I have addressed some of the benefits of growing into adulthood with ADD symptoms. These benefits could be looked at as either the adaptive responses that an individual develops in response to a handicap or inherent benefits of the neuropsychological organization we collectively refer to as ADD. At times it is impossible to tell the two apart and they could complement or detract from each other. Some of these tendencies would include adaptability, empathy, tolerance of others, creativity, openness to new information from an unexpected source and passion . Just think about our ancestors who first thought of migrating to new places on the planet searching for better and more novel opportunities; were they running away from teachers and bosses who thought they were management problems or impulsive?!
This is a special time of the year for people from many wisdom traditions. Some form of fasting and monitoring of physical aspects of our existence is practiced by many. The Baha’is (www.bahai.org) will be observing a Baha’i month long fast when they will be abstaining from eating and drinking from sunrise to sunset for 19 days. For those who are not familiar with the practice, this sounds odd at first. The wisdom of fasting has been beautifully elaborated as a symbol of spiritual rejuvenation. In one of the meditations one is reminded that the physical fast is a reminder of our spiritual needs. I have observed many psychological benefits from fasting. ( I am purposefully staying away from the physical benefits as I am a bit tired of our cultural bias of evaluating every behavior based on its value to lower our cholesterol level!!) Fasting provides a sense of courage to monitor impulsivity and integrity of the senses. It reminds us of automatic habits and addictive behaviors. It also provides us with venue to mediate on our vulnerabilities and propensities. Another obvious benefit is the heightened awareness of the needs of others. All this is specially beneficial for the ADDer who at baseline has a greater challenge dealing with impulsivity, anger threshold and structure. Fasting should not be tried however if there is a medical counter indication as it is not meant to harm the body but to fortify the mind/spirit/ body. May all on Earth have a peaceful and joyous season.
Recently a patient whom I had not seen for almost a year showed up in my office demanding that her antidepressant prescriptions be filled for another year. She made it clear that she had no interest in engaging in any form of therapy and refused to provide any necessary information in the way of medical workup, emotional and life , or any other interaction that did not revolve around her immediate intention of renewing her prescriptions. This incident disturbed me deeply. As I sorted out my own feelings, my anger towards this rude patient gradually turned into deep frustration with the current state of the field and our cultural biases that has reduced us as humans into imbalanced chemical machines only needing to be fixed. No room for mind/body/soul integration has been made. Standards of therapy are set by pharmaceutical companies and prescription filling third parties who often demand a year supply of potentially dangerous treatments that require close monitoring. Besides, the doctor/patient therapeutic relationship is the most important component of the healing process as confirmed by the high placebo response for these conditions. So let’s work together to minimize risks and maximize your well-being, unless you are determined to ruin my day by insisting on devaluing the whole process!
At a recent medical conference I attended, a Pharma-sponsored speaker was passionately promoting treatments to eradicate residual symptoms of ‘depression’ in afflicted individuals. He was heroically promoting a complex and potentially toxic combination medication regimen to ”erase” the last remnant of “depression”.
The case presentation highlighting this process was summarized in less than three lines and presented a woman who experienced periodic “dysphoria” despite taking two concurrent antidepressants. Comparison was drawn to disease states such as incomplete treatment of a urinary tract infection or poorly controlled diabetes mellitus.
All along I was thinking to myself, “What else might be going on in this person’s life? Is the medical model of a case such as this, although useful in some circumstances, sufficient to decipher her presentation? Do we really want to continue with our treatment decisions solely based on a set of questionnaires we have devised to assess ones state of well being? What happened to the realm of ‘meaning’, ‘angst of existence’, ‘processing of fears of being’, ‘honoring individual variability of temperament’ ,and ’spiritual isolation’?”
Currently, questions such as these are anathema to our prevailing theories of depression, and most of the voices of non-materialist theorists have been quiet lately. I will let you be the judge of our current model!
I have had many calls and inquiries about a recent Newsweek article concluding that antidepressants show no advantage over placebo (sugar pills) in treating mild to moderate depression. Many have felt betrayed and confused not because they were taking useless medicines but mostly because their own personal experience did not match the Study’s conclusions.
As I have briefly mentioned before, my own response is different than the criticisms that have since been raised against the article. The responses have been mostly focused on the selectivity of the studies for a ‘meta-analysis’ and ‘technical’ criticisms. My approach is quite different as I do not believe our current definition of DEPRESSION is valid! We have come up with a set of descriptive symptoms and call them a single entity DISEASE. We then try to TREAT this arbitrary entity with protocols that do not take in to account individual variability. Two affected individuals might suffer from a set of similar symptoms but the approach to their treatment need to be very different: The first person might have existential dilemmas needing attention and the second one might be suffering from unresolved traumas.
Our ‘antidepressants’, when deconstructed, are no more than chemical modulators to make changes that ‘might’ lead to alterations in our attention, reward seeking, tendency to obsess, etc. The model I prefer is much more nuanced and does not dichotomize medications and non-medication interventions. Placebo, moreover, is not ‘no treatment’ but rather regular visits and care from doctors perceived as ‘healers’.
Overall, the article is useful as it challenges the current flawed views of the ’chemical imbalance’ models. Hopefully, it will not deter people from getting the help they need. As the title of a recent movie fits so many real life situations; IT’S COMPLICATED!
It is not an exaggeration to say that the question of ‘unjustness’ of the universe is a core problem that keeps people disconnected and confused existentially. Some are not even aware that they are being affected in this way. A devout ‘believer’ sees her personal problems as a personal attack on her core beliefs in a just and good God. I have seen the events of 9/11 and Haiti tragedies lead people to nihilism and hopelessness. The constant encouragement of being in the NOW has also been misinterpreted by some as permission to adopt an attitude of selfish self absorption and the cult of self-improvement. I do not claim to know or be able to answer such human conundrums in a blog! Since I am fascinated by this topic however I will list some of the answers I have accumulated from the wisdom literature of world religions and philosophies especially from the Baha’i Faith writings. So to reiterate the question , If a just God exists , how can so much injustice and ‘evil’ exist in the world?
1. We are not privileged to grasp Reality in full in this realm of existence; creation is not limited to this sense perceived world , hence what appears as injustice might be ’set’ right if the full picture is taken into account.
2. Test and trials have educational effects in some circumstances.
3. Pain and suffering could give depth and meaning to our development.
4. The very fact that we judge events into good and bad, reminds us of the ultimate Goodness and Justice that is not always apparent to us.
5. If our personal reasons for gratitude seem to be decreasing , the blessings and bounties in other areas will be ever present.
6. We can adopt a Yea attitude towards life as opposed to a Nay attitude which seems so pervasive; the complexity of existence demands it intuitively!
No single answer is completely satisfying and fits all situations. Some might correctly argue that even addressing such topics is counter productive. I do however believe that we don’t share enough of our existential questions with each other. The super bowl is over and winter is a good season to reflect, especially in Cleveland!
You have been working hard all week and really look forward to going out with your fiancee to a nice restaurant and enjoying yourself. She has not seen you all week and is excited about finding out about your work and reconnecting with you emotionally. After answering her third question before finishing your appetizer you snap and say something harsh and stupid! the evening is ruined and you are totally baffled as to what happened. You feel guilty and frustrated and vow not to do this again. Next week something similar happens with a slightly different theme. My experience with adult ADDers is that they need a period of ‘idling’ and ‘alone time’ after a stressful ’sprint’ and attempts at relaxing with others even loved ones is quite difficult . So , I suggest you be aware of this process and allow yourself a bit of a down time before engaging in social activities. If you are at receiving end of this transaction with an ADDer, don’t take the interaction personally and be prepared for it. No, you are not engaged to a jerk ! A bit of understanding and patience will fortify and enrich the relation.
Many of you have experienced the following scenario; after a period of sustained stress with accompanying poor sleep, heightened anxiety, poor nutrition, the core symptoms of ADHD seem much more prominent and troublesome. Physiologically one can propose a model where chronic stress depletes dopamine and norepinephrine neurotransmitters and hence the heightened expression of inattention, irritability and impulsivity. What’s important here is not to jump into acute ADHD medication treatments as they might only worsen the problem! Anxiety and stress management and balancing sleep and nutrition become the primary focus of therapy. You do need to work with a doctor to take these factors into account and help you through it. Don’t insist on treatment as usual till the exacerbating conditions are addressed first.
As the word ‘neurosis’ became outmoded in psychiatric jargon and was limited to psychoanalytic circles; the concept of ‘neuroticism’ as a fundamental personality trait emerged as a useful concept . Whereas neurosis has been limited to psychoanalytic models of conflict and developmental deficits; neuroticism is thought of as a biologically based hardwired personality characteristic. This trait is thought of as a propensity of experiencing negative emotional states with consequences of anger, anxiety and depression. We have exchanged blaming our ‘mothers’ for our troubles into blaming ‘our brains’ and ‘neurotransmitter’ apparatus! The interaction between our hardwired biology and our environment has baffled philosophers and scientists alike but I tend to shy away from the ones who claim to have found the answer with their oversimplified explanations!
A fascinating new area of genetic studies focuses on changes of gene expression that do not involve underlying DNA structure.(epi:above,over; genetics). Without getting too much into the science of it, the implications are immense; we could be altering gene expression over generations without altering the DNA code. In behavioral medicine this could mean alterations of this expression via life experiences. Could then your grandparents experiences of depression, religious persecutions, and or war have any effect on your genetic expression? and could your adaptations to life events and challenges in turn alter your epigenetic expression in generations to come? The science is new and these questions remain mostly unanswered but amazingly relevant and interesting.