Dr Caroline Leaf – stop spreading ADHD stigma and ignorance

“Nothing in all the world is more dangerous than sincere ignorance and conscientious stupidity.” ~ Martin Luther King Jnr.

Sincere ignorance … conscientious stupidity – I’m struggling to know which category to put Dr Leaf’s latest e-mail newsletter into.

Dr Caroline Leaf is a communication pathologist and self-titled cognitive neuroscientist and self-titled mental health expert.  She is not a doctor.  She is not a psychologist.  She does not work for a university.  She hasn’t published any peer reviewed medical papers for two decades.  She is not accountable to any peak professional body.

Yet the Christian church gives her unfettered access to their pulpits despite the ignorance and stigma she enthusiastically promotes.

Take the “Mental Health News” e-mail that she posted today for example.  Dr Leaf seamlessly moves from one misrepresentation to another, weaving a narrative that unfairly undermines scientifically proven treatments for mental illness, eroding confidence and destroying hope.

She starts with the story of Michelle and Carter, although it wasn’t Michelle and Carter as her e-mail newsletter stated. It was Michelle Carter and Conrad Roy, something which Dr Leaf got right in her blog post dated 1 August 2017 (see the image at the bottom of the page), but then got wrong in her e-mail newsletter on 30 August 2017. Dr Leaf says that Michelle texted Conrad to kill himself, and he did. Michelle and Conrad were on “brain-disabling” (psychiatric) drugs. Therefore, psychiatric drugs killed Michelle and Conrad. In my opinion, that Dr Leaf would stoop so low as to use the suicide of a teenager to try and push her own ideological barrow says much about her character, but then I shouldn’t be surprised as she did the same thing when Carrie Fisher died earlier this year. It’s sick, and it’s low, and it’s something that Dr Leaf should apologise for.

It’s also incredibly disingenuous, drawing a conclusion from incomplete evidence. Dr Leaf has no experience with the case. Instead, the source of this information is Dr Peter Breggin, himself an outspoken and discredited critic of psychiatric medication with a penchant for cherry picking and bias. Dr Leaf has used the story of Michelle and Conrad based on the tainted recall of half a story. She has no idea what really contributed to Michelle and Conrad’s tragedy. Her statement, “Yet, as is often the case, there is a large and dreadful disparity between what actually happened and what we are told happened” is therefore sadly ironic.

Dr Leaf then moves on to ADHD and drugs. Dr Leaf treats the concepts of ADHD and its treatment with the same respect as she gave Michelle and Conrad. She makes statement after misleading statement which do nothing but demonstrate her myopic bias.

Let’s just take one sentence: “These drugs create, rather than cure, chemical imbalances in the brain, are difficult to come off and can have terrible side-effects that last for years, including suicide and homicide.”

ADHD is often misunderstood and almost always stigmatised.  ADHD is more than just being an active child who likes to play.  ADHD is a dysfunctional lack of control that’s abnormal compared to other children the same stage of development, is long standing and affects their entire lives.

ADHD is caused by an abnormal pattern of genes, the expression of which are triggered by environmental conditions in pregnancy and early childhood, resulting in slower maturation of the brain and an uncoordinated network of “connectomes”, which disrupts the attention and planning processes of the brain.

We know that children with ADHD have slower maturation of the grey matter [1] and structural changes in the frontal regions and deeper parts of the brain [2].  In more recent times, modern brain imaging techniques have been able to show differences in the way that the regions of the brain link together to form networks.

Think of the brain networks as a tug-o-war team.  When all the members of a tug-o-war team work in unison, they increase their collective strength, but if the different team members don’t co-ordinate their efforts properly, the strength is lost.  The same goes for the brain.  Modern neuroscientists have discovered that the function of the brain relies on physical networks within the brain, called “connectomes” and how these connectomes co-ordinate with each other.

In the ADHD brain, the connections between the different connectomes are immature [3].  These immature connections weaken the collective strength of the network, because they aren’t synchronously “pulling” together.

What’s better understood is that the neurotransmitter called dopamine is crucial to the ADHD disease process [4].  Medications such as Ritalin which enhance the dopamine signals in the brain significantly reduce the symptoms of ADHD [5].

So Ritalin and other drugs like it actually balance the neurotransmitters in the brain.  Dr Leaf’s argument that they “create … chemical imbalances in the brain” is as misleading as trying to argue that diabetic treatments are creating an “insulin imbalance”.

“These drugs … are difficult to come off” is also misleading.  Once the brain eventually matures as it does in most children with ADHD, the drug is simply weaned.  Dr Leaf doesn’t seem to understand that some children with ADHD will grow into adults with ADHD who will still need medication.  This isn’t because the drugs are hard to come off, they are simply treating an ongoing condition.

“These drugs … can have terrible side-effects that last for years, including suicide and homicide.”  Actually, the effects of Ritalin last less than a day because the drug is rapidly metabolised, and ‘homicide’ is not listed anywhere in the official product information.  Suicide has been reported in patients taking the Ritalin although the official product information notes that, “Adverse events reported since market introduction in patients taking methylphenidate include suicide, suicide attempt and suicidal ideation. No causal relationship between methylphenidate and these events has been established.”  Even so, medications like Ritalin are not meant to be given to people who have severe depression, anorexia, psychotic symptoms or suicidal tendency, just in case Ritalin might worsen these conditions.

Indeed, a Cochrane Review as recently as November 2015 said, “The evidence in this review of RCTs suggests that methylphenidate does not increase the risk of serious (life threatening) harms when used for periods of up to six months. However, taking methylphenidate is associated with an increased risk of non-serious harms such as sleeping problems and decreased appetite.” [6]

So “these drugs” don’t have side effects for years, don’t make people homicidal, don’t make people addicted and don’t unbalance their brain chemicals.  It’s amazing how much profound mistruth Dr Leaf was able to pack into one littlesentence.

Then Dr Leaf goes on to attack the concept of ADHD itself – “Unfortunately, there is little scientific evidence for these labels … the very idea of ADHD, which includes vague operational definitions such as ‘often fidgets with hands or feet or squirms in seat,’ is subjective and defined by what society currently deems as ‘normal’ or ‘abnormal’”.

Denying the existence of ADHD is an old trick used by medication critics and the ignoranti for decades, but it’s like denying the existence of rain so you don’t have to buy an umbrella.  Dr Leaf’s assertion that the diagnosis of ADHD includes ‘vague operational definitions’ is just a strawman, because ADHD diagnosis is rigorous and relies on more than just a single characteristic like fidgeting.  I have listed the diagnostic criteria for ADHD at the end of this post, or you can look it up here: http://www.cdc.gov/ncbddd/adhd/diagnosis.html

In all of Dr Leaf’s railing against medications for ADHD, she fails to cite the evidence that shows that medications for ADHD improves the lives of those with ADHD [6], more than restrictive diets or cognitive retraining or neurofeedback [7].

Dr Leaf may like to think of herself as an expert, but her claims on ADHD and it’s treatment do not hold up under scrutiny.  She may think she’s acting benevolently but the promotion of her Dunning-Kruger style ignorance erodes the enormous hope that medications like Ritalin give to people who, without it, are held back by the mental and physical chaos that ADHD causes.

Dr Leaf, please, stop spreading the ADHD stigma and ignorance.  We already have to put up with enough suffering from the disease itself and the social stigma without you adding to it.

References

[1]       Shaw P, Lerch J, Greenstein D, et al. Longitudinal mapping of cortical thickness and clinical outcome in children and adolescents with attention-deficit/hyperactivity disorder. Archives of general psychiatry 2006 May;63(5):540-9.
[2]       Cortese S. The neurobiology and genetics of Attention-Deficit/Hyperactivity Disorder (ADHD): what every clinician should know. European journal of paediatric neurology : EJPN : official journal of the European Paediatric Neurology Society 2012 Sep;16(5):422-33.
[3]       Cao M, Shu N, Cao Q, Wang Y, He Y. Imaging functional and structural brain connectomics in attention-deficit/hyperactivity disorder. Mol Neurobiol 2014 Dec;50(3):1111-23.
[4]       Wu J, Xiao H, Sun H, Zou L, Zhu LQ. Role of dopamine receptors in ADHD: a systematic meta-analysis. Mol Neurobiol 2012 Jun;45(3):605-20.
[5]       Reichow B, Volkmar FR, Bloch MH. Systematic review and meta-analysis of pharmacological treatment of the symptoms of attention-deficit/hyperactivity disorder in children with pervasive developmental disorders. Journal of autism and developmental disorders 2013 Oct;43(10):2435-41.
[6]       Storebo OJ, Ramstad E, Krogh HB, et al. Methylphenidate for children and adolescents with attention deficit hyperactivity disorder (ADHD). The Cochrane database of systematic reviews 2015 Nov 25;11:CD009885.
[7]       Sonuga-Barke EJ, Brandeis D, Cortese S, et al. Nonpharmacological interventions for ADHD: systematic review and meta-analyses of randomized controlled trials of dietary and psychological treatments. The American journal of psychiatry 2013 Mar 1;170(3):275-89.

ADHD Diagnostic Criteria

The current criteria that must be matched to qualify for a diagnosis of ADHD is:

(1) Inattention: Six or more symptoms of inattention for children up to age 16, or five or more for adolescents 17 and older and adults; symptoms of inattention have been present for at least 6 months, and they are inappropriate for developmental level:
* Often fails to give close attention to details or makes careless mistakes in schoolwork, at work, or with other activities.
* Often has trouble holding attention on tasks or play activities.
* Often does not seem to listen when spoken to directly.
* Often does not follow through on instructions and fails to finish schoolwork, chores, or duties in the workplace (e.g., loses focus, side-tracked).
* Often has trouble organizing tasks and activities.
* Often avoids, dislikes, or is reluctant to do tasks that require mental effort over a long period of time (such as schoolwork or homework).
* Often loses things necessary for tasks and activities (e.g. school materials, pencils, books, tools, wallets, keys, paperwork, eyeglasses, mobile telephones).
* Is often easily distracted
* Is often forgetful in daily activities.

(2) Hyperactivity and Impulsivity: Six or more symptoms of hyperactivity-impulsivity for children up to age 16, or five or more for adolescents 17 and older and adults; symptoms of hyperactivity-impulsivity have been present for at least 6 months to an extent that is disruptive and inappropriate for the person’s developmental level:
* Often fidgets with or taps hands or feet, or squirms in seat.
* Often leaves seat in situations when remaining seated is expected.
* Often runs about or climbs in situations where it is not appropriate (adolescents or adults may be limited to feeling restless).
* Often unable to play or take part in leisure activities quietly.
* Is often “on the go” acting as if “driven by a motor”.
* Often talks excessively.
* Often blurts out an answer before a question has been completed.
* Often has trouble waiting his/her turn.
* Often interrupts or intrudes on others (e.g., butts into conversations or games)

In addition, the following conditions must be met:
– Several inattentive or hyperactive-impulsive symptoms were present before age 12 years.
– Several symptoms are present in two or more setting, (e.g., at home, school or work; with friends or relatives; in other activities).
– There is clear evidence that the symptoms interfere with, or reduce the quality of, social, school, or work functioning.
– The symptoms do not happen only during the course of schizophrenia or another psychotic disorder.
– The symptoms are not better explained by another mental disorder (e.g. Mood Disorder, Anxiety Disorder, Dissociative Disorder, or a Personality Disorder).
(http://www.cdc.gov/ncbddd/adhd/diagnosis.html)

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Anti-psychotics, damn lies and statistics

Today, I was asked to clarify some information surrounding an earlier post about Carrie Fisher and the role that anti-psychotic medications may or may not have played in her death from a heart attack.  I appreciated the question which was about whether I’d seen the statistics put up by the Mad In America (MIA) blogger who wrote about Carrie Fisher (the blog which, incidentally, Dr Leaf had then uncritically decided to slyly try to regift it in the form of her newsletter article).

In the opening of her post, the MIA blogger said, “There’s an important question here. Is she one of the cases in point to explain why our community has a 25 year lower life expectancy?” and then threw in a table plucked out of context from a journal article.  At least, unlike Dr Leaf, the MIA blogger was intellectually honest enough to attach the source of the table, which was an article published in the European Heart Journal in 2012.

While the MIA blogger is certainly entitled to her opinion, I thought it was worth discussing the statistics in a bit more detail, if for nothing else than to give some context to the whole “anti-psychotics kill you” trope that keeps getting around.

First, there needs to be the proper context.  No one is denying that there’s a higher mortality rate amongst people with schizophrenia and other forms of psychosis, though I don’t see exactly where she got her “25 year lower life expectancy” line from. To me, that seems excessive.

Then to the study itself.  The paper that the table is extracted from is Honkola et al [1]. The study specifically examines the association between the use of different classes of psychiatric medications with the rate of sudden cardiac death during a coronary event (a heart attack, or angina).

In her post, the MIA blogger throws around a lot of numbers but she was loathe to put her numbers in the right context.  For example, she claimed that “smoking is four times safer than the older types of antipsychotics. And it’s twice as safe to smoke as it is to take any antipsychotic, including the newer ones”.  Except, her comparison is a fallacy of conflation – she’s comparing the all cause mortality of smoking (which is more like three-fold rather than two-fold, just FYI [2]) with the highly specific ‘sudden cardiac death during a heart attack’ mortality of the study she’s referencing.  It’s apples and oranges – the groups aren’t directly comparable.

Besides, even if her numbers were directly applicable, the positively immoral sounding four-fold increase in the rate of death sounds is just an association, not a cause.  There is a dictum in science, “Correlation is not the same as causation.”  Just because two things occur together does not mean that one causes the other.  There may be other explanations beside the medication that might explain that number, including but not limited to, statistical anomalies and lifestyle factors, and other factors not considered in the analysis.

There are other problems with relevance too.  Most of the numbers in the table were small and not statistically significant (that is, could have been related to chance alone).  The only strong numbers were for old anti-psychotics, phenothiazines, tricyclic antidepressants and butyrophenones, none of which are first line medications for psychosis or depression anymore.  Newer anti-depressants and the newer atypical anti-psychotics did not have a statistically significant association.

And, like I said before, this study is looking at the association between sudden cardiac death in people having a heart attack, which is a very specific form of mortality.  It’s not particularly applicable to everyone on the medications, so even if the 4- or 8-fold increase is rock solid, you can’t translate that statistic to everyone on anti-psychotic medications or anti-depressants, or Carrie Fisher for that matter since no one really knows how she died other than she had a heart attack.  The rest is just disrespectful speculation.

For me, rather than trying to take a table full of weak and inapplicable statistics and beat a conclusion out of them, a more useful thing would be to know the benefit or harm of anti-psychotics on all causes of death.  If anti-psychotics were really as poisonous as Dr Leaf and the MIA blogger portrayed, then all-cause mortality would be much higher in those exposed to the drugs versus those who were never exposed to the drug, which is why this study by Torniainen and colleagues [3] is particularly interesting, and in particular, this graph – https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4393693/figure/F1/

In this study, the chance of dying from any cause was significantly higher in those people with schizophrenia who were never treated with anti-psychotics compared to those who were treated.

Does this answer the question why there is a lower rate of mortality? Not really, because in fairness, this study also showed just an association between no anti-psychotics and a higher death rate.  It doesn’t specifically prove causation one way or another.

Does it show that we should throw anti-psychotics around like lollies, or that they are wonder drugs without any associated harm? No, they are medicines and need to be used responsibly.

It does show there’s a general benefit to anti-psychotics for people with schizophrenia so they’re not the toxic killers Dr Leaf and the MIA blogger try and make them out to be.

Anyone can cherry-pick weak statistics and bend them to suit their self-interested propaganda.  The remedy to damn lies and statistics is to look more broadly and consider the strength of the numbers and their context.  When we do that with the studies on anti-psychotic medications we see that they aren’t the evil killers that some people would like to make them out to be.

References
[1]        Honkola J, Hookana E, Malinen S, et al. Psychotropic medications and the risk of sudden cardiac death during an acute coronary event. Eur Heart J 2012 Mar;33(6):745-51
[2]        Jha P, Ramasundarahettige C, Landsman V, et al. 21st-century hazards of smoking and benefits of cessation in the United States. The New England journal of medicine 2013 Jan 24;368(4):341-50
[3]        Torniainen M, Mittendorfer-Rutz E, Tanskanen A, et al. Antipsychotic treatment and mortality in schizophrenia. Schizophrenia bulletin 2015 May;41(3):656-63

Kintsukuroi Christians

When I was a kid growing up, there wasn’t much that my father couldn’t repair.

Dad was extremely gifted with his hands, a talent that I certainly didn’t inherit. He was able to take a problem, come up with a practical solution in his mind’s eye, then build it out of whatever scraps of wood, metal or plastic he could lay his hands on. It was the ultimate expression of frugality and recycling that comes from a limited income and four growing children.

Dad was also able to resurrect nearly everything that broke in our house. Plates, cups, teapots, toys, tools … it seemed there wasn’t anything that couldn’t be fixed by the careful application of Araldite.

Araldite, for those unfamiliar with it, is some sort of epoxy resin that, in the right hands, possesses mystical properties of adhesion. It would stick anything to anything.

Dad’s gift for repairing things with Araldite meant that a lot of our things were patched up. Some of our most loved possessions were the most cracked. Despite being glued together several times, each item was still functional. Maybe not as pretty as it may have once been, but still useful, and more importantly, still treasured. Each time the Araldite came out, it taught me that whilst all things have the capacity to be broken, they also have the capacity for redemption.

There’s an ancient Japanese tradition that shares the same principles. For more than 400 years, the Japanese people have practiced kintsukuroi. Kintsukuroi (pronounced ‘kint soo koo ree’) is the art of repairing broken pottery with gold or silver lacquer, and the deep understanding that the piece is more beautiful for having been broken.

The edges of the broken fragments are coated with the glue made from Japanese lacquer resin and are bonded back into place. The joints are rubbed with an adhesive until the surface is perfectly smooth again. After drying, more lacquer is applied. This process is repeated many times, and gold dust is also applied. In kintsukuroi, the gold lacquer accentuates the fracture lines, and the breakage is honoured as part of that piece’s history.
Mental illness is a mystery to most people, shrouded by mythology, stigma, gossip or Hollywood hype. It’s all around us, affecting a quarter of the population every year, but so often those with mental illness hide in plain sight. Mental illness doesn’t give you a limp, a lump, or a lag. It affects feelings and thoughts, our most latent personal inner world, the iceberg underneath the waters.

On the front line of medicine, I see people with mental health problems every day, but mental health problems don’t limit themselves to the doctor’s office. They’re spread throughout our everyday lives. If one in four people have a mental health problem of one form or another, then one in four Christians have a mental health problem of one form or another. If your church experience is anything like mine, you would shake hands with at least ten people from the front door to your seat. Statistically speaking, two or three of them will have a mental illness. Could you tell?

It’s a fair bet that most people wouldn’t know if someone in their church had a mental illness. Christians battling with mental illness learn to present a happy façade, or face the judgment if they don’t), so they either hide their inner pain, or just avoid church altogether.
Experiencing a mental illness also makes people feel permanently broken. They feel like they’re never going to be whole again, or good enough, or useful, or loved. They’re often treated that way by well-meaning but ill-informed church members whose idea’s and opinions on mental illness is out-of-date.

The truth is that Christians who have experienced mental ill-health are like a kintsukuroi pot.

Mental illness may break them, sure. But they don’t stay broken. The dark and difficult times, and their recovery from their illness is simply God putting lacquer on their broken pieces, putting them back together, and rubbing gold dust into their cracks.
We are all kintsukuroi Christians – we’re more beautiful and more honoured than we were before, because of our brokenness, and our recovery.

I’m pleased to announce that my book, Kintsukuroi Christians, is now available. I’ve written this book to try and bring together the best of the medical and spiritual.
Unfortunately, good scientific information often bypasses the church. The church is typically misled by Christian ‘experts’ that preach a view of mental health based on a skewed or outdated understanding of mental illness and cognitive neuroscience. I want to present a guide to mental illness and recovery that’s easy for Christians to digest, adopting the best spiritual AND scientific perspective.

In the book, I look at some scientific basics. Our mental world is based on the physical world. Our mind is a function of the brain, just like breathing is a function of our lungs. Just as we can’t properly understand our breathing without understanding our lungs, so it is that if we’re going to understand our thinking and our minds, we are going to have to understand the way our brain works. So the first part of this book will be an unpacking of the neurobiology of thought.

We’ll also look at what promotes good mental health. Then we’ll look at what causes mental illness, specifically looking at the most common mental health disorders. I will only look at some of the most common disorders to demonstrate some general principles of psychiatric illnesses and treatments. This book won’t be an encyclopaedia, and it doesn’t need to be. I hope to provide a framework so that common and uncommon mental health disorders can be better understood. I also discuss suicide, which is sadly more common than most people realise, and is rarely discussed.

I know mental illness is difficult, and we often look at ourselves or others as though the brokenness is abhorrent, ugly and deforming.
My hope is that through Kintsukuroi Christians, you’ll see the broken pieces are mended with gold, and realise that having or recovering from a mental illness doesn’t render someone useless or broken, but that God turns our mental brokenness into beauty.

Kintsukuroi Christians is available to purchase from good Christian bookstores around the world including:

Kooyong = https://www.koorong.com/search/product/kintsukuroi-christians-christopher-pitt/9780994596895.jhtml

Amazon US = https://www.amazon.com/Kintsukuroi-Christians-TURNING-MENTAL-BROKENNESS/dp/0994596898/

Amazon UK = https://www.amazon.co.uk/Kintsukuroi-Christians-TURNING-MENTAL-BROKENNESS/dp/0994596898/

Smashwords = https://www.smashwords.com/books/view/720425

~~

Mental illness can be challenging. Sometimes learning about mental illness can bring up difficult feelings or emotions, either things that you’ve been through yourself, or because you develop a better understanding of what a loved one is going through or has been through. Sometimes old issues that have been suppressed or not properly dealt with can bubble up to the surface. If at any point you feel distressed, I strongly encourage you to talk to your local doctor, psychologist, or pastor. If the feelings are so overwhelming that you need to talk to someone quickly, then please don’t delay, but reach out to a crisis service in your country

In Australia
Lifeline 13 11 14, or
BeyondBlue
Call 1300 22 4636
Daily web chat (between 3pm–12am) and email (with a response provided within 24 hours)  https://www.beyondblue.org.au/about-us/contact-us.

USA = National Suicide Prevention Lifeline 1-800-273-TALK (8255)

New Zealand = Lifeline Aotearoa 24/7 Helpline 0800 543 354

UK = Samaritans (24 hour help line) 116 123

For other countries, Your Life Counts maintains a list of crisis services across a number of countries: http://www.yourlifecounts.org/need-help/crisis-lines.

Black is the new black – Mental illness touches more of us than we realise (or want to admit)

I rarely get sick.

I say this while superstitiously touching my wooden desk to try and avoid putting the mockers on myself.  Thankfully, I have a fairly robust immune system and, after years or working in hospital paediatrics and general practice, and having been sneezed at or coughed on multiple times a day, I have been exposed to just about every variation of the cold virus and influenza possible.

Even for those of us with an immune system as solid as a prize bull, we still get sick every now and then.  We all get upper respiratory viruses so commonly that we just consider it a normal part of life.  Most people will take some paracetamol or ibuprofen and keep going.  Some people will go to their GP, and while a most will (… should …) come away some simple reassurance, occasionally some will need a prescription medication for a nastier bacterial infection.  An even smaller percentage will need admission to hospital because of a much more severe infection.

I read an interesting blog this week on Psychology Today by Dr David Rettew.  Its provocative title was, “Is Mental Illness the Rule Rather Than the Exception?”

The blog discussed the study being carried on in Dunedin which has been following a cohort of a thousand people for the last thirty-five years.  This particular study looked for common factors that were shared by those people who had never been affected by a certifiable psychiatric disorder.  What was interesting was that only seventeen percent of the people in that cohort had NOT been affected by a mental illness at some point in that thirty-five-year time frame.

Now for the average Australian, there are some obvious kiwi jokes going begging here (like, I’d be depressed too if I had to live in New Zealand, or how can someone tell if a sheep is really depressed or not, etc. etc.).  All jokes aside, seventeen percent of people not affected … that’s a remarkable figure.  In researching my latest book (soon to be released …) I had come across the figure of fifty percent of people had a lifetime prevalence of any mental illness.  That’s one in every two, and chances are that if you weren’t the person affected, you would know someone who was affected, but the Dunedin figures are even higher.  If you can accurately extrapolate them, four out of every five people will be affected by mental illness at some point in their lives.

The inevitable response from modern psychiatry’s critics is entirely predictable – there will be claims that the DSM5 is simply making diseases out of normal human life experiences, that our humanity is being pathologised and over-medicated for the benefit of big Pharma.

But as Rettew points out in a separate blog post, something may be such a common occurrence as to be considered part of the normal human experience but it can still be a pathology.  The common cold is so common that it’s a normal part of life, but it’s still a disease.

Whether four out of every five people will be affected by mental illness or one out of two, whatever the number, the idea that most of our population will be afflicted with a mental illness at some point in their lives isn’t necessarily a negative thing.  As Rettew also discusses, we don’t arbitrarily change the definitions of physical illnesses to match how many people we think should suffer from them, and neither should we arbitrarily change the diagnostic boundaries of mental illness so less people appear mentally unwell.

We need to accept that, at times, people will be functionally impaired to varying degrees because of mental illness just like people will be functionally impaired by physical illness.  We need to treat mental illness with the same respect as we would physical illness.

In the same way that not all physical illnesses require medication, neither do all mental illnesses.  By and large, most mental illnesses that people suffer from will be short lived and self-limiting, the psychiatric equivalent of having a cold.  Some people will need treatment for their mental illness, but usually this takes the form of structured behavioural therapy like ACT or CBT.  Occasionally, people will need to take a medication and very occasionally, some people will need to be hospitalised because of their mental illness.

For too long, mental illness has been viewed from an extreme perspective – mental illness is uncommon and severe. The nuances of mental illness have been lost or ignored in the white noise of ignorance and sanctimony.  The lack of subtlety and understanding has failed us as a community.  When treated early, mental illness has a much better prognosis, but the stigma, fear and misunderstanding perpetuated by the all-or-nothing approach has left a lot of people without treatment and therefore with worse outcomes overall.

If people were to realise that most of us will be touched by mental illness at some point, then perhaps there would be more understanding and less judgement, something that would lead to less suffering because of mental illness.

That would only be a good thing.

~~~~~

If you think you might be affected by mental illness or if you would like to know more, see your local GP, family physician or psychologist.  On line information can be found at many reputable sites including Beyond Blue – https://www.beyondblue.org.au

Prescribing dangerous drugs for a made up disease

Honestly, I don’t know if I can go on much longer.

I feel like every time I approach the wild waters of social media, I find myself drowning in a sea of shameless ignorance.  It’s like a post-modern intellectual zombie apocalypse where brainless morons roam cyberspace, relishing the opportunity to infect the minds of the innocent and gullible with their delusions of expertise.

As I’m sitting here writing, the little angel on my right shoulder is trying to get my attention.  “Everyone’s entitled to their own opinion,” she whispers softly.

Except it’s hard to hear when the little devil on my other shoulder is digging his pitch-fork in my brain and twisting it to make a point.  “But their opinion is crap,” he angrily retorts.

Tonight, the subject of my inner voice’s great debate was the Facebook headline, “ADHD: Drugs to treat disorder could create heart problems for children, researchers say.  Children under 18 who had ADHD and were prescribed methylphenidate were more likely to get an irregular heartbeat in the first two months, researchers said.”

Screen Shot 2016-06-07 at 9.49.38 PM

The little paragraph on Facebook didn’t mention any important facts, like what the article was that they quoted, or that the actual number of events linked with drug were miniscule.

That didn’t stop some clearly stupid people from publically venting their rancid opinions all over social media.

There were the usual paranoid delusions claiming that ADHD is over-diagnosed so that the American Psychiatric Association could get more funding from pharmaceutical companies.  Or that Ritalin has never been properly tested, and that children on Ritalin have been human experiments for the last 30 years.

Then there were all of the old chestnuts too, like ADHD is because of poor parenting or poor diet, or teachers with sub-par intelligence who aren’t challenging their pupils enough.  And who needs Ritalin anyway when all you have to do is stop feeding them artificial flavours and colours, high fructose corn syrup, GMO’s and fast foods.  Better yet, treat them with cannabis.

There were also some brazen displays of intellectual impotence within the heady mix of stupidity, like the people who suggested that children shouldn’t be given ANY drugs unless they’ve got diseases like cancer.  ‘Cause, clearly, paracetamol and penicillin are just as toxic as Ritalin.

Then there was the cherry on top:

“The doctor who came up with ‘ADHD’ and ‘ADD’ confessed on his deathbed that they were made-up diseases.”

Really??  Oh, come on, that’s both pathetic and grossly insulting.  ADHD is a real disease.  It’s been proven by real scientists and real doctors working in real labs and real hospitals.  Yet in the post-modern mind-bubble, an unverified viral meme on social media carries more weight than decades of scientific enquiry by some of the worlds smartest people.

For those of us who aren’t intellectual zombies, there was no death-bed confession about ADHD’s concoction.  According to a fact-check by Snopes.com, the doctor who ‘made up’ ADHD never said ADHD wasn’t real, but only that he thought the biological cause of ADHD was over-estimated.

Those who clearly knew nothing about ADHD or its treatment decided to further perpetuate their ignorance by embellishing and catastrophizing the “heart problems” that the Facebook headline alluded to.  Except that if they had bothered to review the article Facebook was referring to, they would have seen that there really wasn’t anything going on.

According to the article “Cardiovascular safety of methylphenidate among children and young people with attention-deficit/hyperactivity disorder (ADHD): nationwide self controlled case series study” [1], the only significant heart issue with Ritalin is a condition broadly classified as ‘arrhythmia’, which is medical speak for an irregular heart beat.  However, the peak risk for arrhythmia in the study was in children with congenital heart defects in the first few days of treatment.  For this, the relative risk was 3.49.  That means that a child with an already dodgy heart will have a three and a half times greater risk of an irregular heart rhythm than a child with a normal heart who’s not on Ritalin.  This sounds terrible, but “lies, damn lies and statistics” – in reality, the overall number of children who will actually get an arrhythmia because of Ritalin is still incredibly low because the total number of children who get arrhythmias is incredibly low.  Mathematically speaking, 3.49 x diddly-squat is still diddly-squat.

Besides, all of this is old news.  The current study was simply trying to use a larger source of data to get better statistics on case-reports of the possible effects of Ritalin.  But in the product information of methylphenidate, heart problems are clearly listed as a possible complication.  Because of this, and to ensure that Ritalin isn’t thrown around like candy, only medical specialists like paediatricians and child psychiatrists can start a child on medications like Ritalin.

So the reaction to the new study is nothing more than a storm in a tea-cup, but it clearly demonstrates the stigma and ignorance towards ADHD that, I’m ashamed to say, still exists in our modern, progressive society.

Is it any wonder then that parents actively avoid getting an assessment for their struggling children, or do everything they can to avoid Ritalin even when they have a clear-cut diagnosis of ADHD?  ADHD causes enough suffering by itself, but the baseless and incoherent ranting of the uninformed masses adds stifling layers of unnecessary stigma and misery to those who deserve our support, not misleading advice or irrational judgement.

References

[1]        Shin JY, Roughead EE, Park BJ, Pratt NL. Cardiovascular safety of methylphenidate among children and young people with attention-deficit/hyperactivity disorder (ADHD): nationwide self controlled case series study. BMJ 2016;353:i2550.

Dr Caroline Leaf – Increasing the stigma of mental illness again

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Let me tell you a story.

A couple of years ago, one of my patients was an elderly gentleman in his late seventies.  He was living in a nursing home at the time, but because of his history of psychosis, he remained on a treatment order – a requirement by law that if he was to remain outside of a mental facility, he had to have regular anti-psychotic medication every few weeks.

This man was on a treatment order because his disease caused him to have delusions.  He misinterpreted what was going on around him, and would not consider that he could be wrong.  In his particular case, he was convinced that his next-door neighbour was a paedophile, and he was planning to ambush his neighbour and castrate him.  Luckily the police had taken my patient into custody before he got the opportunity.  With treatment, my patient had clear thoughts, although needed close supervision.  Without his medication, he became confused and violent.

According to a post on the blog Mad in America and promoted by Dr Caroline Leaf, my patient’s diagnosis was spurious, and he was denied his basic human rights by being forced to take medications.

Dr Caroline Leaf is a communication pathologist and self-titled cognitive neuroscientist.  She is also a self-declared expert in mental health, despite not having any professional training in medicine, psychiatry, psychology or even cognitive neuroscience for that matter.

Indeed, if she had any experience or expertise in mental health, she would have recognised the basic factual errors and logical fallacies that riddled the post she quoted from.

Take the quote that Dr Leaf posted on social media.  The full quote from the Mad in America post is:

“Despite the fact that no one in history, not even the omnipotent American Psychiatric Association – which produces and profits mightily from the ‘Bible’ of mental disorders — has come up with a halfway good definition of “mental illness,” and despite the fact that the process of creating and applying the labels of mental illness is unscientific, any of those labels can be used to deprive the person so labeled of their human rights. This is terrifying. It ought to terrify those who are so labeled and those who are not, because deprivation of human rights on totally arbitrary grounds is inhumane and immoral.”

This is the same tired, emotionally laden and misleading rhetoric that’s so often barked in fervent paroxysms through the foaming lips of those opposed to modern psychiatric practice:

  1. There is no good definition of ‘mental illness’
  2. The American Psychiatric Association is just a profit-driven cabal
  3. The DSM5 (which the author alludes to as the ‘Bible’ of mental disorders) is unscientific
  4. Psychiatric diagnoses are unscientific
  5. Any psychiatric diagnosis can be used as a trigger to force people into unwanted treatments or incarceration
  6. Therefore psychiatric diagnosis and treatment is against basic humans rights and is inhumane and immoral.

Inhumane and immoral hey?  Tell that to my patients neighbour who almost became a eunuch except for that “inhumane and immoral treatment” of my former patient.

Caplan claims just don’t stand up to any rational scrutiny.

  1. There are lots of good definitions of mental illness … modern psychiatry critics just don’t like them. But take the definition used by the CDC, “Mental illness is defined as … ‘health conditions that are characterized by alterations in thinking, mood, or behavior (or some combination thereof) associated with distress and/or impaired functioning.’” There’s nothing wrong with this definition. It describes mental illness and helps differentiate mental illness from variations of mood, thought and behaviour that are part of the everyday human experience.
  1. The American Psychiatric Association isn’t the only group to have created a classification of psychiatric illnesses. The World Health Organisation publishes the International Classification of Diseases, or the ICD, which is also used for psychiatric diagnosis. Is the WHO an evil profit-driven junta too?
  1. The DSM, the ICD, and any other system of diagnosis, are simply different classification systems. Over the last century, clinicians have noted clusters of symptoms and have tried to classify them into common groups. How is that unscientific?  It’s no different to scientists looking at the different characteristics of various animals and creating a taxonomy, to provide a common system and language for clinicians and researchers across disciplines and across countries.The DSM system isn’t perfect, but what system ever is?  As knowledge of neuroscience grows, the classifications are reviewed and tightened in an ongoing process of improvement.  If those who oppose the DSM want to come up with something better, they’re welcome to put something forward.
  1. The old saying goes that medicine is an art and a science. Human beings, as nuanced as we are, often don’t fit into diagnostic criteria as easily as we would like. That doesn’t invalidate the diagnostic criteria or make the process unscientific as critics of modern psychiatry would have us believe, just like an unusual and hard-to-classify form of cancer doesn’t invalidate the other cancer classifications that are well defined.  Psychiatry, by it’s nature, relies on verbal report from patients rather than a clean-cut blood test or piece of tissue under a microscope, so at this stage in history, it seems imprecise.  That doesn’t make it any less scientific.
  1. The allegation that any psychiatric diagnosis can any be used to deprive the person so labeled of their human rights is utter nonsense. It’s a giant scarecrow – it seems really scary, but on closer inspection, it’s just a tarted-up mound of straw.People are never forced into treatments unless they really are “dangerous to themselves and/or others”.  This rule can’t be invoked willy-nilly.  There are multiple checks and balances, and a whole school of civil rights lawyers expectantly circling, ready for the whiff of blood in the water (http://www.mhrt.qld.gov.au/?page_id=2 is an example of the process in my home state, but each jurisdiction has their own version).

Caplan rightly pointed out that those with mental illness were less likely to be the perpetrators of violence and more likely to be the victims, but that doesn’t negate the need for protection of the community from those with mental illness who have shown violent intent and no capacity to control their behaviour.

If you want to find a group that really are suffering from inhumane and immoral deprivations of their human rights, then that would be Christians.  Around the globe, millions of Christians are oppressed, imprisoned, tortured, raped, and murdered every year.

Time and space preclude a full analysis of Caplan’s post, but what’s really important is that both the American Psychiatric Association and the U.S. Department of Health and Human Services’s Office of Civil Rights, an independent ombudsman, dismissed formal appeals by Caplan relating to her hysterical claims of inhumane forced psychiatric treatment.  Dr Leaf conveniently left that out of her social media post.

Instead, Dr Leaf chose to publish one of the most alarming quotes from an article heavy on scaremongering, from a disaffected author on an extremist blog.  If Dr Leaf was a real expert on mental health instead of being a self-declared one, she would have easily seen how nonsensical Caplan’s post was.

By posting this quote on social media today, it’s highly likely that Dr Leaf has caused harm to thousands of vulnerable Christians by unnecessarily increasing the stigma and fear of a mental health diagnosis.  This, in turn, is likely to lead to these same vulnerable Christians missing out on (drug and non-drug) treatment which would help them rise to their true potential in God and in life, leaving them trapped and suffering in their mental destitution.

Dr Leaf has a track record of misinformation when it comes to mental health.  Christians suffering mental illness need more support, not more stigma.  It’s time Dr Leaf stepped aside, and stopped making things worse.

Let boys be non-stigmatised boys

Boys will be boys ...

“When I was a boy …”

Many a stirring yarn has been started with those exact words, as aging men relive their childhood adventures with sentimental grandiosity increasingly taking over from detail as each passing year blends in with the blur of distant memories.

Ps Greg Gibson wrote an article that caught my attention as it floated across my Facebook feed last night.  Gibson is a pastor in Knoxville, Tennessee.  His “when I was a boy” story recalled his happy times as an energetic child, a serene innocence punctuated by two years of Ritalin-induced misery.

His point: “I think we should let boys be boys, and non-medicated ones at that. Therefore, parents, if at all possible, don’t medicate your boys.”

I think I understand what he’s trying to say, that it’s ok to be an energetic child and to see the extra energy as a strength to harness, not a weakness to control.

That would be fine, except that in trying to normalise energetic behaviour, he also winds up demonising Ritalin.  It may not have been his intention, but whenever someone respected in the community says something negative about stimulant medication or ADHD, it reinforces the oppressive stigma attached to those who suffer from it.

Ps Gibson’s fundamental assumption, that normal but energetic children are being misdiagnosed as ADHD and therefore unnecessarily medicated, happens far less often than the opposite – children with ADHD are misdiagnosed as energetic children that just need to be taught how to control themselves.

Personally, I don’t know of any parent who ever wanted to medicate their child with Ritalin.  If anything, it’s the opposite, because if your child’s on Ritalin, then you must be a lazy parent, or given them too much sugar, or too much screen time, or not hugged them enough as babies, or didn’t practice vaginal seeding, or whatever other form of parent-guilt is being perpetrated by the media at the time. Parents will do everything they can in their power to avoid using Ritalin, because of a culture that blames and shames.

Unfortunately, this means that children who could be helped by Ritalin or other stimulant medication are left behind, because ADHD isn’t the mislabeling of normal energetic children who just need better structure, or better posture, or who learn differently.  ADHD is a real disability, a dysfunctional lack of planning and control that’s abnormal compared to other children, affecting their entire lives.

For example, these children find it hard to play with other kids because they can’t follow basic social rules like the rules of games, or waiting their turn.  These children find school difficult, because they can’t concentrate for long enough to focus on completing a multi-step task, or have a long enough attention span to make new memories for words or facts.

One of my patients, a little boy about seven years old, was brought in by his mother because a chiropractor wanted me to arrange a blood test on his behalf.  When I asked why, the mother said the little boy had dyslexia which the chiropractor was ‘treating’ (actually, this chiropractor was blaming a disease that didn’t exist, and wanted me to arrange a test that was resigned to the pages of history, but that’s another story).  When I talked to the mother about the child’s symptoms, it was pretty obvious that he had ADHD, amongst other things.  After seeing a developmental paediatrician to confirm the diagnosis, and taking Ritalin for just one week, his reading improved three whole reading levels, and after a month, he had not only caught up, but had passed a number of his class-mates.

This is a real life example of how ADHD can hold children back, and how stimulant medication can help.  While there are always exceptions to the rule, stimulant medications help more often than they hinder.  They’re sometimes the difference between a child meeting his full learning potential, or being unnecessarily held back, languishing at the bottom of his class as his peers go further ahead in leaps and bounds.

Our culture needs to move on.  We need to stop our social prejudices making life more difficult than it already is for children and their families who battle with ADHD.  We need to see that medications for ADHD can be the difference between a life of learning and a life unfairly held back.

Let’s change the tune.  Rather than saying, “Let boys be non-medicated boys”, how about we say, “Let boys be non-stigmatised boys.”  It’s only through the break-down of the stigma surrounding ADHD and stimulant medications, that all boys (and girls) can truly meet their full potential, whether they have ADHD or are just a bit more energetic.

If you want more information on ADHD and its treatments, this is a good place to start: http://www.rch.org.au/kidsinfo/fact_sheets/ADHD_an_overview/

If you are concerned that you or your child might have ADHD, talk to your local GP or paediatrician.