This is an actual letter I mailed recently to help raise money for my veteran patient . Identifying information including the dog’s name, has been changed.

 

September 1, 2017

To Whom It May Concern:

VA’s Failure

Skip was referred to me by Sally H, Visiting Nurse for Veterans, Camp X, the South. He flew here to the Washington, DC area because he was informed by Colonel Sharon Z. founder of HELPFOR VETSUSA that I could help him.

Two deployments to Iraq, the deaths of a dozen comrades by enemy fire and by suicide, two suicide attempts himself, as well as musculoskeletal damage due to an enemy IED. You would think that would all be enough for him to deal with: psychological trauma, moral injury, the gut of war. No! His principle dilemma now is iatrogenic. Skip lost count after 40 different drugs had been prescribed for him over the last 7 years. When he arrived at my office on August 17, 2017, he was on high doses of nine different drugs all of which have had profound adverse reaction impact. Before arriving at the VA for medical care in 2010, his vision was perfect, now impaired. Before arriving at the VA he had normal GI functioning, now impaired. Before arriving at the VA, he had normal sexual functioning, now impaired. Before arriving at the VA, although in psychological turmoil, he had excellent cognitive function and could emotionally feel authentically, now, “I fake feeling. I know I’m supposed to feel but I can’t.” And he nods off in the middle of substantive discussion.

Skip flew 1500 miles from the MidWest because he could find no doctor with the will or the knowhow within the VA system to wean him. Be clear. Although I am an “expert,” I made it clear to Skip the complexity of dozens of psychotropic drugs interacting is BEYOND KNOWABLE. Without any guarantees, Skip and I have entered into a struggle, requiring daily monitoring and extraordinary help from his fellow vets, a different vet showing up each day to bring him along with Charlie, his companion dog, to my office since it would be dangerously foolhardy for him to drive himself.

What’s the big deal? Just stop the drugs! Well, stopping these drugs cold turkey would be inviting mortal danger. The body and all its systems, neurological, gastrointestinal, cardiovascular, adapt to the onslaught of these potent substances with a myriad of potential adverse reactions. Abrupt withdrawal would be like blowing up a dam, psychologically flooding – overwhelming the organism. It must be done slowly. Unfortunately, it is also painful. It takes courage, “I’m willing to put up with the pain if I can just be normal again.”

Why all the drugs? Thousands upon thousands of veterans are going through this. I believe the difficult answer to this question is that the VA has been infiltrated with self-defeating, and what I consider odious ideas about what it means to have suffered the damage of war battle. Pathologizing these returning warriors rather than accepting, hearing, understanding, and supporting their terror-filled experiences drives them further into misery, e.g., as soon as the idea of “suicide” is mentioned almost invariably the VA physician reaches for the prescription pad. And as the veteran experiences the first adverse reaction, the second drug is added, then the third, the fourth, etc. In time there is utter confusion about what is “real” and what is drug-induced. The chance then of finding a remedy becomes less and less.

So I will work with Skip this next year, seeing him frequently, daily when necessary, doing the necessary testing (e.g., he is probably Mg depleted as his GERD caused by one of his many drugs is being treated with yet another drug, a proton pump inhibitor (PPI), which potentially depletes this essential element. Note, he has been on this drug for more than six years while the recommended length of time to use PPIs is about three months!) and, most importantly working psychotherapeutically, existentially, spiritually as he comes to grips with war trauma. Ultimately, his goal is to help other vets. I believe he’ll do it.

Finally, Nurse Sally is paying for his treatment out of her own pocket. I am giving her some discount. This is a travesty! The government agency that has so poorly treated this veteran does not now take the responsibility of paying for the treatment that he had to seek out on his own. As an American, I feel shame and I am disheartened.

Sincerely,

Joseph Tarantolo, MD

Board Certified Psychiatrist

by Chuck Ruby, Ph.D.

A recent study in Neuropsychologica about veterans and brain trauma is a prime example of how medical model thinking and nomothetic research design and analysis wrongly imply: (1) that meaningful human experiences can be best understood by looking at the brain; and (2) that differences between research groups as identified by statistical tests, mean that the class of people in one group share a common characteristic different from the class of people in the other group(s). Unfortunately for the authors of the study, this is not true.

First, the follow quotes from the study reveal how meaningful human experiences are falsely reduced to brain structures:

“…religious beliefs are critically represented in the anterior frontal lobe.”
“…fundamentalist religious beliefs arise from the integrated processing and computations in a distributed brain network….”
“…a vmPFC lesion induces increased fundamentalism.”
“…religious beliefs are partially dependent on correct functioning of the PFC.”

None of these statements are accurate. We’ll never find religious beliefs inside the skull and brain activity does not give rise to religious belief, even though religious belief cannot happen without brain activity. Religious belief, in addition to a plethora of other kinds of meaningful human experiences, can only be understood by understanding the individual person, and even that changes over time. Further, given that they are individuals, people are inescapably nuanced, complex, and unique in terms of the factors that interact and lead up to any one particular characteristic, such as religiosity.

It is true that damage to an area of the brain necessary for a person to have a certain opinion, belief, conviction, or feeling can change the person’s experience of those things. However, especially in the case of highly meaningful things, like religiosity, such changes occur more often not because of damage to those areas but because of experiential changes in living. This study never takes this into account: that veterans who have suffered TBI had more severe and meaningful experiences (both during the trauma and post-trauma) than those who hadn’t suffered TBI. How did those experiences, and not brain damage, affect their turn toward religious fundamentalism?

Regarding the second issue, there was a statistically significant difference in fundamentalism scores between the group of veterans who suffered damage to the ventromedial prefrontal cortex and the group with damage to the prefrontal cortex but outside the ventromedial and dorsolateral regions. Yet, the Cohen’s D was only .71. This means the two group distributions of fundamentalism scores overlapped around 73%.

Given this amount of overlap of groups, it does not justify the researchers’ claim that, “…participants with vmPFC lesions reported greater fundamentalism.” or “[p]atients with vmPFC lesions scored higher in fundamentalism than patients without PFC lesions….” Neither of these claims represents the data. In fact, a large number of people in the ventromedial group had lower fundamentalism scores than the other group, and vice versa, contrary to the claim. If damage to that region increases religious fundamentalism, it should apply to all of them.

Moreover, the amount of variance in the data explained by the ventromedial lesions was only 1%. That means 99% of the observed variance in fundamentalism data among the participants was due to something other than the lesions. In fact, this study found that openness (9.7%) and cognitive flexibility (4.6%) explained far more variance in the data than did the lesions. This suggests a person’s subjective understandings of the world, separate from brain injury, are more important in understanding religiosity. And note that even with all of the studied variables included, only about 18% of the variance was explained; 82% was unexplained. This is the important statistic. Much of what people do can't be explained by using medical model, nomothetic approaches. It is important to understand one person at a time.

Despite the above, the “moral of the story” according to the authors is how damage to brain structures affects one’s religious fundamental beliefs. This perpetuates a medical model of humanity that reduces meaningful experiences to sterile brain activity, and it stereotypes people without even a minimal amount of justifying evidence.

"I Want To Die"

If you are a psychotherapist, counselor, psychoanalyst, and especially if you are a psychiatrist, you have heard variations of this refrain many times, which has soullessly come to be called "suicidal ideation". “I don’t want to live anymore… I want to kill myself… I wish it were all over…," etc. What to do with these laments?

Before I address the question, a personal note. I am 74 years old and I’ve been depressed many times. I have never had ETC or pharmacological intervention. I worked on the “depressions” the old-fashioned way. Reflection. Talk. Analysis. Struggle. My bias is that I don’t trust colleagues who claim they have never been depressed. Really? Never depressed? I don’t prescribe ECT either. I’ve witnessed only one ECT administered and that was during my training. OK, I got that off my chest.

Back to suicide talk. In Tom Szasz’s last book, Suicide Prohibition: The Shame of Medicine, (see my book review in Ethical Human Psychology and Psychiatry, Vol. 14, #1, 2012, pg. 74) he makes a powerful case that by locking up patients who speak about self harm we not only infringe on their civil liberties, but also drive that speech underground.

Think of it, if someone tells me they are suicidal I am duty bound to call the cops! An exaggeration, but not much of one. Hospitals and doctors are frequently sued by surviving families. “You should have been more attentive, careful, protective. Had you not been derelict my son/daughter/wife, etc., would still be alive.” So hospitals and clinics and counselors always have on their checklist a rating for self-harm. That checklist surely is for legal purposes. Or perhaps it is there for reassurance for the institution.

You would not be surprised, I suspect, that some in conventional psychiatry would promote, then, their various somatic treatments as suicide preventative. Allow me if you will to focus only on ECT. This blog is not going to be a diatribe against ECT. If you are hankering for an “I-hate-ECT" thesis, read Linda Andre’s Doctors of Deception: What They Don’t Want You To Know About Shock Treatment (2009, Rutgers University Press). She claims that ECT “impaired my intellect” (pg. 131) and did irreparable harm to retrieving her early life memories. She rakes the ECT profession over the coals.

If you are in a particularly angry mood you’ll like Andre’s book. She bashes Peter Breggin as well calling him a “costly disaster “(pg. 118). Evidently the Marilyn Rice case way back in 1977, the first case to adjudicate a malpractice suit against an ECT Doc for memory loss, did not go well for the plaintiff. Breggin was Rice’s expert witness. I’ve never discussed the case with Peter. I assume it is no easy task to prove that ECT treatment in one particular case is the cause of the memory loss. Do your own research. I’ll comment later.

Oh, but you may feel kindly about ECT. Then by all means read Edward Shorter’s and David Healy’s Shock Therapy, A History of Electro Convulsive Treatment in Mental Illness (2007, also Rutgers University Press) which they dedicate to a “small band of European emigres [who]… saw the merits in ECT… [they are] heroes in [the] 20^th century of psychiatry…” (dedication page)

Shorter is a prominent medical historian and Healy was a presenter at the 2015 ISEPP Conference. Healy is the beloved psychopharmacologist of our organization because of his litigative efforts that helped lead to the black box warning for SSRIs. In his book Let Them Eat Prozac (2004, New York University Press) he takes on the fraudulence in the psychopharmaceutical industry that hid the danger of SSRI therapy. In his book he also shares some of the best work I know of in testing the impact of these drugs on “normals.” On the other hand he is anti-beloved by many in our organization because of his high regard for ECT. Nobody’s perfect. 

In Shock Therapy, Shorter and Healy toss a lot of statistics at us (see page 97) supporting their thesis that ECT prevents suicide. Maybe. “[There is]…no doubt that ECT was effective in the prevention of suicide. This was confirmed in 2005 in a large multi-center study led by Charles Kellner at University of Medicine and Dentistry of New Jersey.” The second of 16 authors this study was Max Fink, the father of American ECT. The authors hold out this study as particularly worthy to their cause. The conclusion of this very ambitious study is that it was “irresponsible" not to prescribe ECT sooner clinically, not as a “last resort” after the failure of chemical treatments. I had to read this study. After all, I don’t want to be “irresponsible.” But first, some statistics.

If you go to the American Foundation for Suicide Prevention website you are quickly smacked with the statistic: “An American dies every 12.3 minutes by suicide.” That is 42,773 in 2016. Wow, a lot of suicide. And, oh, BTW, 90% of them had diagnosable disorders. Thank God for the DSM to clarify difficult issues!

Hold on. Let’s put aside the hysteria. Just how many people did die in 2016? According to the National Center for Health Statistics that would be 2,626,418. That is, one American died every 12 seconds in 2016. I did the math. What did they die of? The usual suspects:

-Heart Disease: 614,348

-Cancer: 591,699

-Stroke: 133,103

-Alzheimer’s 93,541

-Diabetes: 76,488

-Flu and Pneumonia: 55, 227

-Nephritis: 48,116

-Suicide: 42,777

In other words, only 1.5% of those who died in 2016 were those who chose to die sooner rather than later. When talking about death in America, suicide is not common. Yes, of course it is often tragic, like a kid suffering bullying who can’t stand it any more. Tragic does not mean common.

Back to Kellner and Fink’s large multi-center (there were 5 hospital centers throughout the country) work. They “studied “ 444 depressed ECT patients, 131 of whom reported suicidalness according to the Hamilton Depression Scale. Results: after one ECT treatment, 15% dropped their Hamiltonian suicidalness to 0; after 3 ECT treatments 38% dropped their Hamiltonian suicidalness; 61% after 6, and 76.3% after 9 ECT sessions. And 87.3% dropped their Hamiltonian suicidalness after completing the treatment course. Wow, pretty impressive. No? Well I’m not convinced either. Remember the statistic – suicide is really not that common. Thinking about ending an unhappy life is very common. So let’s go to the fine print.

There were 2 patients in the study who died of suicide, 2 white men aged 76 and 80. One had expressed “no suicidal intent” before or after the treatment and the other scored a “1” before and a ‘0’ after the treatment. Thus this study only corroborates that ECT has a dramatic impact on stopping thinking about suicide. It tells us nothing about the actual action.

And this is why I don’t prescribe ECT. It interferes with thinking and remembering. For me it is more a philosophical stance than a medical-statistical position. I value thinking and remembering. Thinking about suicide is so common, so important, but actual suicide is so rare, it is my impression that suicidal thinking and dialogue in therapy is much more about life than it is about death. What I mean is that many unhappy people just don’t have the language to examine their unhappiness. The best they can do is, “I want to die, end it.” The therapeutic relationship helps give voice and create expressive language. Scrutinizing why someone is suicidal is important, ok. But really, we know why people want to die: despair, rage, hopelessness, pain, profound shame, abject loss. That needs to be validated of course. But as important, perhaps more important is what keeps us alive. So for me it is more important to ask, “What stops you? Why haven’t you done it?” And then I begin to hear about their life. That’s where the therapeutic action is.

I’ve had one completed suicide in my practice, that is, one who killed himself while in therapy. He never once talked of ending his life. Not once. I wish he had. If he had, he might still be alive today.

ISEPP's Joanne Cacciatore is helping to pave the way for a new model of care for those traumatized by loss. See her recent review of the literature on carefarming and traumatic grief. 

In a dramatically different approach to traumatic grief than traditional Western treatment (which often focus on diagnosing and medicating people who are deeply grieving) the carefarm approach is simple, safe and focuses on three restorative areas of support:

1. Carefarming which will include offerings such as gardening and therapeutic horticulture, animal therapy, rescue animal caregiving, green recreation, landscape maintenance, and ecotherapy;
2. Contemplative practices which include meditation/centering prayer, mindfulness based support groups, bibliotherapy, grounding, and ritual;
3. Physical well-being which includes yoga and other exercise, massage, physical activity, acupuncture, and psychoeducation around sleep hygiene, healthy eating, stress resilience, and traumatic grief counseling.
4. Carefarming, as a whole and in its individual components, has been shown to help many vulnerable population groups. Many countries in Europe utilize care farming as a humanistic approach to human suffering in vulnerable groups with powerful psychological and social outcomes that reduce harm and help people improve their coping abilities. And, carefarming costs a fraction of treatment as usual. The average day at a carefarm costs between $60-$150. The cost of treatment as usual in an inpatient setting is about $1000- $1100 a day. 

No One Cares About Crazy People.

Actually, that’s not true. Ron Powers, the author of the book with the above title very much cares about “crazy people”. It took him 10 years to write this book, a highly personal, well thought out, historically accurate and depressing book about madness in America. No, not madness in America, better to say the madness about madness in America. So why 10 years? Well, he had 2 sons, only 1 now. His younger son Kevin, who was diagnosed schizophrenic, suicided by hanging 10 years ago. The father has been stewing and grieving and questioning ever since, struggling to understand what happened. What happened not only to Kevin, but what will happen to his older brother, Dean, also diagnosed with schizophrenia, and what has happened to us, the mental health field. The subtitle is telling: The Chaos and Heartbreak of Mental Health in America. I am a psychiatrist so therefore I am part of that heartbroken mental health structure. Oh dear!

Powers does a particularly good job describing the tragedy of de-institutionalization, “a name that carried the lilting harmony of silverware spilling from a clean-up tray” (page 187). Nice metaphor. Indeed, liberals and conservatives were able to come together for once and completely make a botch of it. Liberals loved the idea of getting rid of inhumane state hospitals and conservatives loved the idea of getting rid of expensive state hospitals. Both could then pretend that community clinics would give out the new wonder drugs, some counseling, and madness would be contained. What happened instead was the mad were transferred to jails and out onto the streets. Powers is cognizant of Robert Whitaker’s work (Anatomy of an Epidemic) so he has some familiarity with the serious limitations of drugging madness. He is too impressed, I think, with genetic and neurological research, which he uses to try to deepen his understanding of his kids. I get it. A decent man, a devoted, loving father, how could this happen to my 2 brilliant, artistically talented sons?

“What is schizophrenia?” he asks (page 21). “So little is known abut schizophrenia that neuropsychiatrists and researchers hesitate to offer a definitive theory of causation.” So perhaps you now see the problem. He is thinking “brain” rather than “person". Madness or schizophrenia or whatever label you wish to use, is a person problem, the problem of the person not getting along. Wow, after 40 years of practice, Dr. Joe, is that the best you can come up with? Schizophrenia is not getting along? My mentors would be so disappointed in me.

Harry Stack Sullivan warned his colleagues, his patients, and his students, to beware of the seduction of the sense of individual uniqueness. No crazy person, no sane or normal person, no one has an absolutely unique psychological interpersonal problem. That is why AA, support groups, NAMI, Hearing Voices International, and group therapy, are such effective healing agents. “I am not the ‘Lone Ranger.’ Others are like me. Others like me seem to do OK. I am not alone.” But, there is no cure for being human. And to be human means to be up against never wholly fitting in. In fact, fitting in is an illusion.

We label the young men/women who seem to be seeing the world in some peculiar way, hearing and seeing stuff others can’t see or hear, believing their own set of “alternate facts.” They act out the not-fitting-in whereas the normals (an interesting name for a rock band – THE NORMALS) ‘go along to get along.’ We normals – I have never been labeled schizophrenic , I have been called a bunch of other names on some occasions – suffer more quietly, discretely, keeping it to ourselves: “Thank you so much for the invitation. I will not be able to attend your gathering because of a previous engagement.”

If you haven’t read Freud’s Civilization and Its Discontents, I recommend it. The “death instinct” he postulates is not, I believe, to be taken literally. He is talking about the yearning to rid ourselves of anxiety. Being dead is really the only way to be anxiety free. To be a person, a unique creature, with common struggles must contend with anxiety, that felt experience anticipating disapprobation, rejection, and abandonment. And we do deal with it, sometimes constructively, sometimes foolishly, sometimes with deadening drugs, and sometimes with suicide.

God be with you!

If you are not sick and tired of the question, “Is MADNESS a neurological disease of the brain or is it a mythological disease of the mind?” you should be! I defy you to have a thought without your body or to work your body without a brain. There is no mind/body split. And the countless scholarly papers regaling us with the proofs of how schizophrenia is a disease of the brain and not the mind or that schizophrenia is a disorder of the mind and not the body (remember, the brain is part of the body), well, to my mind they are all for naught.

Some historical perspective: There is a 1924 paper in the American Journal of Psychiatry, authored by the then prominent pathologist, Charles B. Dunlap, M.D., entitled, “Dementia Praecox. Some Preliminary Observations from Carefully Selected Cases, and a Consideration of Certain Sources of Error”. I reviewed this paper because one of my favorite mentors, Harry Stack Sullivan, who died in 1949 when I was 6 years old, referred to it when making the case that schizophrenia is NOT a brain disease.

Read the very first sentence of the paper: “Too many changes have been described in [autopsy] brains of dementia praecox even to be enumerated in this paper” (p. 403). He continues on page 404: “We have considered control brain [autopsy] material, collected from so-called normal persons [italics mine] without psychoses to be absolutely necessary…. No one knows the limitations of what is normal in the brain anyway…. Nissl [a prominent pathologist] who all his life was searching for a normal brain, died without finding one…”!!

Suffice it to say that Dr. Dunlap was not able to find any consistent gross or microscopic (cell counts & cellular pathology - pain staking work) abnormalities in these schizophrenic brains to warrant "an organic [my italics] basis for dementia praecox.” Thus, H.S. Sullivan was satisfied he was not dealing with neurological issues in his schizophrenic patients.

What interested me even more, though, was what was said in the discussion of the paper by other prominent physicians including Dr. William Alanson White, a pioneer of 20th century psychiatry and the director of St. Elizabeth’s Hospital (where I currently supervise residents). By the way, White was also a mentor to H.S. Sullivan.

Anyway, White points out that there was so much wrong with these patients whose brains Dunlap studied, that “… a pathological explanation of the mental disease [need not] be found in the [cerebral] cortex.” There were “defects of organs, thyroid, gonads, and adrenals and the circulatory system…that we would not expect the individual to be able to function efficiently, at least under stress.” Don’t you love that phrase “function efficiently”? In other words Dr White is beginning to suggest what I am more emphatically proclaiming, that schizophrenia, madness, is a “disease” of the PERSON, not the brain and not the mind.

Fast forward 78 years and E. Fuller Torrey in his “Studies of Individuals with Schizophrenia Never Treated with Antipsychotic Medication: A Review”, in Schizophrenia Research, Vol 58, pp. 101-115. Torrey wants to take on Breggin’s and Whitaker’s and others’ arguments that the brain pathology in people diagnosed with schizophrenia is all iatrogenic. He concludes: “…schizophrenia is a brain disease in the same sense that Parkinson’s disease and multiple sclerosis are….”

But wait, two other observations in his paper: “…psychiatrically normal individuals also [may] have structural changes in their brains” (p. 102) and on page 111, “It should be emphasized, however, that there is no single abnormality in brain structure or function that is pathognomonic for schizophrenia.” Torrey is an honorable man, I think. But he too is stuck in an either/or world of mind or body. None of the papers he reviews take up the challenge of examining the whole person, physiologically, psychologically, spiritually, and sociologically.

I say let’s be forgiving though, for indeed that is no simple task. We human creatures are so complex as are our ape relatives and other mammalian creatures. It is the role of the psychiatrist, ideally, to take on this task with each individual he treats. Few of us do that, I fear. The system is just not cut out that way yet. If we are to “save psychiatry” there has to be a change in medicine as a whole not just psychiatry. You might want to read Jim Gordon’s A Manifesto For A New Medicine. He takes on this dilemma. More to come.

by Chuck Ruby, Ph.D.

The results of a study, published in JAMA Pediatrics, claims that ADHD causes an increased risk of automobile crashes. I'll explain why this is a trivial conclusion. What's more, it is absurd that the authors suggest more research into “the specific mechanisms by which ADHD influences crash risk to develop effective countermeasures.” ADHD is not a disorder that causes anything. ADHD is a label that describes a constellation of behaviors. To say it is a disorder that causes an increased risk of crashes is like saying walking is a disorder that causes an increased risk of moving.

If we look at the definition of ADHD contained in the DSM, we find that it consists of an arbitrary checklist of items about not paying attention and not inhibiting impulses. It has nothing to do with brain dysfunction. There are no laboratory tests to detect it. It has nothing to do with pathology in the person. It describes people who do not pay attention, not people who can’t. It is written in the language of medicine and to the untrained eye, it seems to be talking about a brain disorder, when in fact there is nothing mentioned about the supposed disorder and no medical evidence ever presented that demonstrates its pathological basis, and thus why there is no lab test for it.

And yet the announcement of this study will worry parents of children who have been labeled with this mythical disorder. They will fear when their children start to drive and wonder if driving privileges should be contingent on their children being in psychiatric “treatment” consisting of daily stimulant drug doses. The already bloated departments of motor vehicles across the country might even see this and similar studies as reason to implement new rules and programs about monitoring or denying driver’s licenses to people “with ADHD”.

But if we brush away all the medical-sounding and misleading language, we are left with a trivial study. In short, its results are saying that people who don’t pay attention while driving are at increased risk of having accidents. Aren’t we already able to make that assumption? When we don’t pay attention, we don’t notice things. It doesn’t take a scientific study to tell us this. And it doesn't need the creation of a disorder.

In addition, there are basic statistical issues with this study that further trivialize it. When comparing the driving records of people “with ADHD” and people who have not been given that diagnosis, the study concluded, “…the crash hazard among newly licensed drivers with ADHD was 36% higher.” In the first place, this is inaccurate. The wording makes it sound that people “with ADHD” are more dangerous on the road than people without that diagnosis. But the statistics used in studies like this one are based on group averages, not individuals. In this study, the average number of accidents for the group of ADHD people was claimed to be 36% higher than the average number of accidents in the non-ADHD group. Graphically, this would look something like the following display of two normally distributed (bell curved) groups. The horizontal axis represents the number of accidents and the height of the curve is the number of people with that number of accidents. The dark group would be the people without a diagnosis of ADHD and the lighter color group would be those “with ADHD”.

One can easily see with this graphical representation that even though the average (indicated by the vertical line) number of accidents of the ADHD group is higher than the non-ADHD group, many people in the ADHD group have less accidents than many people in the non-ADHD group. The reverse is also true: many people in the non-ADHD group have more accidents than people in the ADHD group. The reason the researchers say there is a 36% increased crash hazard among ADHD drivers is only because the average number of crashes is higher than the average number of crashes for the non-ADHD group. Still there a many ADHD people with less accidents than people with no diagnosis.

This is because the 36% increased risk of accidents is minimal. As an example, ADHD males in this study had a 13% risk of having an accident within 6 months after getting their driver's license. On the other hand, non-ADHD males only had a 9% risk. Even though this is only a 4% absolute difference in risk, the relative difference is a 44% increased risk when compared to non-ADHD males. Using the relative difference in risk makes it sound more important than it really is.

As an aside, it is interesting to note that the researchers had the diligence to test whether stimulants prescribed to the ADHD people had any effect on accident risk. One might think that taking a daily dose of Ritalin, which is chemically similar to cocaine, could negatively affect driving skill. But, the researchers found that it didn’t. But this begs the question, then, of what value are the stimulants? If those ADHD people who were prescribed stimulants had the same accident risk as those who hadn’t been prescribed stimulants, but who were still diagnosed with ADHD, that suggests the conventional stimulant drug treatment is useless in increasing attention and, in this study, in reducing accident risk. This is not good news for the advocates of drug treatment.

In short, this study is trivial because it is saying that people who don't pay attention while driving are at a higher risk of having accidents. This is a "duh!" conclusion. Nonetheless, the authors mislead away from this simple fact of life and give the impression that a disorder called ADHD causes those accidents. Recommending further study to identify the "specific mechanisms by which ADHD influences crash risk" is absurd. It is absurd because there are no mechanisms of ADHD. It is tantamount to saying we want to find the specific mechanisms of inattention. What would those be? Inattention is inattention and it can be problematic. But even worse, the authors talk about developing "countermeasures" to this inattention. Those so-called countermeasures are very likely going to be just further authoritarian and inhumane attempts at control, not because they would be focused on reducing accidents, but because they would be focused on "treating" a mythical disorder.

Let me introduce myself and my blog.

I am a physician, first and foremost. Ironic though, when I first decided to become a doctor, at age 19, it was “psychiatrist” that I told myself was the goal, not simply physician. And throughout my training I oscillated between medicine and psychiatry. Intrigued by psychosomatic medicine yet hounded by my mentors, “Joe, you have to decide! Medicine or psychiatry.” Little did I realize at the time that this quandary, physical OR psychological, would become the hallmark of psychiatry’s split-personality: mental illness, a disease of the brain; no, mental illness a mental/social problem-of-living construct. And the debate has been belabored for millennia. Throughout this blog I will favor the concept that ALL ILLNESS IS PSYCHOSOMATIC/SOMATOPSYCHIC. There is no mind-body split.
In future blogs I will address what motivates one to become a physician but here just a few ethical reminders associated with the Hippocratic Oath:

(1) Primum Non Nocere (First Not To Harm)

(2) Keep confidential what the patient tells you, and

(3) Never promise more than you can deliver

I made #3 up but it is implied in the oath to honesty. Alright, it was not exactly how Hippocrates said it. In fact, the first do-no-harmer was a Frenchman, Auguste Francois Chomel (1788-1858) in his oral teaching to students. Then as now, I think, the debate centered on natural healing vs. radical intervention.

So, I want to SAVE psychiatry. Really? Psychiatry seems to be thriving without my help. Well over 10,000 psychiatrists attend their yearly conference, the American Psychiatric Association. No, I say “save” because I belong to ISEPP, I have contributed to Mad in America, I support Mind Freedom, and other similar organizations. In all of these and others there are folk who would like to disband psychiatry all together.

“No,” I say, if we rid ourselves of Psychiatry: WHO WILL MIND THE MAD HOUSE? WHO WILL MIND THE PHYSICIANS?

I liken this Anti-Psychiatry movement ushered in by the likes of Tom Szasz and Ronald D. Laing to the Anti-War movement of the 60’sand 70’s. But first I must clarify, Szasz would be livid to be placed in the same category as R D Laing. He saw Laing as an irresponsible “trickster” and miscreant. In fact he wrote a book about it:”Antipsychiatry: Quakery Squared” published in 2009. Szasz makes the case that Laing and others abandoned liberty, responsible science, and ethical social commentary. “Anti psychiatry” was merely a catch phrase for Laing and his followers, Szasz believed, in an attempt to appear like authentic critics of the status quo.

But back to the Vietnam war: We who were against the war were told to “Love It (i.e., the USA) or Leave It!” Most of us knew we were patriots but patriotic to the ideas of liberty, justice, and international peace. We knew the war was a horrible mistake, immoral, foolish, and ultimately self defeating. We opposed the war policy, not our country. We paid a heavy cost for that military adventure: 56,000 Americans dead, over a million Vietnamese dead. Laos suffered the worst per capita dead ever in the history of war! As you probably know given the front page publicity, the suicide rate of veterans is 2-4 times the civilian rate. More soldiers have been dying from suicide than in combat. And most of these suicides are Vietnam vets. Yes, 40 years after the fact of that foolish war, the moral, spiritual and psychological ill effects still haunt us. Some commentators believe, and I agree, that the moral injury of our current 14-year (and counting) middle east war(s) will be worse.

In my next blog rendition I will be asking the question “Are you really anti psychiatry?”—IF THIS IS AN EMERGENCY GO TO YOUR LOCAL EMERGENCY WARD. Hmmm.

by Chuck Ruby, Ph.D.

A recent article in Health News From NPR asks the question: "Is 'Internet Addiction' Real?" Other than the possible minimizing effects of using quotes around the term, this article does nothing but reify a concept in a very misleading and potentially dangerous way. It adds to a long line of others that perpetuate the myth of mental illness, and in particular the recent technological phenomenon of social media over the Internet.

This article is an example of how mental health professionals are notorious for over-complicating human behavior. Instead of focusing on real life problems teens face in an increasingly compliance oriented and superficial world, they obsesses about what is the correct “disorder”. Then the “disorder” is the focus of investigation instead; meaning that something is wrong with the teen. To quote the DSM, it is “…a dysfunction in the individual.” It is the dysfunction “in” that causes the behavior. And this leads to meaningless questions as posed in the article, like “when does an obsession become an addiction?” Would it be better to think of these professionals having a “diagnosis addiction”?

In actuality, there is no dysfunction “in the individual”. There is a challenge over how, when, why, and to what extent technology is used and what things are considered popular and of value to teens. Internet and other IT technology is going to stay with us and probably get even more complex. My great grandmother once told me how terrible the invention of the telephone was. Up until then people would write letters to each other. After the telephone, she feared they wouldn't write to each other anymore. Instead, they would become impersonal and spend too much time on the telephone. Her fears panned out. But was that an addiction at work?

Much of the description of Naomi’s behavior in this article is attributed to her “addiction” to the internet. But it actually just describes typical teen turmoil in their attempts to navigate that line between separation and belonging. But once a scapegoat like “addiction” is identified all sorts of problems can be attributed to it. The article actually points this out when it notes she also had to deal with how to become popular among her peers, how to cope with her parents’ discord, how to handle less then perfect academic performance, and how to cope with the death of her grandmother. These are all quite typical challenges of adolescence.

The overall flavor of this article reminds me of the alarmist quality of “Reefer Madness”, a 1930’s film that demonized marijuana, and implied that it led to all sorts of antisocial and dangerous behaviors. The psychologist at her $10,000 a week “treatment” facility said, “these teens are using smartphones and tablets…for the same reasons others turn to hard drugs - to numb what is really going on inside.” Really? Is that what doctors in the 1800’s would have said about my great grandmother’s prediction about telephone use?

The problems facing teens are significant and they can be very serious. But it is not because they “have” an “addiction” to anything. It is because they are faced with the most difficult set of social circumstances any teenagers throughout history have had to face before now. They struggle with the means of instantaneous gratification, the ever-increasing demand of consumerism, the age-old longing to belong, and how to meet parental expectations.

The term “addiction” is merely short hand for “a strong urge to do something because that something is enjoyable in the short term, but causes problems in the long term.” There is no need to reify it as if it is an entity that invades people and causes them to do things. In fact, it could easily be argued that talking about it and treating it as if it were some alien entity calling the shots is harmful and perpetuates the problem.

by Elizabeth Szlek, LMHC, CGP

On April 9, 2017, an article appeared on the website, “The New American”. The writer, Joe Wolverton II, J.D., tells the story of a seven-year-old boy who was taken away from his family by Child Protective Services because his school decided he was “mentally unstable”. The parents of Cameron Maple, of Lebanon, Ohio, were instructed to take him to a hospital so that his disorder could be diagnosed. When the parents demurred, the state stepped in and placed the child in protective custody, citing “health neglect” against the parents, since they would not comply with the psychological evaluation recommended by the school administration.

This situation is wrong on many levels. There is no such thing as “ADHD” as a literal neurobiological disease that can be diagnosed and treated. With this in mind, it is regrettable this child was ripped from his parents’ home because a nonexistent “ADHD” was suspected. I think that something else could be going on. There could be a real bodily dysfunction that is being overlooked in many of these unfortunate children who are being labeled “mentally ill”. They could simply be malnourished.

There are many books out there written on the topic of “ADHD”, but as a Nutritional Therapy Practitioner and a Gut and Psychology Syndrome (GAPS) Practitioner, I have a different take on a possible answer to the question, “What is ADHD?” We know that a child’s brain requires nutrient-dense foods for proper development. This means things like eggs, cod liver oil or other fish oils, butter, liver, beef, lard, and a host of other fatty foods. The brain, of course, is largely made up of fats. When the proper fats are lacking or deficient, the brain does not function properly. We would say the child is malnourished.

How does a child with these nutritional deficiencies behave? They are not able to manage their behavior very well, and are apt to appear fidgety and unfocused. They lack the self-control they need to fit into social situations, like school, effectively. They have trouble controlling their moods, as well, and often seem inappropriate in their responses to the environment.

Children who are properly nourished, are much more able to control their behavior, to stay on task, and they suffer less from negative moods, like anxiety and anger. Their bodies can create the neurotransmitters their brain needs to calm themselves down and be happy, because they are eating the proper amino acids and other micronutrients their bodies need to do so.

A study done in Norway in 2013 showed that children who ate a diet largely consisting of processed sugary foods, and lots of starches like bread and buns, pizza and the like, were far more apt to exhibit either internalizing behaviors like worry, sadness and anxiety or externalizing behaviors like tantrums, hyperactivity and aggression.

On the other hand, children who ate lots of cheese, fish, vegetables and eggs showed fewer such symptoms. The point is, a child’s diet affects behavior and moods, either for good or ill, and diet is an important factor in this.

Another thought is that when a child develops his or her own diet, choosing starchy and sugary foods over anything else, it is likely that they are suffering from small intestinal bacterial overgrowth (SIBO). We know that if candida albicans, a fungus/yeast, takes over the small intestine, it is capable of sending messages to the brain instructing the person to eat more sugar and starch, its favored foods.

Thus, you have children who will preferentially eat these foods, to the exclusion of the healthier vegetables, meats, eggs, yogurt and other raw and fermented foods. This becomes a vicious cycle, eating the wrong foods, and being reinforced from the gut to continue to do so. Many parents despair of ever seeing their children take a bite of a vegetable. This is gut dysfunction, and when this situation continues for too long, intestinal permeability, or “leaky gut” appears. Toxins, produced by bacteria, or other toxic wastes, can leak into the bloodstream, and past the blood-brain barrier and into the brain, causing disordered thinking.

If some of you recall, ADD or ADHD used to be called “Minimal Brain Dysfunction”. It would be wonderful to get back to that concept, and apply the cure: Proper nutrition and healing the gut. Then, we could look forward to complete remission of that real dysfunction!

Elizabeth Szlek is the Director of The Door Counseling Center of Yorkville, NY. She is a Licensed Mental Health Counselor, a Nutritional Therapy Practitioner and a Certified GAPS Practitioner. She can be reached at (315) 768-8900 or at door@thedoorcounselingcenter.com.