Friday, January 27, 2023

Comments by Stephan Schleim

Showing 11 of 11 comments.

  • That brain damage can lead to neurological, psychiatric, or psychological disorders/problems merely proofs this: that the brain (or, more largely, the nervous system) is causally necessary for psychological processes.

    That doesn’t mean that the psychological process IS nothing but a brain process, or that the psychological process (or mental disorder) can be grasped, described, treated beset on the neural level.

    P.S. Already in ancient Rome, the physician Galen described all kinds of functional deficits in gladiators with all kinds of wounds, including head wounds.

  • Thank you for sharing your personal experience. I find the “hunter example” also very interesting.

    I wonder how soldiers experience that (i.e. ADHD-like symptoms) during their service. But actually the armies around the world started using stimulant drugs long before the diagnosis ADHD even existed.

    Some even argue that, for example, the Nazi’s Blitzkrieg in WW2 wouldn’t have been possible without methamphetamine, see:

    https://www.history.com/news/inside-the-drug-use-that-fueled-nazi-germany

    (In the end, the side effects were severe.)

  • Thanks a lot for that remark. But AD(H)D was not added to the DSM before 1980 (DSM-III). Probably those kids were labeled as having MBD (Minimal Brain Dysfunction) – or possibly “Hyperkinetic Disorder”.

    Now in the year of 2022, the most predictive factor of an ADHD diagnosis is, to my knowledge, indeed the age at entering school: You see that the youngest in each class have the highest likelihood of getting the diagnosis. That sounds to me as if those kids are labeled (and then treated) for behaving childish. Well, they are children.

    And this has been shown for many countries and is evidence based:

    Whitely M, Raven M, Timimi S, Jureidini J, Phillimore J, Leo J, et al. Attention deficit hyperactivity disorder late birthdate effect common in both high and low prescribing international jurisdictions: a systematic review. J Child Psychol Psychiatry. (2019) 60:380–91. doi: 10.1111/jcpp.12991

    (And, again, this is not to say that “ADHD doesn’t exist” or that there aren’t some individuals severely suffering from insufficient attention spans or impulsive behavior.)

  • I think it’s accurate to say that the description of ADHD in particular is about a mismatch between individual and the social environment: such as not paying enough attention (to someone or something), interrupting others, not following rules (e.g. to stay seated at one’s place).

    Some people say that they benefit from drugs (with interesting class and race differences, by the way), some from psychotherapy or other kinds of behavioral training, some from changing the social environment (to a place where their behavior is perceived as less disturbing). Until a while ago, 20 years or so?, it was widely believed that ADHD is exclusively a childhood/adolescent condition and disappears as people grow up. This has now changed and clinicians’ consensus is that adult ADHD can exist independently.

    Thus “recovery” seems to be possible in many ways such that the mismatch between individual and social environment disappears or is at least reduced. As far as I know, many children also stop taking the drugs during the holidays (i.e. out of school with its behavioral demands).

    To me, that’s an odd “disease”, that seems to only exist in particular environments (particularly schools), not others.

  • I want to avoid discussions about whether “ADHD is real”, as people identifying with this label then often get the impression that their problems are not taken seriously.

    My position is that “ADHD” describes certain kinds of problems, in a certain historical period and a certain cultural context. This is complicated by the fact that, particularly in the case of ADHD, we are talking about a mismatch between the society’s moral expectations (e.g. not to disturb class, to sit still, to pay attention) and a person’s (often a child’s) behavior.

    I especially don’t want to “convert” people identifying with that label and benefiting from the therapy to my theoretical view.

    P.S. I’ve summarized research on how stimulant drugs, including amphetamine, work (or rather don’t) in healthy people in my new “brain doping report” which can be accessed for free here:

    Pharmacological Enhancement: The Facts and Myths About Brain Doping
    https://research.rug.nl/files/228970238/Schleim_2022_EN_Pharmacological_Enhancement.pdf

  • Scientists must “publish or perish”, a fact known since the 1930s/1940s already. (Nowadays they must publish, communicate, get funds etc. or perish.) To publish, they must succeed in a hypercompetitive system (and increasingly competitive society) shaped by vested interests and subject to financial incentives.

    Whether such a system facilitates the pursuit of truth more than the pursuit of career aims and profits is questionable. If people want another science, they should contribute to changing the scientific system. The continuous attention generated by Mad in America is a contributing factor to such a change, in my view.

  • The original quote is Wilhelm Griesinger’s (1817-1868), a pioneer in not only scientific psychiatry, but also clinical reform. Unfortunately, he died early and thus could not develop his ideas further.

    Later, Emil Kraepelin (1856-1926) continued the biological approach and has become an inspiration for the DSM since the DSM-III of 1980.

    Localizationism and the biological model make sense for many health-related problems; but it’s an exaggeration and fallacy to believe that ALL of medicine (and particularly all of psychiatry/clinical psychology) could be understood that way.

    Griesinger’s ideas are still interesting today. You can find a selection of them in my article.

  • My argument is that the psychological phenomena (including states we now call ADHD) are way too heterogeneous and complex to understand them on a biological level (I did cognitive neuroscience research myself for my PhD).

    Importantly, that doesn’t make psychological phenomena any less real.

    Many people would feel better taking stimulant drugs, focus better and feeling more motivated to get things done. I believe that much of the “illicit drug use”, as the authorities call it, could be seen as some kind of self-medication.

    I want to look beyond moral categories and think that people should have all means available that help them live their lives. I have a book forthcoming on mental health and substance use in which I try to explain that point in more detail.

  • That there are differences in how people react to trauma does not necessarily mean that they are based on genetic differences.

    We embody histories of our experiences, relationships, including our biology. So I’m not against biological research at all. But as a matter of fact, after decades of genetic research with now data from more than 100,000 people for some mental disorders, the genetic differences between people only explains very little of their psychological problems.

    A recent scientific review, summarizing the genetic data:

    What Do We Know About the Genetic Architecture of Psychopathology?
    https://www.annualreviews.org/doi/abs/10.1146/annurev-clinpsy-081219-091234

  • Thank you for this apt summary of my research. I would have preferred to exemplify these points for depression, but the research topic (special issue) was on ADHD. I’ve highlighted more interesting aspects of the history of ADHD in a German essay, but have an English book on mental health forthcoming where I have more space to elaborate on the philosophical points.

    I was wondering what this remark refers to:

    “Although Schleim acknowledges that mental disorders are not ‘only constructs,’ he critiques over-attachment to that which is concrete and tangible while also committing the same logical fallacy himself.”

    It may be that in this very short article – with a 3,000 words maximum (which I already exceeded) – not every expression is sufficiently clear. But I’d still be interested in what my “logical fallacy” supposedly consists in.

    “The conversation would be deepened by an acknowledgment that things do not need to be biological to matter.”

    That’s an interesting last sentence. My view is that we are embodied beings, where biology and physiology are an essential basis of perception, emotion, and cognition. But that doesn’t mean that biology itself could provide a sufficient basis for grasping what it means to be human (including our psychological problems). The distinction between strong and weak biologism is meant to emphasize this.