Thursday, November 23, 2017

Comments by firewoman

Showing 42 of 42 comments.

  • Thanks. I agree people certainly have the right to talk about parents causing behavioral issues in children (and agree parents are often at the root of child problems, so it is something that clearly IS important to talk about). What bothers me is the hyperbole that EVERY case of “ADHD” is due to parents, and if you try to present alternate viewpoints that suggest there are kids who may truly have these issues independent of parents/environment, some posters think it is okay to personally attack you, as I have experienced here. Just wish this issue in particular would get treated with some more balance (and some people would show a little more respect).

  • Also agree with Liz. I have stopped commenting here, in part, because of some of of these gross overgeneralizations and attacks that usually ensue if you say think that ADHD has any construct validity (even if you don’t think of it as a disorder that should be remedied with drugs). I think the contributions of people like Steve McCrea on this topic should be given more spotlight- would give MIA far more credibility than these hyperbolic pieces. Enough is enough (of this hypocrisy that MIA promotes half of the time)

  • Hey, I think most psychiatric conditions are a normal response to abnormal environment. You don’t have to convince me that biological perspectives are mostly bad. But in developmental disorders, SOMETIMES there are neurologic contributors. For example, there is an association between being born preterm and BOTH ADHD and autistic spectrum in kids. In those cases, that suggests a biologic basis. Whenever I read these articles about ADHD, I do wonder why ADHD is generally considered fake here, but that’s generally not what people say about the autistic spectrum. Why did people get offended by BPDs remarks last month that autism is related to bad parenting, but it would it would be okay to say the same thing about ADHD? That’s the core of what I’m asking. I’m not seeing a difference between the validity of autism spectrum and ADHD.

    Oldhead, to repeat, I have a lot of the same issues myself (I just have spent most of my life without a label since differences in girls are usually less obvious and prone to labeling). I was not the coolest kid on the block by any means, and actually my brother is definitely better off in many respects, today.

    One of the benefits of having a little extra help (not drugs, let me be very clear about that) was a group therapy that gave him friends when he otherwise wouldn’t have had any. And 2 of them are still his good friends today. Do you think he would have been better off with no friends for a few years growing up , in prime social development years? I wouldn’t have minded that myself.

  • Why don’t people view ADHD in the same way they view autism, in terms of being “real”? I think they should. I see this as a backlash related to the overdrugging of this group of kids. (autism “irritability” is drugged too, but that isn’t pushed quite as hard with ADHD)

    To be clear, I am not talking about the ADHD label that gets slapped on something like 20% of all boys. I am talking about people like my brother who was diagnosed with it in the early 80s (DSM 3 days). In him impulsiveness has always been pretty noticeably (as in he did things like buy 4 cars in the course of the year in his early 20s when he didn’t have the money to do so, and no, this wasn’t a manic response to stimulants since he barely had exposure to them), he had a lot of social problems growing up due to his non stop talking/blurting things out nature (and he was bullied pretty badly), and he while he has matured, these traits are still very much there today. He does have evidence of neurodevelopmental issues too- he didn’t talk until he was 2.5 (they actually thought he might be autistic…until he finally talked and never stopped), and still has physical problems with coordination and fine motor skills today (these are less commonly discussed aspects of ADHD, though not part of the DSM criteria). There are a lot of parallels with me, though in a little different, more subtle ways ,as is usually the case with females .

    I guess what I’m saying is that I do wish there was recognition of ADHD as more than a social construct…I haven’t seen many people talk about autism like this. There has been discussion about seeing autism in neutral terms rather than a disease/problem and I would argue that’s how ADHD should be seen- as a difference, with advantages (creativity and being blunt can come in handy, if used well) and some disadvantages that would benefit from recognition and (non-drug) support.

  • I agree that ADHD is real, but over diagnosed. I say this as someone with it, who also has a brother who was diagnosed in 1983 (somewhere on this website said it wasn’t a diagnosis until the late 80s…not true). I think of ADHD as being similar to autism in that both are developmental conditions, yet most people on this website and elsewhere don’t dispute the existence of autism. True ADHD is associated with neurological quirks like fine motor deficits (you should see how I hold a pencil). These are traits that tend to be retained into adulthood.

    I am concerned about the quick jump to meds and long term use of them. Because I am female and usually did well academically, my diagnosis didn’t come until I was 30 and dealing with medical issues that made me unable to use my tried and true “stimulant” of daily exercise. I have learned the hard way that I have too much anxiety ( my other coping mechanism) to go near a stimulant- am still dealing with the shitstorm that came from that experience 2 years ago. My brother had some brief stints on stimulants during periods where he needed extra help, but the bulk of treatment was play therapy with other kids with developmental issues (some of whom he is still friends with). He considered this helpful, and I wish this was more how treatment played out today.

    For those on this “spectrum” I do think it is helpful to have some validation of our different wiring. Particularly if you are female, and expected to be useful and efficient in things like household chores. That doesn’t mean I use ADHD as an excuse, but it’s easier to to make some peace with the things I don’t do well and think of appropriate strategies for coping. I see strengths of ADHD too (like hyperfocus used appropriately), and wish this was more encouraged.

  • Not everyone who writes these articles is out to advance psychiatry in its current dysfunctional state. After all, these authors were inspired by Whitaker to do this paper. I don’t really understand why you want the researchers who write articles that call standard psychiatric practice into question to be fired…

    The lead author’s education is public health, the same area I am currently a grad student in. My hopes are to advance ACE based research that helps develop primary prevention strategies/ stops intergeneration transfer. I know there many others with similar goals in this field

  • I do have access to most articles via my university affiliation, but oddly, this one isn’t accessible. I also looked on ResearchGate (facebook for researchers), and couldn’t find it there either. Doesn’t hurt to ask the authors directly (You write better than most academics in this area anyway and could probably impress them enough to get the article 🙂 ).

    FYI- if you want access to full articles, anything NIH funded becomes available to the public for free via PubMed Central within a year after the article has been published.
    http://www.ncbi.nlm.nih.gov/pmc/
    ResearchGate is another good resource (its free), many articles get uploaded there and you can request access to full texts there as well.

  • If you join Research Gate (it’s free), you can access the full text at this link
    https://www.researchgate.net/publication/286510702_Psychiatrists'_Attitudes_Toward_Non-Pharmacologic_Factors_Within_the_Context_of_Antidepressant_Pharmacotherapy .

    Research Gate is a good way to get articles that aren’t publicly available for free- has a lot articles uploaded on it already and you can also request full-texts of those that aren’t already there from the authors.

  • Dr. Urato, are you aware of studies that have compared the risks of staying on ADs vs the risks of withdrawal in pregnancy? Please correct me if I am mistaken but my impression is that the animal studies were comparing drug exposed to never exposed, which is not helpful in answering this question. I do know of a study that showed discontinuation was linked to re emergence of depressive symptoms (likely withdrawal related, though they phrase it as relapse) – see http://www.ncbi.nlm.nih.gov/pubmed/16449615. And what is your actual experience with how pregnant women who may already be having pregnancy related mood problems and physical issues like morning sickness handle withdrawal? Some people have terrible experiences with it and I can’t image that not harming a fetus too.

    I raised these issues in a different discussion, and am curious what your thoughts are. Seems to me that the discussion should be more around preconception health and dangers of prescribing to women of childbearing age, since even if a woman who becomes pregnant on ADS can successfully wean off, she will still have some exposure (and that exposure would be in the time that is most important for birth defect risk)

  • The_cat,

    Just curious, have you been through a bad psychotropic drug withdrawal? There are plenty of accounts of people here and elsewhere about experiences such as not being able to eat consistently and significant weight loss (the opposite of what a pregnant woman needs to do!) or sleep more than 3 hours a night, for months and beyond? Not just a little insomnia or nausea. And remember, we are talking about pregnant women- who often already are dealing with physical issues like morning sickness (really all day sickness, I have heard). Not everyone will experience this and if things aren’t as bad, then yes the risks of continuing on the drugs may be more important . I’m just saying at least some of these women will have problems with the withdrawal- and the risks of withdrawal should be factored in. The way illicit drug withdrawals are handled (via things like methadone maintenance) should be a clue that withdrawal can be a serious issue.

    Also, what happens if the woman becomes suicidal due to the withdrawal and winds up in a psych ward? Then she is likely going be exposed to things like antipsychotics, which I would imagine are even worse for the baby.

    It’s great that you care about the baby (all dads should), but I don’t think you are being very realistic or empathetic towards women here. We are people too (not just a vessel for the baby who can be locked up for 9 months) who may have gotten placed on an SSRI ignorant of the risks involved, just like many others here. As engineer mentioned, birth control can fail ( more often than many people realize), so this is not necessarily intentional reckless. I think these women deserve to be treated with a little more respect for this difficult situation.

  • Yep, I agree (I’m not a clinician either, though I am a grad student in Public Health). I think the key concept here is harm reduction- the drugs carry risk, but that has to be balanced with the risks of withdrawal. I don’t think the pregnant women taking the drugs should be vilified- most seem to want the best thing for their baby and many feel guilty about taking medicines during pregnancy. Also, some women who are on high doses or have been on SSRIs for many years may not realistically be able to come completely off without having withdrawal issues (only working with 9 months to taper), so for some a more realistic goal may be reducing exposure (rather than eliminating it).

  • So, do you think SSRI discontinuation symptoms have no effect on the baby? Things like mom not being able to properly sleep or eat, having elevated blood pressure, etc? That can go on for months and these things ARE associated with significant risks for the baby too- actually it sounds like a good way to get a preterm/ growth restricted baby. I get it, the fetus is exposed to the drugs via the placenta and that obviously carries risk- I’m not disputing that. However, the real question, IMHO, is which risk is worse, and I haven’t seen data addressing that question.

  • I think engineer’s comment is actually meant for the_cat. I do at some point hope that we can discuss what a pregnant woman who is already on meds is supposed to do. That I think is the more relevant issue- and I think most here are ignoring that point. Yes, some people may start them during pregnancy, but my impression is that the bigger dilemma is whether to come off them (especially in cases of unplanned pregnancy), given the risks of withdrawal

  • My experience has been the opposite of yours. i’ve seen a good number parents on places on NAMIs Facebook page/TAC/ people like Susan Inman and my non internet life who fiercely resist the idea that family dynamics are related to mental illness and that meds are the answer. I think of it as a form of not taking personal responsibility for their own adverse life experiences, by not even allowing the line of questioning that they may be passing down the fallout and contributing to their child’s problems . I have been accused of furthering stigma against those with “mental illness” by a relative ( who is heavily involved in NAMI) for relaying information about kids in foster care being at high risk of being drugged without any actual diagnosis and discussing the connection between child abuse and mental health problems. Note, the context of this situation was discussion of an article about using of antipsychotics in very young children, (not older teens, the age when her son started having problems…really this context was pretty far removed from her personally, yet she seemed to interpret it as an attack on her). Agree this is not all parents and I need to watch my stereotyping, but unfortunately this group of parents does exist and we need to think about how to relay this message effectively given their existence, particularly since a lot of them are heavily involved in outreach/promotion of these ideas .

  • Well said, Alex. Great point that forgiveness is part of the picture too….I think it’s important that we try to find ways to frame things in a more positive way than simply blaming. Another concept that is important here is resilience/post traumatic growth. I believe the latter is especially important…if we have to go through the experience of trauma, can’t we find a silver lining to the situation and with our awareness of how terrible and crippling it can be, do something constructive so others do not have to endure the same experience? That has been personally helpful for me (and I think others here).

  • I think blame is a such a loaded word in this context (going back to the days of refrigerator moms, etc) and will be interpreted in less than constructive way. It is the first thing about of many of the NAMI mommies mouth if you dare to touch on the topic and pretty much the end of the conversation with them, so I think it will not be helpful in making change, at least initially. I do like the idea of framing it more along the lines of taking some personal responsibility for not passing on the effects of bad things that happened to you.

  • Of course, I agree that there is big problem with giving women of childbearing age (well really anyone, but them especially) ADs. However, I think the topic of discontinuation syndrome is especially important for pregnancy. Half of all pregnancies are unplanned, and as many of us have personally experienced, withdrawal can be hell that can go on for months/years and I’m betting that isn’t so great for a fetus either. So there will be women who find themselves pregnant unexpectedly and they may have serious problems with withdrawal, especially if they had been on the ADs for an extended period (and remember, many of them will already be dealing with other pregnancy symptoms). Is coming off the drugs necessarily a better choice? I wonder about this in particular since, as others have pointed, the association between maternal AD use and autism may not necessarily be causal (AD use could be merely a marker for women who were more likely to be on autistic spectrum themselves and there is a fair amount of evidence that autism is genetically inherited). If it were me facing this decision, I’d probably have an abortion, but not everyone would chose that. Just a thought

  • I definitely agree the we need to make the effects of child abuse/”bad” parenting a less taboo subject. That said, I think we need to recognize that many will interpret this as parent blaming and not necessarily use the information in helpful ways. Thus, I do think we should be a little more careful about how this topic is discussed when the data is less than convincing. As I said earlier, the link between “bad parenting” and mood disorders/anxiety/psychosis is pretty clear, but developmental disorders that start very early, not so clear.

    Perhaps we need to be clearer that abuse/ bad parenting is typically a multigenerational problem, that the abuser/bad parent was often subjected to abuse themselves. Maybe that is a way to lessen the preoccupation with shame/blame that always comes up with this topic.

  • The association between maternal history of child abuse and austism is not necessarily causal. Kids with developmental disorders are also at higher risk for being abused. If autism is genetically inherited and these mothers had were on the spectrum themselves, then there would be a spurious association between maternal exposure to abuse and autism. I think maternal abuse is a bigger contributor to offspring mood disorders, anxiety disorders, and psychosis. with developmental disorders, the more relevant environmental factors are likely things like being born preterm, low birth weight, etc.

  • It’s not news, but to be fair this was a meta analysis. The goal of that kind of paper is to come up with a pooled estimate of the association between abuse and depression from existing studies, not do something ground breaking. I see coverage of these articles as good, as I think the message really does need to be hammered home given resistance from others to accept the truth. That said, we really are at the point where we need to spend a lot of research efforts on prevention of abuse and strategies to stop intergenerational transmission.

  • completely agree. And it concerns me when I see that the Treatment Advocacy Center (talk about a misnomer) is so organized in this regard. Actually, that’s where I got information that the bill was moving forward and which congressmen were on the subcommittee, their phone numbers, etc. The TAC supporters were out in large numbers calling/leaving facebook messages for the congressmen involved and we need to match these efforts.

  • What I think would help is if people who have some authority on the subject of psychosocial origins of mental illness like Vincent Felitti spoke up. Unfortunately, the ACE study didn’t specifically look at so called SMI as an outcome (so people like DJ Jaffe will just say that is useless) There are plenty of other studies though that have found associations between SMI and ACEs, so I wish someone if that area would speak out.

  • Not an article, but I do know that his research institute is privately funded by the Stanley family. I looked in the NIH database for grants and he has not been funded by them as far back as the electronic database goes (early 90s). We can critique NIMH funding priorities, but I think the fact that he hasn’t been funded by the main government agency for mental health research at all for over 25 years does say something about his lack of representativeness of his field. Also, as the article says, his expertise is on infectious origins of schizophrenia. He’s not an expert of the preventative measures utilized by SAMSHA, so it’s odd he is being used as the main “expert” witness.

  • Hmmm…Tim Murphy has a PhD in clinical psychology. Surely has had exposure to people who have recovered from mental illness.

    I also think Tim Murphy should know that DJ Jaffe isn’t at all qualified to assess the research literature and should know better than weigh on him so heavily, or really, at all. As a PhD psychologist, he should know who to go to get an accurate assessment of the current research on the question of preventability of mental illness, so I’m not letting him off the hook as having noble intent.

  • Ironically, I just got out of a class and the topic was what kind of NIH grants get funded. The general consensus was that NIH tends to be most likely to award “innovative” grants. To me that is a big reason why you see them funding more of the biological based studies. Biomarkers, fancy expensive GWAS studies are seen as “innovative”, and therefore more fundable than boring old psychotherapy.

  • Great read.

    Just FYI, UCLA has recently undertaken a “Depression Grand Challenge”, which is estimated to cost 525 million dollars over ten years. The projected is headed by 2 geneticists and the centerpiece project is a genome wide study of 100000 people. Through this approach, they somehow think they will be able to eliminate depression by 2099. Laughable

    http://newsroom.ucla.edu/releases/combating-depression-is-uclas-second-grand-challenge

  • Hi anonime,

    I definitely agree with your point about dsm validity being questionable considering that it is a form of self report. Keep in mind though, the dsm assessment is different vast majority of measures for childhood trauma, where, in the research setting at least, there is no sort of clinical interpretation involved at all. We just have people fill out the questionnaire, and add up the scores. I think the perception is that having someone else supposedly more objective involved makes it more “valid”. Which, when you think about it doesn’t really make sense, and if anything, we do know that people are far more likely to underreport rather than falsely report trauma. Any self reported questionnaire gets this criticism, although for some exposures like smoking, there are laboratory measures that can validate the exposure. Some people consider court validated abuse/CPS reports the true abuse gold standard because someone else is involved, but considering how little maltreatment is reported, this is rather ridiculous (you would have to use self report anyway to assess non reported abuse). My long winded point is that when an exposure measure is imperfect/bias prone, it is particularly important to have replication studies with a variety of populations.

    The other holes in the literature I was referring to largely deal with specific populations/outcomes. For the population I work with, there are reasons to believe they could actually be more vulnerable to the effects of abuse, but there is little previous work in this area. Which is important to know, from a public health pt of view

  • I agree this is a great article. Just wanted to chime in, as someone currently doing a thesis pertaining to adulthood effects of childhood trauma, I can understand why Felitti/Anda and others aren’t speaking critically of psychiatry. For many outcomes, researchers are still at a point where they still may need to rely on psychiatry for their research efforts (e.g., get a heavily “exposed” trauma sample from a psychiatric clinic). You could critique this as not being a terribly generalizable sample, but sometimes it is what works out to being most feasible. My own dissertation is an example of this. Some of my data in fact come from the patients of psychiatrist who has gotten involved in a pharma funding scandal. Hence, you won’t see me using my real name here on MIA, and although I am currently recovering from an adulthood trauma and subsequent bad experience in psychiatry, it doesn’t help my cause of advancing ACE research to be openly critical.

    Although the ACE body of literature is getting rather big, keep in mind that not only are there some areas where holes exist, it is an exposure that is easy to be critical of because most ACE exposure are derived from retrospective self report. Hence , you will always have people reluctant to accept it because of things like recall bias, so there really does need to be a lot of ammunition. Though, I will say 17 years after the original Felitti article, public health is past the point where it needs to start really pushing ACE based interventions. I see some people doing this (e.g., Nadine Harris and others testing out the feasibility of using the ACE questionnaire to screen parents about their own histories in a pediatric clinic setting). In general, I think we need to reach a point where childhood maltreatment becomes a more open conversation, though this is going to take a lot of work. That is something I aim to do once I finish my own dissertation (and heal from my own traumas, though engagement in this field of work is something I find therapeutic).

  • @alex I agree that unusual experiences, generally speaking, may be linked with psychosis in and that in and of themselves, they aren’t necessarily a problem. But what about experiences like abuse and bullying? For these types of things, I don’t feel we should just sit back and say life’s not perfect (and not try to do anything to prevent them). If you link these exposures to a “problem”, that is how to justify these exposures being worthy of action. We shouldn’t need the studies to show things like abuse and bullying are bad, but good luck getting support without them.

  • @ rebel, I am wondering what you find so ridiculous and implausible about this study. It suggests that early life social experiences are linked to psychosis. True, young age for one’s grade is just a proxy for these experiences and more research is needed to tease out what is the real underlying factor, but I think this article is a good start for looking at factors such as bullying (which sound pretty plausible linked to mental health issues down the road such as psychosis to me). And FYI, yes there are some pharma paid researchers who use their research to propagate bad science, but that is far from universal. A lot of researchers are trying to use their work to help advance programs that aim to have kids grow up in better environments and are not linked to psychiatric interventions.

  • They probably do have data where they could look at differences between brains of teens who have bipolar (but have not taken drugs) versus a comparison group . I’m sure someone has done studies that include a battery of testing, including brain imaging, at the time of diagnosis ( should look through NIH Reporter and PubMed for this). Actually, I would expect this more for schizophrenia, with all the emphasis on first episode and prevention programs. Of course, it would be easy to just say that these brain changes take time to develop, but this study design could be useful for teasing out effects of drug versus disease.