Friday, September 18, 2020

Comments by Barliman

Showing 23 of 23 comments.

  • re sam plover January 5, 2020 at 3:25 pm
    I couldn’t find a reply button for your last reply to me, so..

    However as an introduction _ Im 58 in 2 weeks- so am close behind you.

    “I do believe that much can be resolved without meds if only we had not become conditioned to view all unexplainable things as “mental illness”.”

    I think the problem her lies in the vague use of the word Mental.
    It makes you think that there is something fundamentally wrong with you as a person.
    – As you will see, I believe that a great deal can be resolved without medication.

    Heres one way we go about illustrating that. Im using this as en example because it is the one that I know- not to be advertising one approach or another
    Im a Buddhist and as such I provisionally accept that mind is “that which is luminous and knowing” – our Buddha nature- and no stain can adhere to it.
    In face the have three levels: coarse, subtle and very subtle and these definitions are derived as the pooled experience of millons of adepts over 2,500 years.
    The core nature is very subtle mind, or rigpa and it underpins everything else– so the term “mental illness” is something of a nonsense.
    What ‘s worse is it is contaminated by Judeo-Christian ideas of original sin and mind body dualism.
    “Coarse mind” (ordinary human consciousness) is a fusion of pure awareness (rigpa) and various unhelpful ideas that we have picked up throughout the course of our life (possibly – lives, if you wish to go that far.

    My fear of looking at it as physical, is that it will still be about “behaviour”. And even if looking it from a functional view, do we really want to keep differentiating normal from abnormal?
    IF we could actually come up with a thought process within society where these distinctions don’t affect the observer or the observed, that would solve the problem.

    Well, as someone who has ADHD (much better than it was due to the help of my chiropractors) still uses a small and variable dose of dexamphetamine, and also has Bipolar 1 with several admissions in my past:

    For simplicity’s sake- lets go with ADHD
    As a rule people come to see a doctor with these conditions (especially ADHD that has been missed until adulthood)- the behaviours are what matter. People seek help, as I did about 12 years ago because the behaviours are driving us nuts.
    The behaviours cause people to lose jobs, to have car accidents, to lose everything all the time, break up marriages. We end up unable to have a full nights sleep because of the flood of memories of things we forgot to do that day. That is no fun at all

    We have a huge problem on our hands where we not only hate psychiatry, but ourselves, if we buy into the construct of something being ‘wrong’ with ourselves.
    It has ruined many people’s lives. It has always been that way but only seems to get worse.

    It is also a problem if we allow an inanimate discipline turn into people eating monsters.
    I know some excellent psychiatrists- none of them works in the state/involuntary system.
    I would see the problem being more in the hierarchical arrangement– very much like the Medical Hospitals in the state system.
    Those environments promote bullying and aggression, and the hierarchical structure stifles most innovation outside of the approved way of seeing things. Thats ok for a cut and dried area like thoracic surgery, but it is not appropriate in a highly theoretical area like psychitry

    “I do believe that behind every human lies a secret, but not for fluffy diagnosis and harsh pills.
    It is so simplistic that it boggles my mind. If they really wanted to get ahead, they would be wise to drop their idea of norms, listen to people’s ideas about themselves and the world. Not as disorders, but as glimpses into what could be.”

    The funny thing is that all of us ADHD adults have gone through the process you describe- but we find ourselves listening to people who have no idea of the nature of our problems.
    The advice on attention of someone who has not a clue of what the problem is like, does not, unfortunately help.

    Now in ADHD, we have this idea that there is something called attention that is miraculously fixed/ palliated by medications.
    This delusion makes it hard to make any real progress.
    However ADHD has a huge number of “comorbid problems”- such as binocular vision disorder, dyslexia, dyspraxia, dysgnosia, sensory processing disorder, dysautonomia.

    In Sweden these are called Disorder of Attention, Motor Control and Perception.
    In Australian public hospitals (RCH in Melbourne) the patients get ample occupational therapy work.
    However I assert that these are all part of the one problem (See ADHD as a Disorder of Brain Behaviour Relationships or Subcortical Structures and Cognition- Koziol et al).
    The trouble here is not with the core idea of “ADHD”, it is of the DSM process that has split off the learning disorders so that doctors looking at ADHD using only the behaviour questionnaire and not thinking further. Compliance to the mainstream system, one which is supported by enormous amounts of pharmaceutical company money — that is a problem.

    In my own case, yes I see a psychiatrist every couple of months for ongoing prescriptions- and with time and observation I have seen that the medications help my tendency to low blood pressure when upright.( Dysautonomia) I would like to dispel the myth that these are harsh medications. Careful dosing by a competent prescriber will avoid side effects and they wear off fast as well.
    However the bulk of what I have had done on myself has been chiropractic and chiropractic neurorehabiitation, along with meditation practice, training myself particularly Vipassana body scanning to identify the physiological signature of the key mental states.

    “WE ALL want to hold some importance, not as someone disordered or ill.
    If we can’t come up with ‘care’ that is not dehumanizing, we should throw in the towel.”

    In terms of holding importance there are a great number of support groups that help us understand the great contributions that many ADHD people have made, and the same for Bipolar.
    Equally, the mode of Mind that I propose to use here clearly separates out the disorder from the Self.
    In terms of dehumanising care, Ive been far less than impressed with the approach of doctors when I was in inpatient care,but that is another story. Ive also sacked more than my fair share of psychiatrists.

    ADHD is maybe the best example here because the symptom lists do define a clear patient group (to the extent that I prefer the company of ADHD individuals to non ADHD) and that defines a reasonably narrow number of functional neurological problems, which are highly treatable, or would be if we could get more practitioners here.

    Re this functional neurorehabilitation that I was mentioning:
    This short video on You Tube is a case history of neurorehabilitation in a teenage girl.
    No medications at all.
    However the history of her ADHD symptoms
    14 year old with ADHD https://www.youtube.com/watch?v=J92vg3nrgSY&t=269s

    In the end it is not necessary to throw the baby out with the bathwater.

  • Sam Plover,
    re neurology, the problem is that Medical Neurology is more slanted towards diagnosis of tumours and diagnosis and management of very recalcitrant degenerative diseases.

    There is a newer area called functional neurology which works more with TBI, balance and coordination problems, neurodevelopmental disorders anxiety, improving symptomatic control of Parkinsons.

    These sorts of problems are usually accompanied by a host of physical signs that us conventional doctors never really knew what to do with.

    It is getting much better results than we have been used to seeing, without drugs or need to resort to deprivation of liberty.

    That is somewhat beside the main point- which is that the majority of ADHD and anxiety patients can be shown to have these minor functional deficits that clearly generate most of the symptoms are amenable to a rehab approach.

    I dont know whether I made this point but conventional psychiatrists do not even do physical examinations– despite claiming that all psych diseases are brain diseases. This is clearly an area where they could do much better.

    That points to these problems having a subcortical brain origin -even though there will always be an overlay of reaction formation whch will need counselling and support.

  • Yes, mental disorder is real, and sometimes medication is of great value.
    Im 58, and on treatment for Bipolar 1 and ADHD- but with a sensible doctor who is keen on lower doses.
    Now, in my case, the mental disorder creates trouble and hurts people I care about.
    I worked as a doctor until 12 months ago- having to stop because of symptoms from an old whiplash injury.
    I have spent lot of time thinking about this, and seeing other people in similar situations.
    Most of them have a range of closely related issues with eye coordination, balance and fine motor coordination, and irregular stress responses.
    I can meditate well- despite having ADHD and have been a Buddhist for about a decade.

    My conclusion is that all these extra symptoms that I mentioned are part of the ADHD, and each one impairs attention.

    The trouble is that we in the West do not have an adequate definition of “Mind” let alone mental disorder. Most of our mind is subconscious/unconscious and is more involved in background tasks- like getting your eyeballs to point at the same target quickly enough to be useful.
    The opthalmologists call this “binocular vision dysfunction” and it has the same symptoms as ADHD!

    However the ADHD symptoms are exhausting and demoralising (a second level of dysfunction) and do need attention of some sort, or your “patient” will struggle in almost all activities for the rest of his life.

    Now here is what bugs me
    1) ADHD is recognised as a neurodevelopmental disordeer.
    2) It has all these co-morbidities (dyspraxia dyslexia, binocular vision disorder, dysautonomia) which are guarantee to produce a poor outcome on any academically based attention task but for some strange reason are classified as a separate problem.
    3) The Swedes have come up with an umbrella term “Deficits of Attention, Motor Control and Perception”

    So, in Australia, some kids get an occupational therapy review, but the majority do not. They do not get a comprehensive and careful neurological examination needed to find these issues.
    No adults get that or any sort of neurological assessment.
    I should know, I’ve been seeing psychiatrists for 30 years.
    Psychiatry is like the curate’s egg: good in parts, but in all that time i have never had a psychiatrist do any more than examine my blood pressure.

    My breakthrough was being approached by a chiropractor who specialises in neuro- rehabilitation/ functional neurology because he was concerned about my bloody gait and neck posture ( we met at a conference focussing on meditation in psychotherapy- and sitting up right with a straight neck is highly relevant to good results in meditation). His initial assessment was frankly scary- he believed I might have Lewy Body Dementia (not good at age 46). His work has been immensely valuable to me and he has had me read a good deal of the neurology work that underpins his practice. Things are improving in terms of my attention and alertness, despite the orthopedic issues with my neck.
    Trust me- it is a humbling experience for a medical practitioner to meet a chiropractor who surpasses him in virtually all areas of practice.

    So here it is:
    We do not have a proper definition of mind.
    Therefore we do not understand the relevance of the symptom clusters I mentioned above (even though some radicals in Sweden know better).
    Therefore we classify them as “not ADHD, but comorbid”.
    Therefore we do not do examinations. Who the hell thought that an assessment of a person with a supposed neurodevelopmental disorder could possibly be complete without doing a [email protected]@dy neurological examination?
    It beggars belief.
    The neurological signs of ADHD are very clear if you know what you are looking for.
    What is wrong with people?
    It comes down to this– if you do not operate from a solid and sound definition of mind, you should stay out of the field.
    The bad results we are seeing are a result of woolly thinking.

    However, there is an antithesis to this– if you don’t have a definition of mind that makes it possible to understand these conditions— how can you hope to criticise current medications or treatments?

    Any comments gratefully accepted- I want to sharpen this one up. The task of making the most of this line of thought has been troubling me for a good while.

  • Sam Plover:

    re the following:
    “I suppose in general, humans are just not bright enough to see underlying falsities,”

    I don’t think this is quite right. I think the issues stems from our inbuilt intuitive empathy and need to coexist in a tribal setting- at the peril of being banished, or having a bone pointed at us.

    We evolved as tribal creatures in an interdependent society- and our core instincts are to fit i and be agreeable. In fact one of the big five personality traits that our psychologists talk about is “agreeableness”.

    That’s all very well, but it leaves most of us following the line of being agreeable and fitting in even when the agenda is being set by a disreputable bully. That’s not stupidity, it is ore down to the psychopaths who rise to the top– especially in the higher levels of the public service.

    I do not know how we re-balance this see saw of agreeableness vs dynamic but greedy individuals though.

  • Sam,
    Psychiatry is more gravy train than cult.
    The system of chief psychiatrist for each state also establishes a power structure that ensures that psychiatry as a whole is doing what its political masters (and therefore the media behind them) want.
    There are some great practitioners out there, but it is a mixed bag, especially if you have to deal with any psychiatrist in the state system.

    The issues with psychiatry are largely issues of bureaucratised medicine- and find an analogy in the bureaucratic delusion (strictly enforced) that Lyme disease doses not exist in Australia.

  • Thanks for the article, it is a very helpful read.
    One section stood out for me:
    Should suffering so clearly connected to sociopolitical turmoil be reduced to psychiatric phenomena, or handed over to psychiatric intervention?

    “Is EMDR able to cure traumatic history and the traumatic ongoing present of Palestinian people? Or does it simply veil the violence of history? How helpless did the social worker actually feel and how much had her historical consciousness been colonized by a hegemonic trauma discourse that assumed EMDR could work in Palestine?”

    The impairments associated with PTSD are well known- especially in areas of family and work history.
    If it is left untended it has the capacity to cause serious harms, so when we see a patient we are obligated to do the best that we can to minimise their symptoms and maximise their function.

    EMDR is also a powerful tool, one which does not require medications, and one that can be used safely and effetively.

    To me, the biggest question is how we can make it stick in a currently traumatising environment, to the point where our client is calm and functional in the environments that he/ she has to confront in their life.

    EMDR does not seek to cure traumatic history, it seeks to stabilise harmful reactivity in a client whohas not been able to do it for himself.
    The trap here is the nature of the traumatising environment. Even after an effective course of EMDR- ending them out back into a traumatising environment with the risk of retraumatsation.

    In that scenario, EMDR therapy would not be complete without some work on ego strengthening.

  • There has always been an element of that.

    I did a tour of the old Aradale psychiatric hospital and the adjacent prison for the criminally insane. It interested me to see that the “Cheif Psychiatrist” was very much a part of a power clique along with senior police and the senior forensic pathologist.

    However, for all that a few get involved in power games- that is only a tiny minority. I’ve had to see psychiatrists since a first onset of hypomania at age 27- so I have had close relationships with many psychiatrists, both as a patient and as a referring doctor. Most of them are highly skilled professionals, and I would be in a much worse position but for their professionalism, so I do not think it is right to demonise “psychiatrists” as a set.

  • I’m not surprised at this result. It is based on the idea that there is something globally wrong with the brain in ADHD. There is not – there are a number of functional problems (essentially being caught in a mental loop) in ADHD and they predictably result in the symptom pattern we see in ADHD. The basic problems are in vestibulo-cerebellar function- and result also in a number of conditions that have erroneously been called co- morbidities, as though they are separate. They are not.
    These problems include developmental coordination disorder, dyspraxia, dysarthria, sensory processing disorders (not as severe as autism), eye movement issues with convergence and eye tracking issues, and dysregulation of the autonomic nervous system (which is biolgically based and does not reflect a primary problem with threatening environment/trauma.

    Furthermore there are clear cut neurological signs visible if we care to do a physical examination. Normally we do no, because the way that we think about the problem misdirects our attention.
    Ive personally verified these signs in about 150 adults with ADHD- between 2014- 2015, but have had to retire so cant follow this up in patients myself.

    The underlying neurological dysfunction is remediable mostly through specialist neurological rehabilitation (ie chiropractic functional neurology.

    I offer up this case history- which clearly shows an enormous improvement in only 8 weeks with a patient who was not fully compliant.
    The presentation clearly shows the signs of autonomic overactivity, autonomic asymmetry-R pupil dilated more than L, difficulty with eye tracking and documents the treatment along with the results. That is a very strong result with no medications.
    https://www.youtube.com/watch?v=J92vg3nrgSY&t=25s

  • In the end these brain volume issues really apply only to small and quite specific areas. They really are visible evidence of different ways of processing information (which may be maladaptive).

    The real trouble is that because ADHD is defined by psychiatrists they take arather limited view of it- neglecting the physical signs which should by all irghts be identifiable in a neurological condition. Things are less backward in Europe though:

    A Swedish study:

    http://onlinelibrary.wiley.com/doi/10.1111/j.1469-8749.2009.03407.x/full
    “Reliability and validity of the assessment of neurological soft-signs in children with and without attention-deficit–hyperactivity disorder”

    Additionally we are getting stronger and stronger evidence of problems like oculomotor problems – which are stimulant responsive:
    https://www.ncbi.nlm.nih.gov/m/pubmed/12672781/?i=4&from=/24691355/related
    Altered control of visual fixation and saccadic eye movements in attention-deficit hyperactivity disorder.

    Oculomotor Abnormalities in Children with Attention-Deficit/Hyperactivity Disorder Are Improved by Methylphenidate.
    Bucci MP, et al. J Child Adolesc Psychopharmacol. 2017.

    https://www.ncbi.nlm.nih.gov/m/pubmed/28452866/?i=1&from=dopamine%2C+fatigue%2C+oculomotor%2C+exercise
    Which is:
    Effects of Dopamine and Norepinephrine on Exercise-induced Oculomotor Fatigue.

    So lets think about this- attending with the eyes (reading) is a major part of the disability in ADHD,
    it is correlated with ocuomotor deficiencies that are improved with stimulants
    The same set of problems can be demonstrated in athletes who are exercised past their fatiguing point.

    So we have a plausible mechanism for oculomotor symptoms as a cause of ADHD symptoms, we know that they are ameliorated by stimulants. We also know that at least in the earl stages of treatment they substantially improve attention and learning (until you learn too much, read too much and exacerbate the problem.

    If we take this a little further we see that behavioural optometrists use a questionnaire that asks many questions that overlap with ADHD questions.

    Now these oculomotor problems are treatable by behavioural optometrists and by people who specialise in neurological rehabilitation/ functional neurology, most of whom are highly trained chiropractors.

    I have discussed the issue with one of them (when I was seeing him for treatment for my ADHD/Oculomotor issues [now almost full settled]) and he agreed with my reasoning that given the serious oculomotor fatigue and problems with training in bad habits during neuro-rehabilitation, the use ofsimulants then may be indicated.

    That’s pleasing really- hitting relevant mechanisms, and aiming to minimise duration of treatment.

    however, I do not think there is any sense in denying the problem exists, and zi think there is no sense at all in labelling a condition as a neurobehavioural condition without doing a proper physical examination. This approach is rare in psychiatry though.

  • Lisaloo1969,
    it is not quite as simple as you suggest- the experiences are usually not of non dual awareness. The majority of nyam are far from that and most of them are more likely symptomatic of autonomic imbalance.

    I have been meditating off and on for about 7 years with slow but steady increments of benefits. I can’t sit for too long because I have a bad back, and after a certain time persisting with the one position becomes just too painful to be beneficial. it is better to fall back and find the point at which the pain arises and work with that. This approach has helped me identify and manage the postural imbalances that drive the pain (an incorrect posture inevitably loads one muscle group excessively and that drives pain).

    The points that concerned me about the story you linked to were
    1) No attempt to screen applicants and see they were fit for a 10 day intensive both in previous psychological history, in meditation experience ( this is an arbritrary guess on my part, but maybe the ability to do 2-4 hours meditation 4 days in a row might be a suitable qualification?) and in grounding in Buddhist philosophy.
    2) No experienced teacher to warn students of what was a healthy, normal experience and what was not), and to take daily reports of their progress. The latter is a standard practice in many Buddhist monasteries.
    3) No debriefing.

    One aspect that worries me (I am a medical practitioner) is that meditating with pain for a long while can drive a severe stress response- and in a suitably vulnerable, anxious individual this may drive an anxiety state into a frank psychosis.

    A second point which may need to be considered (less applicable to Vipassana, which is done eyes closed) but strongly applicable to eyes open sitting meditation and to Tai Chi retreats, relates to the question of vision.
    At the very periphery of our visual field there is a margin in which one cannot see a stationary object, but can see a moving object. Now it turns out that movement in that marginal area will always trigger a strong stress response This is good thing as this reflex will save us from being run over and I understand that no less an authority than the Dalai lama has said that this kind of core survival reflex is not expected to be removed by Buddhist practice. However the trick is that in a crowded meditation or Tai Chi room there is continuous subtle movement at that margin- and that might be enough to tip a fragile individual into psychosis.

    Really I think that this might be more likely to trigger psychosis than spontaneous experience of non dual awareness– after all most of us get little hints of that quite frequently (ie that moment when you found yourself skiing perfectly– the moment before you thought to yourself “Hey, I’m skiing perfectly”— and crashed”.

    However the points raised in the article you linked to were well made, and I for one will take them up with my teachers, one of whom is heavily influenced by Goenka.

  • The studies you mentioned lead to an interesting conclusion:
    If the rate of ADHD diagnosis is related to age of entry to school, and ADHD is being conceived as a neurodevelopmental problem, then this logically suggests that school is not a good environment for the development of young children. That seems like a logical conclusion to me.

  • Steve,

    thanks for the links- I was only aware of the Australian one- and there are questions about the independence of one of the people involved in it. I will look into them.

    It disturbs me that so few practitioners are aware of the nature of DSM. All you have to do is read the introduction– but it seems that that is rarely done.

    The “chemical imbalance’ model is just nuts ( unless you are talking about depression due to hypothyroidism or some such problem). The proponents of that model can never account for the fact that these neurotransmitters subserve multiple functions in many parts of the brain, and that in most cases chemical therapies are “shotgun treatment”. In that regard I suspect that the stimulants are the most pathway specific medications, as the dopaminergic pathways are quite limited in the brain.

    I do think that there is value in making the syndromal diagnosis- simply because it predicts a lot of the sort of problems that the individual will experience. In particular people with ADHD are being told they are being wilfully lazy, and to just try harder. That sort of help usually makes the problem worse and it betrays a fundamental misunderstanding of the nature of the problem.

  • Steve, how many times have the studies regarding age at diagnosis been replicated?

    I do agree that there is a real issue with kids going to school too early and spending too much time seated doing work that they could compete in 1/4 of the time if they did it a year later.

    Equally, the structure of DSM is not powered to identify causes. I’m sure that a significant group of the kids who experienced many adverse childhood events would be classifiable as having ADHD if they were fully assessed.

    I remember a paediatrician commenting that an ADHD diagnosis should be the start of investigation- not the end.

  • You can’t do a scan in an individual to come up with a specific label because the labels are based on clusters of behaviours.

    So a syndrome like ADHD is always going to be heterogenous and there will be great variations between individuals.

    However, as I said, finding neural correlates is important and helpful as it allows us to tailor interventions down to specific rehab exercises, and that decreases the need for medications.

    Plenty of kids with ADHD grow out of it for many years, but the underlying problems do tend to crop up again in middle age, as we age, and as we are forced to work in sedentary positions Not only that but they also show up in other ways- like a chronically overactivated stress syndrome, and as chronic pain as the body takes more and more wear and tear from one’s clumsiness.

    I can only agree that the use of labels in psychiatry is often clumsy and over -rapid, but that does not mean the labels are useless.

  • You seem to have missed the whole point of my comment.
    I am saying that the ADHD label is a real label describing a discrete problem, that does have distinct features that can be linked to particular areas of the brain.

    I do not agree that stimulants are the best solution in most cases. In fact I support the treatment recommended by Biedermann- manual therapy where there is an identifiable suboccipital problem, but I would add physical rehabilitation to address the physical issues like coordination and ocular congergence issues.

    Stimulants can help, but not all people benefit from them. The real issue is that psychiatry has got dumbed down to medication only treatments or preoccupied with complex and often unhelpful talk therapy ( I hate to think how much I personally wasted going down that path).

    I had intended to follow my previous post up with a comment that the issue with ADHD being a psychiatrist’s diagnosis is that they have a VERY limited repertoire of treatments and they tend to overuse their tiny arsenal of medications when usually non medication approaches are better.

    The problems caused by unreliable attention have actually been the subject of discussion for some millenia, and if you look carefully you will see that what the Buddha said boils down to “suffering occurs because of inadequate attention (to the nature of reality).

    I have highlighted the common issues with coordination and also the fact that these link well to predictable brain areas. If you cannot understand the subcortical (and therefore utterly unconscious) nature of ADHD symptoms it is difficult to offer any useful advice to us which does not sound like more of the same abusive nonsense tht we have been subjected to since we entered school.

    However having an understanding of the nature of the problem in brain terms actually points to better solutions:
    We have clear evidence of the value of meditation in reducing anxiety and stress, and good evidence of brain changes that correlate to that activity. If we broaden our view a little, some other meditative practices like Tai Chi (which involves slow and precise movements repeated until they are perfect and the underlying posture is also perfect) are working on the areas of the brain which are not working so well.

    This sort of knowledge is empowering- not disempowering.

    The latest material linking brain areas with particular problems is extremely useful, but it is not the last word. My own position is far from the “Scientism” point of view (which I am utterly at odds with) that the brain is the seat of consciousness. We have more than enough material from near death experience studies to support the continuation of consciousness after the cessation of neural activity.

    However ADHD is a behavioural disorder, and all behaviour is expressed through the nervous system, so the nervous system is of interest to those keen to deal with the problem, rather than just take positions.

  • Here is the catch ceebee, the behaviours that are a problem in ADHD are not voluntary. They do not occur because they are being rewarded. They usually are not even driven by threat in the environment- (though that can worsen them). The behaviours represent escape of behaviours, and that escape will happen pretty much as soon as our back is turned and our awareness focusses on another subject.

    We do actually know better, we don’t like them, but it is very hard to suppress them.
    Yes- things like hostility in the classroom or home will effect us, as will inadequate physical exercise and too long at the computer– they will affect anyone- but we tend to be the first affected. All this creates considerable stress and worsens the problem, but correcting those will not fix the problem.

    We are told to just pay attention and be disciplined- but paying conscious attention is effortful and there are a limited number of things anyone can attend to at one time. What is really going on, as best as I can understand that the routinising of subbehaviours (components of larger behavioural repertoires) has not worked well.

    You can take the simple example of clumsiness as a good analogy (and also appropriate given the prevalence of clumsiness in ADHD). If you are clumsy, and trip on things all the time, you have to pay more attention to walking and that limits what other things you can do when walking. The same with typing or handwriting- more effort has to go into the basic act of getting the thought on paper- and that leaves much more chance of losing track of your train of thought.

  • As a rule we don’t even have an adequate definition of “mind”!
    Then there is the confusion as to whether mind and consciousness are simply emergent properties of matter, or whether they have a reality at another level.

    I prefer the Buddhist definition of “coarse mind” ( the consciousness that is wedded to this body) Subtle mind (the consciousness that passes from birth to birth) and very subtle mind- or pure awareness.

    Now plenty of people won’t subscribe to the idea of reincarnation, but I like the idea of consciousness being entangled with the body. In that sense the entire distinction between mental illness and bodily illness becomes much more subtle. In fact it is subtle- as can be seen by the number of phrases for mental illnesses and emotional states that reference the body- ie a jaundiced view, bitter and twisted, the straight man.

    However these problems would still exist even if we used some other label for them. There are good descriptions of the ADHD phenotype in the 18th Century by Alexander Crighton (a Scottish physician) and Melchior Adam Weikerd (a German physician), and a probable example from Hippocrates too. We do not gain much by simply relabelling them.

  • As with all research we see the biases of the author coming out in statements like “Their data, the authors wrote, confirmed that patients “with ADHD have altered brains; therefore ADHD is a disorder of the brain.””.

    In fact ADHD, like all other DSM categories (I believe the term diagnoses is semantically incorrect) consists of a population defined by their common behaviours.

    We have plenty of evidence of neuroplastic brain changes, so inevitably a set of commonly repeated behaviours will result in predictable changes in the brain. In making the comment above I believe the authors simply unconsciously expressed the biases inherent in their professional orientation.

    There is a great deal of confusion about ADHD, but as I say it is defined as an inherent part of the DSM, and no amount of tinkering with the definitions will make it go away unless we jettison the whole DSM and all the diagnoses. That’s not practical, as all these definitions have clinical utility. My ADHD was finally picked up 9 years ago- at age 45. It would have been helpful to know about it earlier. Though it has not prevented me from working as a doctor, it has caused an awful lot of misunderstanding in interpersonal situations and made work much harder. In adults most of the impulsivity and hyperactivity diminish greatly, but the inattention remains, and causes a great deal of difficulty with mislaying necessary items and being disorganised. These inevitably create the impression that one is an uncaring partner.

    The neuropsychologist Leonard Koziol has written extensively on the role of subcortical structures and cognition, including a book called “ADHD as a Model of Brain -Behaviour Relationships” his comments about the diagnosis ADHD are interesting:
    First, ADHD is a behaviorally defined diagnosis as it is charac- terized in the DSM system. And in this regard, we com- pletely agree with Carmichael and colleagues’ (this issue) bold statement that from a neuropsychological perspec- tive, ADHD does not exist. There are absolutely no broad-based neuropsychological test batteries that can ever lead to that diagnosis nor is there any ‘‘litmus test’’ for the disorder called ADHD (Koziol, Budding, & Chi- dekel, 2013; Koziol & Stevens, 2012). However, the fact of the matter is that from the behaviorally defined DSM system, ADHD does exist.
    and….clinical neuropsycholo- gists are compelled to agree with the proposal that history, observation, and behavioral rating scale data are the primary methods for diagnosing ADHD (Barkley, 2006). In fact, we go a step beyond that viewpoint in stating that these simple behavioral meth- odologies are the only justifiable means for making that diagnosis. This conclusion is based on one simple fact: If a clinician is bound by the DSM system
    ( “Attention and other constructs:Evolution or Revolution” Koziol et al APPLIED NEUROPSYCHOLOGY: CHILD, 0: 1–9, 2015)

    Now while the category ADHD, which is behaviourally defined, is a useful construct as far as it goes, it is also misleading as it focusses attention only on behaviour. It is now becoming accepted that cognition essentially involves the internalisation of movement and developing the skill to execute ever more complex movements- so why is this area not investigated?

    It is already well known that there is a significant overlap between dyspraxia, dyslexia and ADHD, but these disorders are separately classified. They should not be because all three disorders share a common neurological basis with problems in the planning and perfection of routine movements (cerebellar), and the routine switching between tasks at will (basal ganglia).

    Furthermore, when you look around you will find that therapists dealing with ocular convergence and coordination issues in children use screening questionnaires that actually borrow many of the same questions that would be used to diagnose ADHD. A classic feature of cerebellar issues is difficulty adjusting movement to the requirements of the moment- with a tendency to overshoot or undershoot the target- and that issue is most marked

    Additionally the German Orthopedic surgeon Heiner Biedermann (book- Manual Therapy In Children) headed a multidisciplinary team looking at the consequences of birth injuries to the upper cervical spine, (which is common, and becoming commoner as babies get bigger). He found that the injuries tended to persist due to ongoing instability in the upper cervical spine, and the children would develop dyspraxia and dysgnosia (a broader term than dyslexia) as well as common postural issues. He found that these children were effectively behaviourally indistinguishable from other ADHD children, but that early manual therapy was effective in greatly reducing the ADHD symptoms, and usually in ceasing medication.

    The association of the upper cervical region is interesting because most of the proprioceptive (body position) information comes from the muscles at the top of the neck, and there is ample evidence that abnormal tension in these muscles can impact on eye coordination and dynamic visual acuity. Biedermann’s book also covers other types of incoordination.

    Since my diagnosis I have seen several hundred ADHD adults, and have had the chance to physically assess them. Issues with balance and coordination are virtually universal, and of varying severity. Many ADHD adults have developed mastery in one sport or another, but have frequent injuries, and also have a history of frequently tripping on minor floor irregularities or bumping in to furniture- usually in their home or workplace (where they are less vigilant). A thorough physical examination will almost always reveal mild cerebellar signs, and problems with eye movements. However the signs are more mild than we as doctors are used to looking for in more severe cerebellar disorders.

    So the point is that while the label ADHD is useful it is limited by the fact that psychiatrists mostly think about thoughts and cognitive processes. The way this plays out at the moment is that it obscures the real physical issues that are driving the problem.

    Stimulants are often helpful, especially when the situation is spiralling out of control, but their effect is not long lasting, and tolerance will inevitably develop.
    Addressing the underlying problems is going to be a more permanent solution – good manual therapy to correct underlying postural issues, rehabilitation of the coordination problems ( and I would include specific play therapy like one to one work to improve ball handling skills- which will allow ADHD kids to enjoy sports, as the clumsy ones usually get excluded) and a substantial reduction in the amount of seated time in class, and in front of screens will all help.

  • Re Alan Wallace’s book- pages 105-107 (Stage 6: Pacified Attention). Alan directly references “The Vajra Essence”- and enumerates a long list of anomalous psychophysical experiences that can occur.
    “while many of us would likely respond to some of those disagreeable experiences by stopping the practice or seeking medical help, Dudjom Lingpa actually calls them all signs of progress…. whatever comes up was already there, previously hidden by the turbulence and dullness of the mind”.
    We can see already from the tone of the paper that there is a tendency to look upon these experiences as pathological or harmful, and this may be the trap in the approach of Western psychology which adopts and teaches mindfulness practices, often without being aware of the fine print.

  • The point of the recently developed therapies involving meditation is specifically to move away from any religious framework, and nobody is forced to engage in them.

    Most of the therapies involve being able to establish a calmer mind with less unnecessary wandering and less tendency to get trapped in obsessive negative thinking. They also involve greater awareness of body sensation, and learning to be calm and non-reactive to bodily sensations.

    This is important as it is now well established that most of our actions and responses are driven by emotional reactions- that these emotional reactions all have a distinctive key signature of body sensation and those sensations feed in to our brain where they will drive actions which are sometimes too impulsive and potentially harmful to ourselves and those around us. These therapies will not cure everything (acute mania, severe depression, and florid psychosis would all be major barriers to success).

    However they are distinct from TM- which as i understand it is only based on achieving stable attention.

    Meditation really only becomes religious when it is coupled with religion specific practices. I agree 100% – those have no place in therapy. It sounds like your experience was pretty awful.

  • These experience are well known in Buddhism, and in Tibetan are called Nyam. They are well described in Alan Wallaces book “The Attention Revolution”.

    They differ from Schizophrenia in that they are transient, and have many psychosomatic symptoms and provided one does not either become obsessed with reproducing them or frightened by them (avoiding attachment and aversion) they will pass and the meditator will settle to a normal mental state afterwards. Usually you need to be meditating a lot to get them- -ie 4-8 hours a day on a retreat going for some days.

    They are actually regarded as a good sign- that your mind is still enough to pick up on these things (which I suspect would only come to you in dreams).

    If they occur on retreat you have the advantage of being able to discuss them with your teacher- but they could be frightening if you did not have that support.

    I do use a Buddhist based meditation technique (Mindfulness Integrated CBT) as a therapy in come cases, and it interests me (as a Buddhist) that there is little discussion of these possible symptoms, as some patients do get very inspired and go off and do lots of meditation without supervision.

    Equally, I suspect that as one progresses further down the meditation path, one may get little hints of the experience called emptiness, or Sunyata. That may well be unsettling as well- again highlighting the need for support.

    So- appropriate support by an experienced teacher is always important, as is access to ongoing advice and support if the patient wishes to pursue an ongoing practice, as many do. However the possibility of some of these difficult experiences is NOT a contraindication to using these therapies.