ADHD in 1937, stimulants have served us well as one tool–not the tool–for helping children and adults learn how to strengthen the brakes of their race car brains and become the champions they can be.

    Hallowell

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    • “Ritalin, like all medications, can be useful when used properly and dangerous when used improperly.”

      So is alcohol, so is marihuana, so are opiates. They are not medicines, they are psychoactive drugs which have some medicinal uses. You don’t prescribe alcohol to kids to treat social anxiety. You should not prescribe amphetamines to kids to treat “ADHD” either. Because kids are supposed to have a chance to develop their own personalities and coping strategies, not get addicted to psychoactive substances (not to mention that neither of the example drugs does anything good used chronically and long-term).
      If you’re an adult and have a need to a little change of perception – I think you should be allowed to. Performance enhancing drugs or psychoactive drugs should be legal or at the very least decriminalized. That’s very different from calling them medicines and pretending like they treat a specific illness. Nor are they safe as aspirin. Aspirin causes side effects in very few people (it should never be used in small kids due to the risk of Reye syndrome so if you want to use this comparison to push Ritalin on children you’ve picked a very bad comparison), amphetamines cause side effects in pretty much every user (appetite loss and insomia are ones of the most common). Amphetamine causes dependency/addiction, aspirin doesn’t. They are not comparable.

      “I call “pseudo-ADHD,””
      Yeah, and how do you distinguish it from “real ADHD” when symptoms are exactly the same?

      “Going all the way back to the first use of stimulants to treat what we now call ADHD in 1937”
      You may want to recall why we stopped using amphetamines in the past…

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  19. ADHD is a ficticious disease. It does not exist. There are certainly kids who have more active temperaments who need to be dealt with appropriately. Some children with these temperaments, when subject to formative trauma may well spin out of control. They need appropriate care, mostly within the family and school environments. There is no good use for amphetamines at all, ever, no matter what the dosage. Speed is a bad drug period. It’s history is very dark. Psychiatry is not about brain diseases at all. As I said, personality operates on a higher level of brain organization than the molecular. Of course character issues are manifest in the brain. Everything is. Change does not take place by changing the brain. Personality change takes place through therapy and the brain follows suit. Psychiatric drugs are destructive – antidepressants, benzodiazapenes, amphetmines, etc. Schizophrenia and manic-depression have an additional brain element, unlike all the rest, that may be genetic, may be epigenetic, or early trauma. There can be a place for judicious use of some anti-psychotics or Lithium for people to come out of awful states of terror, or out of control mania.(and there is no place for destructive antidepressants in the depressive side of manic-depression.) This is not the treatment. Good psychotherapy is.

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  20. Thanks doctor. Appreciate your explanation.

    “ADHD is a ficticious disease. It does not exist.” It doesn’t have to be a disease to wreak havoc in one’s life. In my opinion, it is not as critical what it is called as it is to help those overwhelmed by its most disruptive characteristics: distractibility, impulsivity and disorganization.

    What do you believe are the best ways to help an adult who is unable to concentrate consistently, having ruled out all other health issues?

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      • I greatly hesitate in using the “T” word and that is why I responded to him against my better judgement. No matter what you call him, I get the sense there is no intention to have any type of discussion with posters on this board as blakacake keeps moving the goalposts and also minimizes people’s experience while wanting us to respect his. It isn’t a fair debate.

        He also claims we use anecdotal evidence that isn’t valid while doing the same to prove his point. For example, he used a quote by Edward Hallowell to claim that essentially stimulants were safer than aspirin and could be used long term. Hmm, I don’t even think doctors would make that claim.

        I agree that Dr. Berezin should not take the bait. I also apologize to him for letting myself get drawn into debating blakeacake which I feel has distracted from the points in his thread.

        Anyway, I do need to start biting my tongue in a figurative manner.

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      • My feeling is that if someone is truly here to disrupt, not to dialogue, they will eventually make that abundantly clear through the pattern of their behavior, and when they do it will be dealt with. But I would like to set a high bar for designating people as “trolls” in this space, and ask that we try to give the benefit of the doubt. Not just because this is the respectful thing to do, but because one of our goals here is to contest and counter mainstream thought about psychiatry, and as such we should expect opposition from those adhering to the status quo. Ideally, we would be prepared to address or rebut their arguments.

        Of course, no one (including site authors) is obligated to respond to anything they aren’t interested in, don’t have the patience for or find pointless or baiting. I’m just saying that, generally speaking, when someone challenges our views they offer an opportunity — the opportunity to strengthen our case. Such a person can serve as a useful “foil” in a way. Maybe not useful for ourselves so much as for the thousands of unique visitors who read this site every day and may be encountering these challenges to the status quo for the first time.

        Just something to think about. I realize that it’s generally more enjoyable and interesting to have conversations with like-minded people who’ve put a lot of thought and study into these topics, but there’s a bigger picture to keep in mind too.

        “First they ignore you. Then they laugh at you. Then they fight you. Then you win.”

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    • Dr. Berezin, I appreciate all you have offered. Please ignore me and the questions I ask. I don’t mean to bug you. (You may have seen my uncle play football for the Crimson and dad play basketball for them.)

      I would like to know if any doctors would care to answer this question: What do you believe are the best ways to help an adult control/manage/improve his ability to concentrate consistently when he has a long history of not being able to do so. All known anatomical causes have been ruled out. The person has been unable to follow and participate intelligently throughout the course of casual or formal conversations, one-on-one or in groups, and is unable to follow lectures, regardless of the topic or presenter.

      Thanks

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        • Concentrate on what? Concentration is not the same when you’re reading your favourite book, learning boring stuff, learning interesting stuff, playing a video game, driving a car, are tired, are stressed, … I could go on. I have problems concentrating on reading professional literature sometimes but I almost never have a problem concentrating on reading a good popular fiction. So I don’t quite understand your question. There’s no one way to get someone to ‘concentrate” – depends on a person, depends on a task.

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        • As someone who once was given a diagnosis of adult ADD (no h, and I am not endorsing the diagnosis by mentioning it), I can say that diet changes made all the difference for me, particularly eliminating gluten and dairy. It was something I figured out on my own in college — I’d be working on a paper and take a break to eat pizza or pasta or something, and come back to find that I could barely even follow what I’d written. I also avoid artificial colors and sweeteners, MSG, soy and various other things. It helps.

          I should note that I never had any attention or concentration issues as a child though. It wasn’t until I’d been on psych drugs (“antidepressants”) throughout my teen years that the issues developed, so they might be iatrogenic in origin. But having this basis of comparison, I do know that there’s a difference between being bored with a topic, and finding that your brain simply. will. not. work. when you try to focus on something. It’s incredibly frustrating. Occasionally I still experience this when stressed or overwhelmed, but I’ve learned various techniques for getting things back on track. Sometimes it’s as simple as taking a break to play a computer game or watch a relaxation video. Therapy and journaling can help too, because it’s certainly more difficult to attend if you’re struggling with some kind of chronic internal war like Dr. Berezin talks about in his post.

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          • ps: blakeacake, please get in touch with me via our contact form. I have attempted multiple times to contact you regarding moderation issues and the emails have bounced, as I’ve mentioned before.

            Edited to address your questions: yes, your contact info will be kept private and confidential, and no, nobody needs to “divulge personal, protected medical information to MIA” in order to post here. You do need to have a valid email address that you can be contacted at. Comments that are not within our posting guidelines will be removed, and anyone posting a high volume of such comments will be placed on moderation. More information about our policy can be found here: http://www.madinamerica.com/posting-guidelines/

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          • Emmeline, A criteria of the diagnosis of ADHD (I too have A.D.D.) is onset by 7. I’m not sure why your physician would give you a diagnosis if you did not have considerable difficulty paying attention. Did you daydream a lot?

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          • “there’s a difference between being bored with a topic, and finding that your brain simply. will. not. work. when you try to focus on something”
            Of course. Except that I don’t know a single person who does not experience the latter, especially when the topic is intellectually demanding, or when they are tired or when they are stressed/anxious…and so on. It’s not restricted to some magical ADHD – it happens to everyone, especially in stressful circumstances (I’m talking about chronic stress here – acute stress can have an opposite effect on some people).

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      • Maybe one should do something else with your life then rather than sit on lectures? Btw, I don’t know anyone who would not be able to concentrate on anything ever without stimulants. Even the proponents of ADHD diagnosis admit that the people with this label are able to concentrate very deeply on certain tasks, especially when they find them stimulating. This is total nonsense – if a kid is smart and driven he/she will find a way to do what he/she wants and if not no amount of speed is going to make a genius out of a dummy. Sorry but that’s just the reality (and studies on long-term stimulant treatment show just that – the drugs don’t improve academic outcomes).
        So some kids won’t make it to collage. It’s not the end of the world. Some people won’t become opera singers because they are tone deaf and have a coarse voice – is that a disability too and should be put kids on some kind of pills? People have different talents and passions and we are living in “one size fits all” society – that’s why we have ADHD.

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  22. Hey Steve,

    A friendly reminder.

    “By the way, I don’t know if you are aware of this, but there was a great study back in the 80s showing that “ADHD” kids were indistinguishable from “normal” …” Was it peer-reviewed and published in the literature?

    That “odd one” who doesn’t fit in is the one I’d like to discuss further.

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    • Sorry, it was in 1978, but I now left my reference at home! Thanks for the reminder, I’ll get it to you. There was also one in 1976 by Judith Rappoport, et al, that showed kids in an open classroom having dramatically reduced ADHD symptoms after a year in that kind of environment. I’ll get you that one, too.

      —- Steve

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      • Hey Steve,

        Why do you call ADHD a disease?

        For the odd child who can’t make it in an open classroom, you come up with another plan that works for him.

        Nothing works. Nice kid. Wonderful boy. Helps others. Leader. Polite. Respects teachers. He is unable to focus his attention on anything consistently such that his school work suffers or is not done. Scouting, choir and other activities are not engaged in. His IQ indicates he is performing below his potential. No other known factors explain this quandary.

        “Due to either early trauma or something epigenetic, or genetic, they develop psychotic characters. Real treatment, like for the rest of us, is psychotherapy of character, with the useful addition of antipsychotics to help with schizophrenic terror, reflecting the dissolution of the intactness of their sense of self, and a horrific ‘play’ of consciousness. This is spelled out in more detail, in my book, “Psychotherapy of Character, the Play of Consciousness in the Theater of the Brain”, by Robert A Berezin, MD., specifically chapter 17.

        “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.”

        In your opinion, Steve, how are antipsychotics applicable in these situations Dr. Berezin alludes to? Why do suppose he uses them?

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        • Blake, buddy, I’m getting tired. You talk like you’re open minded, but you really aren’t.

          I made myself clear – it is the school’s job to figure out what works. That’s what they’re paid for. If there is something medically wrong with the child, like he’s had a head trauma or can’t see or hear well or is malnourished, by all means, he should get an assessment, but if he “can’t pay attention,” it’s the teacher’s job to motivate him. If they can’t or don’t care to bother, they don’t deserve to be called teachers. Anyone can assign work to someone and grade it. Real teaching is an art and it involves addressing the needs of each learner. It’s not the child’s fault that we have developed a factory-style school system that is too impatient and authoritarian to care for his needs.

          The open classroom is the ideal scene for most ADHD-diagnosed kids. But since ADHD is a fiction and doesn’t reflect an actual group with the same issues, it won’t work for every one of them. But it will work for a hell of a lot more of them than the standard classroom. So tell me, Blake: why don’t we have this kind of classroom for this kind of kid.

          The citations you requested: Jacob, J.G., Oleary, and Rosenblad, “Formal and Informal Classroom Settings: Effects on Hyperactivity;” J Abnormal CHild Psychol 1978 6, P. 47-49.

          I have given you enough information for you to easily conclude that open classrooms would resolve 90-95% of “ADHD” cases, and yet you persist on harping on the one or two kids out of 100 who won’t do well in this environment. Shouldn’t you be focusing on why the school system doesn’t care enough to create this kind of school classroom for kids who need one? What does it say about the intent of those schools? What does it say about the intent of the psychiatric profession that they aren’t “prescribing” this kind of classroom?

          I’ve done my part. It’s your turn. I’m not going to try and convince you if you don’t want to question the “ADHD” paradigm. I’m sorry it’s hard for you to learn that this paradigm has some gaping holes in it, but I can’t make you feel better by pretending they don’t exist.

          Good luck, and don’t believe everything the professionals tell you.

          —- Steve

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  23. Dear Dr. Berezin,

    Respectfully, I am sure you are aware of the fact medical and mental health professionals most often use the DSM5 with a flawed”Chinese Menu” approach.

    Many individuals suffering from underlying medical conditions that induce psychotic/manic behavior are commonly misdiagnosed with psychiatric conditions.

    While the underlying condition goes untreated, patients are simply rubber-stamped with a psychiatric diagnosis and treated with a one-size-fits-all drug therapy regime that lasts the rest of their life.

    The British Medical Journal has published guidelines for Best Practice Assessment of Psychosis.

    https://psychoticdisorders.wordpress.com/bmj-best-practice-assessment-of-psychosis/

    Psychiatry’s current paradigm of care fails to use best practice standards of care.

    This paradigm prolongs the suffering of patients and subjects them to a life-long and harmful medication management protocol.

    In addition, because individuals suffering from psychosis/mania can have distorted perceptions and beliefs, this psychiatry’s current paradigm of care jeopardizes the health, safety and welfare of the public.

    Recently, here in Florida three young men who were reported to have a history of mental illness committed horrific crimes.

    23-year-old Christian Gomez brutally murdered his mother, cutting her head off with an ax.

    25-year-old John Jonchuk threw his five-year-old daughter off of a bridge.

    23-year-old Jason Rios stabbed to death his mother and young niece.

    Psychiatry’s new paradigm of care must include testing for and treating underlying medical conditions that manifest as psychosis and mania.

    It is very unfortunate this information is being ignored.

    Psychosis Due to a Medical Condition involve a surprisingly large number of different medical conditions, some of which include: brain tumors, cerebrovascular disease, Huntington’s disease, multiple sclerosis, Creitzfeld-Jakob disease, anti-NMDAR Encephalitis, herpes zoster-associated encephalitis, head trauma, infections such as neurosyphilis, epilepsy, auditory or visual nerve injury or impairment, deafness, migraine, endocrine disturbances, metabolic disturbances, vitamin B12 deficiency, a decrease in blood gases such as oxygen or carbon dioxide or imbalances in blood sugar levels, and autoimmune disorders with central nervous system involvement such as systemic lupus erythematosus have also been known to cause psychosis.

    A substance-induced psychotic disorder, by definition, is directly caused by the effects of drugs including alcohol, medications, and toxins. Psychotic symptoms can result from intoxication on alcohol, amphetamines (and related substances), cannabis (marijuana), cocaine, hallucinogens, inhalants, opioids, phencyclidine (PCP) and related substances, sedatives, hypnotics, anxiolytics, and other or unknown substances. Psychotic symptoms can also result from withdrawal from alcohol, sedatives, hypnotics, anxiolytics, and other or unknown substances.

    Some medications that may induce psychotic symptoms include anesthetics and analgesics, anticholinergic agents, anticonvulsants, antihistamines, antihypertensive and cardiovascular medications, antimicrobial medications, antiparkinsonian medications, chemotherapeutic agents, corticosteroids, gastrointestinal medications, muscle relaxants, nonsteroidal anti-inflammatory medications, other over-the-counter medications, antidepressant medications, neurleptic medications, antipsychotics, and disulfiram . Toxins that may induce psychotic symptoms include anticholinesterase, organophosphate insecticides, nerve gases, heavy metals, carbon monoxide, carbon dioxide, and volatile substances (such as fuel or paint).

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        • When I read what you wrote Duane, I felt sadness. I see where you often have kind, encouraging things say to others. Even apologizing for possible, perceived slights. How awesome is that! I think almost every person posting here appreciates you and your thoughtfulness. You try to go out of your way to be open-minded and polite with everyone, even with those you don’t see eye to eye. You are the nicest person here. Know you make an important difference

          “Change does not take place by changing the brain. Personality change takes place through therapy and the brain follows suit.” This quote from Dr. Berezin is interesting. I wonder how much influence Dr. Freud has had in establishing positions like that? His work was astonishingly important, sweeping over the world of therapy and not all that that long ago.

          Dr. B describes places of great therapeutic impact that were born from small rural European communities where the wounded in spirit and life could go and be embraced by the townspeople in loving acceptance. How cool is that?

          Again, thanks for your sincere courtesy

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        • Hi Duane,

          I rarely visit this site for the same reason. I would much rather be engaged in rewarding community volunteerism than feel like I am typing on my computer to a brick wall.

          The fact are, it’s all about job security and since “mental illness” is a money making opportunity for so many, it is very easy to turn a blind eye to the facts, use smokes and mirrors to create illusions and sell a “new paradigm” to those who don’t mind profiting off of the suffering of others.

          Peace to you my dear friend

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    • Thank You Maria,
      From the age of 16 till around 55 metal poisoning from 53% mercury loaded misleadingly called silver amalgam fillings a total of 15 of them got me tortured truly beyond human endurance by the psychiatric arsenal from chemical lobotomy to electric shock plus actually being experimented on with techniques designed for prisoner of war interrogations for real . Plus of course being social worked and plied with therapy for the S word and Bi polar word labeled , alienated from family , child taken away, ostracized and as I’ve said tortured beyond endurance . I am not exaggerating. I couldn’t even put into words how anti psychiatry I really am .
      All you practitioners out there that don’t practice using best practices as Maria describes you can forward all future earnings and present savings to those you have tortured including myself as reparations . Walk away from your “profession ” and turn yourself into to prison authorities for crimes against humanity and write out the real truth of your crimes for public view.
      Most sincerely , Fred Abbe

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      • Fred,

        Thank you for sharing your experiences.

        Isn’t it amazing how with an “epidemic” of “mental illness” no one seems to make the connection to an epidemic of lead/mercury/other toxic poisoning/bacteria/virus and other known causes of psychosis?

        Very sad indeed that turning a blind eye to the known causes boils down to just one thing…..job security.

        The very sad truth is psychiatrist are not the only professionals making a profit from turning a blind eye, main stream mental health advocates are guilty of advancing the Medication Management Monopoly that exists today.

        And it is very sad to see the “new paradigm” that is being advanced by so many also excludes and overlooks the known underlying causes of psychosis/mania.

        We live in a critical time period, all mental health advocates should be supporting a unified advocacy agenda that includes the right of patients suffering from symptoms of “severe mental illness” to be tested for underlying causes.

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    • Great point Maria. And a very useful list. I’d add that untreated HIV infection can also demonstrate itself as psychosis.
      To illustrate your point there was a recent tragic story from Europe (unfortunately I can’t find a press release in English). A teenage girl was admitted to hospital with physical, emotional and cognitive symptoms. The doctors did some basic tests and didn’t find anything so they shipped her off to a psych ward where she was put in restraints for being “agitated”. Her parents were not allowed to see her and she died tied up to the bed before the following morning. Turns out that she had blood poisoning with high ammonia concentrations – have the doctors not dismissed her symptoms as “it’s all in your head” and actually cared to run more tests she could get dialysis and be alive today. Instead she died being tortured, in terrible pain and away from her loved ones. I wonder if anyone is going to go to prison over that or lose his/her license but I’m not holding my breath.

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      • Hi B,

        Very sad indeed.

        Here is just one case of a 15-year-old girl who was misdiagnosed for two years with bipolar disorder.

        She was treated at the same hospital that misdiagnosed me with bipolar disorder.

        Below is a link to a narrative I wrote that was published in the Journal of Participatory Medicine.

        I did receive a worker’s comp settlement and was entitled to sue for malpractice but declined to do so. I was happy to have found recovery solutions through Functional Medicine and complimentary therapies and hoped being a peaceful advocate would help make change for others but I did hold my breath either.

        Neuropsychiatric systemic lupus erythematosus presenting as bipolar I disorder with catatonic features.
        Posted on November 25, 2012 | Leave a comment | Edit
        Psychosomatics. 2009 Sep-Oct;50(5):543-7.
        Alao AO, Chlebowski S, Chung C.
        SOURCE
        Department of Psychiatry, SUNY Upstate, NY 13210, USA. [email protected]

        ABSTRACT
        BACKGROUND:
        The American College of Rheumatology has defined 19 neuropsychiatric syndromes associated with systemic lupus erythematosus (SLE) involving the central, peripheral, and autonomic nervous systems. Neuropsychiatric manifestations of lupus (NPSLE) have been shown to occur in up to 95% of pediatric patients with SLE.

        OBJECTIVE:
        The authors describe a 15-year-old African American young woman with a family history positive for bipolar I disorder and schizophrenia, who presented with symptoms consistent with an affective disorder.

        METHOD:
        The patient was diagnosed with Bipolar I disorder with catatonic features and required multiple hospitalizations for mood disturbance. Two years after her initial presentation, the patient was noted to have a malar rash and subsequently underwent a full rheumatologic work-up, which revealed cerebral vasculitis.

        RESULTS:
        NPSLE was diagnosed and, after treatment with steroids, the patient improved substantially and no longer required further psychiatric medication or therapy.

        CONCLUSION:
        Given the especially high prevalence of NPSLE in pediatric patients with lupus, it is important for clinicians to recognize that neuropsychiatric symptoms in an adolescent patient may indeed be the initial manifestations of SLE, as opposed to a primary affective disorder.

        http://www.jopm.org/perspective/narratives/2011/03/28/psychosis-possibly-linked-to-an-occupational-disease-an-e-patient%E2%80%99s-participatory-approach-to-consideration-of-etiologic-factors/

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  24. I think psychiatry’s umbrella extends too far. We know what most think of “mental illness” doesn’t come from a brain disease. Psychiatry also insists on covering neurological disorders such as Alzheimer’s. Shrinkage needs to butt out of what is neurology’s turf, especially since their drugs regularly kill vulnerable elderly people. Also, you mentioned eating disorders in this article. I suffered from ED for over 30 years and suffered also from “treatment” of ED. This is another field where psychiatry shouldn’t be treading. I have spoken to hundreds of people who suffer from eating problems up and down the scale. If you really dig deep, you find diabetes and other food-related problems running in their families. You find food allergies and stomach problems. These are physical conditions that don’t stem from serotonin or any of that nonsense. Eating disorders are life-threatening difficulties that should be addressed by nutritionists, not shrinks of any sort. It saddens me that shrinkage, in order to ensure that it has its fingers in their ever-widening pie, routinely convinces ED patients of their “concurring” psych diagnoses. Who was it that said, “The power of psychiatry is out of control”? I second that one.

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    • The moment they define you as a “mental case” you don’t only lose all your human rights but you also lose a chance for decent medical treatment (I don’t consider psychiatry medical). Sometimes with lethal consequences as in a recent example from Poland of a girl who came to a hospital with ammonia blood poisoning but nobody bothered to diagnose her properly before she was shipped off to a psych ward, her parents kicked out and she died in restraints before morning (most likely in horrible pain as far as this kind of poisoning goes). Not all cases are so dramatic but I know personally that trying to get help for chronic back pain with a psych label ends you up with doctors suggesting you go and get and anti-depressant.

      Not to mention all the side effects psych drugs create (many of them screwing up your digestive system and creating real problems with proper appetite regulation – Zyprexa, stimulants…).

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  25. Dr. Berezin, I too would like to apologize for welcoming you here with a challenging comment. It was about the impracticality of psychotherapy as mainstream. Even though I don’t see a way through that yet, after having read more of your work here and on your blog, I have to say you are one of the rarest of people I’ve come across; someone who has found their calling in life.

    Your passion and love for your work is so striking and heartfelt that I can’t think of a better advocate for psychotherapy and I wish you well on your “call to arms”.

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