The ample medication of people experiencing symptoms of a wide variety of psychological concerns has been heavily criticized in recent years, with many professionals working to push for greater attention to psychotherapy rather than pharmaceuticals. Amidst concerns over such medications and over the psychiatric profession as a whole, some within the community have taken to questioning the validity of psychiatry as a science, wondering if it may in fact be more of an art. In either case, many community members agree that while pharmaceuticals may be capable of helping to improve or even save the lives of many, there are also considerable issues surfacing within the field that must be addressed in order for the art –or the science– to move forward.

One of the greatest concerns brought to the fore in recent discussions about psychiatry has focused on whether rising rates of depression and anxiety are a logical result of a world that has grown increasingly complex, and, in some ways, more stressful. Proponents of the idea suggest that more widespread depictions of violence, increased distance between families, changing forms of social interaction, and other important lifestyle and environmental factors may be largely responsible for the presence of depression, anxiety, and other common concerns in the lives of modern people. As a result, they question the rationality of medicating such symptoms, arguing that doing so without promoting the resolution of these issues may lead to a population less able or willing to face its most important social concerns.

Of course, there are others who posit that the pursuit of easing unnecessary mental and emotional suffering is necessarily relevant and good, and that psychiatry has been and will continue to be a major contribution to the well-being of scores of people. Through continuing the debate, mental health community members and concerned professionals are bound to help enhance their understanding of the meaning and the utility of psychiatry.

Click here to contact Nicole and/or see her GoodTherapy.org Profile.

As a holistic psychotherapist, I think of depression as a natural part of life. While it isn’t fun, it is necessary for our deepest spiritual evolution. Dealing with depression enhances our resilience and self-confidence, both of which develop when we are challenged.

The more we accept our darker emotions, the less daunting their visits. When the Buddha was becoming enlightened under the Bodhi tree the demons came to frighten him. Finally, after days of wrestling with them to no avail he invited them to tea. They still tried to scare him, but he had changed his attitude, lessened his aversion, and reached enlightenment.

The Hassidic Jews have a practice of thanking god for everything, good or bad, because they believe everything is from god; and, therefore, good.

In 13th century Persia, Rumi wrote his poem The Guest House, in which he suggested opening oneself to everything.

THE GUEST HOUSE




This being human is a guest house.
Every morning a new arrival.
A joy, a depression, a meanness,
Some momentary awareness comes
As an unexpected visitor.
Welcome and entertain them all!
Even if they are a crowd of sorrows,
Who violently sweep your house
Empty of its furniture.
Still treat each guest honorably.
They may be clearing you out
For some new delight.
The dark thought, the shame, the malice,
Meet them at the door laughing,
And invite them in.
Be grateful for whoever comes,
For each has been sent
As a guide from beyond.


It is easy to think of depression and sadness as opposite ends of a continuum, but they are two separate lines. One goes from a little sad to very sad, while the other moves from a little depressed to extremely depressed. Why distinguish them this way? Because a ton of sadness never equals a scintilla of depression; and, a smidgeon of depression never equals a ton of sadness. They are very different emotions. Depression is a full body experience, while sadness is not. You can still function when sad, but it is very challenging to do even the simplest task when depressed.

A recent article in Newsweek, “The Depressing News About Antidepressants,” by their premier science writer Sharon Begley, is a comprehensive assessment of the efficacy of anti-depressants. Her major conclusion was that 82% of the positive response to antidepressants had also been achieved by a placebo. Frankly, I find this incredibly wonderful news as it shows the untapped power of the mind. Ms. Begley also reported, “Only in patients with very severe symptoms was there a statistically significant drug benefit. Such patients account for about 13% of people with depression.”

As a holistic psychotherapist who typically avoids the use of antidepressants, her article also reminded me of how other countries suggest herbs, psychotherapy, exercise, etc. as a first line of treatment, not pharmaceuticals.

There are many holistic techniques that can help someone overcome depression. Even the foods you eat and when you eat them can have a powerful effect on your state of mind. I have treated people who thought they were depressed but upon closer inspection realized their blood sugar was chronically low, producing symptoms and mood fluctuations that mimicked depression.

Herbs might include: St. John’s Wort (the first suggestion a typical doctor in Germany will make for mild to moderate depression), Kava (for anxiety that can accompany depression), Melissa (to help quiet repetitive thoughts).

Nutritional supplementation with 5HTP, fish oil capsules, and Vitamin D.

Homeopathic remedies, which should be chosen on the basis of your constitution by a trained homeopath.

Bach Flower Remedies, including Rescue Remedy, are the most gentle option; yet, they can be a powerful ally.

Aromatherapy with Lavender has been shown to decrease the physical aches and pains that often accompany depression and helps with insomnia. Peppermint, and other essential oils, are mood elevators.

Yogic breath work, preferably taught to you by a trained yogi, can be remarkably calming or energizing, depending on the practice.

Certain foods, like chocolate, have been known to improve mood. See my article, “Chocolate’s Healing Powers,” for more details.

Yoga, meditation, walking in nature, prayer, gratitude practices, positive psychology, music, poetry, journaling, and mantras can all help enormously to lift you out of despair.

Recent research has shown that simply doing one’s accounts improves mood.

Last but not least, is the positive effect of unburdening oneself to a trusted friend, relative, or therapist.

Depression may feel lousy, but one sure-fire way to make it worse is to tell yourself it’s horrible, awful, unbearable, and that being depressed makes you a bad person. It is hard enough to deal with depression without heaping on self-criticism. This is the time to be extraordinarily gentle, loving, and kind to yourself. Try Robyn Posin’s “Rememberings and Celebrations” cards to shift your perspective.

There are many wonderful books that can help you accept depression, and teach you how to re-frame the experience as a conduit to greater appreciation for life, in all its guises. The older I get the more I believe we are here, in these bodies, to experience the full range of life, not just the highs.

A few of my favorite books that help you embrace all emotions are:

• Radical Acceptance: Embracing Your Life with the Heart of A Buddha by Tara Brach.
• Healing Through the Dark Emotions: The Wisdom of Fear, Grief, and Despair by Miriam Greenspan.
• When Things Fall Apart by Pema Chodron (a Buddhist nun) Her CDs are also excellent.
• How To Stubbornly Refuse To make Yourself Miserable About Anything, Yes, Anything! by Dr. Albert Ellis (Dr. Ellis was the founder of Cognitive Behavior Therapy which he called: Rational-Emotive Behavior Therapy.)
• Ask and It Is Given by Esther and Gerry Hicks. A new age and highly positive version of cognitive behavioral therapy. (Their CDs are also excellent.)
• Sharon Begley has another interesting article on “The Upside of Feeling Down.”

If you think you might be depressed, you can take the Beck Depression Inventory, a very reliable assessment tool I have been using for 30 years. Here is a link to the test with scoring instructions.

If you get a high score you may want to consult with a counselor or therapist, but bear in mind your score changes from day to day.

**WARNING: If you are currently taking medication please make sure you contact your doctor before making any changes to your regimen. Abruptly decreasing your dose, or stopping medication, can result in unwanted side effects.**

©Copyright 2010 by Nicole S. Urdang, M.S., NCC, DHM. All Rights Reserved. Permission to publish granted to GoodTherapy.org. The following article was solely written and edited by the author named above. The views and opinions expressed are not necessarily shared by GoodTherapy.org. Questions or concerns about the following article can be directed to the author or posted as a comment to this blog entry. Click here to contact Nicole and/or see her GoodTherapy.org Profile

Click here to contact Jill and/or see her GoodTherapy.org Profile

Remember that feeling of lust, excitement and warm romantic love that comes at the beginning of a new relationship? It turns out that it’s vital for the long-term health of the relationship, and it may be threatened by the prescription drugs you’re taking.

That’s the conclusion of an article by Rutgers University anthropologist Helen Fisher, who has been exploring the biological basis of sex and love around the world for more than twenty years. If you take SSRI (selective serotonin reuptake inhibitor) anti-depressants (such as Prozac, Zoloft or Celexa) you have hopefully been warned by your doctor about libido suppressing side effects. Fisher argues that SSRI’s not only blunt sexual interest, but also the ability to love.

If she is correct, millions may be suffering from a side effect that can’t really be confirmed by research trials. Because how do you “measure” love or the ability to love, care and connect with another person – sexual or celibate?

As we learn more about the brain and its effect on sexual drive, we’re finding that each neurotransmitter sets off a chain reaction when it’s affected, radiating to other neurotransmitters and hormones. SSRIs elevate serotonin levels, but at the same time decrease dopamine (“feel good”) levels, leading to decreases in the levels of testosterone and estrogen that fuel the sex drive.

Dopamine is connected with hormones that bring feelings of calm, security, trust, and social attachment, all extremely crucial emotions that help us to feel closer to our spouse, mate, or partner. The majority of people who seek therapy for relationship problems are suffering from very low dopamine levels, as well as sexual problems.

The guy who can’t maintain an erection or the woman who can’t reach orgasm might be blaming the SSRIs that they’ve been taking to make their depression go away. But Fisher argues that these difficulties are about much more than simple dysfunction. She says that it’s about a decreased ability to feel love and connection. Because dopamine is reduced, the ability to feel love and connection may also be reduced, affecting not just sex but all relationships.

As an anthropologist Fisher has conducted extensive cross-cultural studies that lead her to postulate that “lust” is inextricably interrelated to romantic love and long-term attachment or connection with a beloved. “Just as you can’t affect serotonin without affecting other brain chemicals, “ she opines, “you can’t dampen lust at the beginning of a relationship, or the romantic love that often develops out of lust, without also damping the desire for long-term attachment.”

This cycle of lust, romantic love, and long-term attachment is the same all over the world, in all cultures. Fisher reports a Bushman woman saying, “When two people are first together their hearts are on fire. After a while, the fire cools, and that’s how it stays. They continue to love each other, but in a different way–warm and dependable.”

Some couples who call me are not at all happy with the “different and dependable” form of love that the African woman describes. They yearn for the feelings that SSRIs “cure”: intense energy, ecstatic highs, and intense yearning and motivation to “win” the preferred mating partner. When we ‘mate in captivity’ – in domestic ease – that drive is no longer present.

The poet W.H. Auden defined sexual desire as “an intolerable neural itch.” SSRI antidepressants, Fisher believes, might scratch that itch so strongly that we scrape off the layer of our brains that’s driven us to lust, love, and bond with one another. I’d love to hear from those of you taking SSRIs when you respond to this posting in the GoodTherapy.org blog-o-sphere!

©Copyright 2010 by Jill Denton, LMFT, CSAT, CSE, CCS. All Rights Reserved. Permission to publish granted to GoodTherapy.org. The following article was solely written and edited by the author named above. The views and opinions expressed are not necessarily shared by GoodTherapy.org. Questions or concerns about the following article can be directed to the author or posted as a comment to this blog entry. Click here to contact Jill and/or see her GoodTherapy.org Profile

The effects of combat on the psychological health of soldiers deployed in wars have been show to cause serious detriment to well-being and mental health, with a number of veterans developing symptoms of Post-Traumatic Stress Disorder, or PTSD, after their return home. The US military, swarmed with recent stories about rising rates of suicide among its servicemen and women along with high numbers of cases of an array of mental health concerns, has been looking for ways to respond to soldier needs. While their results have been criticized as disappointing by some, a recent study performed at the Naval Research Center in San Diego has found that in particular, quick-response administration of morphine after wounding may play a major role in preventing future onset of PTSD.

The study analyzed information on wounded soldiers treated for wounds sustained in the war in Iraq between 2004 and 2006. A significantly higher number of veterans who did not eventually develop PTSD had received a morphine shot within an hour of being injured than did those veterans who exhibited symptoms of the mental health concern at a later date. Describing the shot as a potential “morning after pill,” observers have noted that while promising, the treatment also requires further investigation to understand which element or elements have the most meaningful impact on hurt soldiers.

The treatment’s strength may at least in part reside in its speed; though morphine may have an important impact on memory and cognitive processes, the researchers found that the severity of the wounds had no apparent relation to the success of the treatment. Serving soldiers with psychotherapy or other types of non-invasive care on the spot may also become an important part of first aid response for soldiers.

Though the prevalence of therapists and other dedicated mental health professionals is growing in many places throughout the world, many people facing personal concerns first discuss such issues with a general practice physician who may not have or know of local resources for specific issues. The mental health charity Mind has recently released statements calling for the improvement of such resources in needy communities to provide adequate treatment options for doctors and their clients. The statements coincide with evidence from the Mental Health Foundation showing that around three quarters of general practice physicians in the UK have admitted to prescribing medications despite suspecting that other treatments would be more beneficial.

Concerns over the rate of prescriptions for anti-depressant medications in the United States have been steadily rising for some time, as critics suggest that the treatment option alone is sometimes unnecessary or inadequate, and may not provide long-term solutions. Recently, those in favor of promoting different treatment modalities such as psychotherapy and counseling have gained support from a study based at the University of Pennsylvania at Philadelphia, which shows that while the drugs can be significantly effective for clients diagnosed with “severe” depression, those with mild to moderate symptoms are likely to receive a much greater benefit from other treatment options.

The study was based on the work of six previous studies on the efficacy of certain psychiatric drugs, and forms a more comprehensive view of the potential of such drugs to impact the lives of a wide range of clients. In many initial studies of antidepressants, notes the study, trials are arranged to ensure the greatest chance of winning approval from the Food and Drug Administration, and additional considerations may not be given the attention the deserve.

Psychotherapy and other types of mental health treatments may benefit greatly from the study, as more general practice physicians become aware of the potential for more meaningful care through such services, and avoid prescribing medications in inappropriate situations. The information should also be adequately distributed throughout the public consciousness, as clients have traditionally been exposed to considerable amounts of advertising from pharmaceutical companies positing their ability to help with mental health concerns. While many clients may still benefit from the use of such medications, the prevalence of therapy and counseling for moderate issues is bound to become greater as further academic work is produced.

As the financial and emotional costs of depression and other mental health concerns become more prominent throughout the United States and around the world, the understanding of why people may not seek treatment, or may receive inadequate services, is becoming more important as well. A recent discussion in the Wall Street Journal looks at two studies focusing on startling statistics for those with mental health difficulties. One study notes that only half of those affected receive care, and a fourth receive care considered as being on par with modern standards. The second study shows that the prescription of two-–or even three–psychiatric medications in tandem has risen substantially as a type of treatment, sometimes in defiance of industry regulations.

Most modern anti-depressant and anti-anxiety medications are criticized by many in the mental health community due to their abundant use and low probability of definitively providing a meaningful solution to mental health concerns. A study at Northwestern University has stirred up additional debate over the drugs thanks to its findings that many of those exposed to a certain medication experience deep personality changes in two of five major criteria. The findings are a cause for celebration for some, but raise concerns for others, who may question the wisdom of altering seemingly intrinsic personality traits. The debate is likely to continue as psychotherapy and medications struggle to receive honest assessment and use.

A rising concern among the mental health professions in the past few years has been the prevalence of psychiatric medications among those with mental health issues. From over-prescription to the suggestion that major pharmaceutical companies conduct questionable advertisement campaigns and other practices to lure doctors and clients alike, the issue has sparked considerable contention. Helping to dissuade the notion that such companies are outright running the modern face of mental health, however, the National Alliance on Mental Illness of Massachusetts has released a report stating that less that fifteen percent of its donations come from drug companies. The report, released on Tuesday to a congressional investigation committee, notes that the organization refuses all donations from parties that make requests about how the money should be spent. Though doubts about the industry are likely to persist, the report may help ease the worries of some concerned community members.

Click here to contact Matthew and/or see his GoodTherapy.org Profile

The American Psychiatric Association defines attention-deficit/hyperactivity disorder (ADHD) as a “persistent pattern of inattention and/or hyperactivity-impulsivity that is more frequently displayed and more severe than is typically observed in individuals at a comparable level of development” (1). ADHD is further indicated by three subtypes; predominately hyperactive-impulsive type, predominantly inattentive type, and combined type. According to the APA, ADHD primarily affects school-age children, approximately 3%-7% of all children in the U.S, (1), with approximately 30-50% retaining the disorder as adults (2). Not only are these numbers cause for concern, they are increasing: there has been a three or four-fold increase in diagnosis of ADHD since the late 1980s (3).

Undoubtedly ADHD is a serious problem, though ADHD is largely, and suspiciously, an American problem. For every two hundred and fifty U.S. children diagnosed and treated with ADHD, only one child would similarly have been diagnosed and treated in all of Germany, England, France, and Italy combined (4). In England alone, the rate of clinical diagnosis is estimated as only about 1 in 3000 children, or 0.3% (5). ADHD as a diagnosis is virtually unknown in Japan (6), and many other countries. Clearly ADHD has been woven into the cultural fabric of our nation, and our nation in particular. Or is it the other way around. In this paper I will explore how Attention-Deficit/Hyperactivity Disorder relates to, and in many seemingly conspicuous ways parallels, socio-historical developments within the country that gave it birth. I will propose that U.S. cultural values and expectations not only exposed the so-called problem of ADHD, but first helped create it. I will further argue that the label ADHD is not so much a road sign to a mental disorder, but more a road sign to a social one. Lastly, I will suggest that if we are to have any hope of reversing this growing problem, we as helping professionals need to turn our attention outward, to the social matrix that sustains and reinforces it.

So what is this thing called ADHD, and where did it come from? (Or has it always been there, laying in wait to be “discovered?”) I am going to go out on a limb and say that there have always been overly energetic, rambunctious children. I was one of them. So when did this become a mental illness? That ball seems to have got rolling around the turn of the century with the 1902 lectures of George Fredrick Still to the Royal College of Physicians in England, in which Still presented twenty children from his clinical practice who exhibited poor impulse control, or what he called “inhibitory volition.” (7) Still proposed that these children shared a basic “defect in moral control,” which he related to a biological defect inherited from some sort of injury at birth. Of course, the roots of Still’s work, and the oh so American diagnosis of ADHD, go back further than 1902, to the sociohistorical context that made it all possible.

Nearly 60 years earlier, in Philadelphia, a group of thirteen psychiatrists organized and established the Association of Medical Superintendents of American Institutions for the Insane, the forefather of the American Psychiatric Association (8). At the time, a psychiatrist’s job was largely “an institutional and legal task,” (9) with most psychiatrists working or training in asylums, dealing in “madness.” American psychiatry was then, as it is now, grounded in the physiological model of illness, emphasizing organic brain damage, heredity, and moral degeneracy as the causes of mental illness (10).

As the 19th century progressed, so did the “business” of madness. The diagnostic criteria for insanity significantly broadened, while new mental disorders such as hysteria and neurasthenia were being “discovered” and increasingly diagnosed (10). What Hippocrates defined as a “disease of the womb” over two thousand years prior suddenly become reborn by Victorian era physicians (like Jean-Martin Charcot) as a nervous disorder, purportedly caused by sexual repression, perverted habits of thought, and/or idleness. This new hysteria was diagnosable by any number of symptoms, including faintness, nervousness, insomnia, fluid retention, heaviness in abdomen, muscle spasm, shortness of breath, irritability, loss of appetite for food or sex, and a “tendency to cause trouble” (11). Of course, what also hadn’t changed in some two thousand years was the fact that this new “disorder” primarily affected those people born with a uterus. In 1859, a physician claimed that a quarter of all women suffered from hysteria (12).

While some Americans were enjoying the spoils of the Industrial Revolution (roughly 1760-1830) and the subsequent economic expansion of the mid- to late nineteenth century, the gap between the social classes was widening, as was the power differential between men and women, especially amongst the upper and middle classes. Women in Victorian America (1837-1901) were increasingly restricted, desexualized, and kept from positions of power (10). Besides domesticity, women were expected to be pious, pure, and submissive to men (12), forcing many educated and politically motivated women into constricted and powerless lives.10 Without a voice, without an outlet for the anger and angst, despair and disaffection that the Victorian woman must have felt, it’s no surprise that these sentiments would, as Philip Cushman (1995) writes, “show up in forms that were accessible within the Victorian horizon of understandings: as somatic symptoms. Physical symptoms were one of the few avenues of expression available to women within the Victorian terrain.”

The same sociopolitical milieu that limited those without a voice to psychosomatic expression, also limited American physicians to biological explanations. That was their frame of reference. A generation later (1920’s), Freud would understand hysterical symptoms as “symbolic representations of a repressed unconscious event, accompanied by strong emotions that could not be adequately expressed or discharged at the time” (13). Although both Freud and his American counterparts situate the problem within the individual (in this case, within the woman), for Freud, hysteria was rooted in repressed emotions, not biology, stemming from unintegrated trauma. Freud’s theory spoke to the social and situational nature of emotional distress, albeit in individualistic, intrapsychic terms. American physicians, on the other hand, explained the emotional distress these women were experiencing as neurological dysfunction, likely from a genetic defect. By explaining what was largely a product of social disorder in terms of mental disorder, by placing the impetus for change on the individual, rather than sociopolitical institutions and conditions, these doctors unknowingly became part of the very problem they were trying to treat. These women needed a voice, instead they were told they were ill (and likely born that way). In doing so, these doctors overlooked and unwittingly exonerated the sociopolitical structures that made them so, while further internalizing pathology. The symptoms of hysteria were a call for help, a sign of times that needed changing. Unfortunately, not many listened. Which brings us to neurasthenia.

Neurasthenia, as a diagnostic category, was developed in 1869 by American neurologist George Miller Beard. Neurasthenia, like hysteria, was characterized by a wide range of symptoms, including “general lassitude, irritability, lack of concentration, worry, and hypochondria,” (14) which Beard believed resulted from a deficiency in nervous energy, or “nervous exhaustion.”10 Beard, looking across the ever-expanding, ever-accelerating social terrain of modern America, believed this “nervous exhaustion” to be a result of the stresses of urbanization and the pressures of an increasingly competitive business environment (15). He also saw it as affecting men more than women (16), although women were considered particularly vulnerable, due to their “weaker nervous systems” (17). While initially a disease of the upper classes, neurasthenia rapidly spread throughout the social classes,18 so much so that by the turn of the century neurasthenia was being described as “the fashionable disease.”17 Across the Atlantic, neurasthenia was being referred to as “the American Disease” (18).

America post-Industrial Revolution was ambitious and energetic, and expected as much from its citizens. With the U.S. expanding economically, as well as geographically, the country needed its citizens to have initiative and be hard working. That’s what was valued, that’s what was promoted. Seen in this light, it’s no surprise that the absence of these traits would come to be considered an illness. To his credit, Beard recognized the psychosocial nature of neurasthenia, but like his contemporaries, he too located the problem within the individual, and looked to treat it there. Beard reasoned that since neurasthenia was an exhaustion of nervous energy, those afflicted needed a recharge or a jumpstart. Keeping with the belief of the time that electricity was vital to proper functioning of the nervous system, 16 Beard (not coincidently a friend and collaborator of Thomas Edison) treated his patients with low-voltage electricity administered directly to the body, what he called “electrotherapy” (10). This “treatment” remained popular even after Beard’s death in 1883, although serious doubts about the efficacy of electrization began to appear in the 1890’s (19). What Beard knew as neurasthenia died shortly after World War I, and with it died the shared messages of those who somatically protested a society growing increasingly competitive and capitalistic, urban and isolated. Once again, nobody really listened, and time goes on.

At the turn of the 20th century, while Psychoanalysis was slowly emerging in Europe, the Eugenics movement had already landed on American shores and was taking root (20). The work of Francis Galton (1822-1911), borrowing heavily from his cousin Charles Darwin (1809-1882), was furthering the notion that individual differences, including mental illness, were largely hereditary (21). Galton’s work both reflected and reinforced American pragmatism (itself a reflection and furthering of post-Enlightenment scientific reductionism), which seemed to be looking for an empirical cause and cure for everything. With no cure for mental illness in sight, and with increasing acceptance of organic causes as opposed to environmental ones, there was increasing pessimism as to treatment of mental disorders. American psychiatry, joining with the spirit of the times, began focusing more on categorization and studies than on treatment (8).

Like his psychiatric brethren, George Still was also looking for the biological causes of mental illness. But what distinguished Still, and his 1902 lectures, was the fact that Still was the first (at least publically) to look at children who were inattentive and highly misbehaving through the lens of mental illness (22). Still didn’t see these behaviors as learned, much less psychosomatic, he saw them as being caused by something wrong with the brain or body (22). Even though there was no evidence to support Still’s theories, his work focused on childhood behavior, clearing a path for what was to become the disease theory of attentional problems.

American interest in childhood behavioral problems rose dramatically shortly after WWI, following a major epidemic of encephalitis (1917 to 1928) that affected large numbers of children.7 Physicians began noticing that many of the children who survived the brain infection exhibited impairment in attention, activity regulation and impulsivity, symptoms that came to be known as Postencephalitic Behavior Disorder (7). For those looking for biological causes of childhood mental illness, here was pretty clear evidence that damage to the brain can effect behavioral problems. With newfound evidence in tow, researchers of the 1920s and 30s began studying other childhood sources of brain injury, including birth trauma, lead toxicity and epilepsy, and their relationship to behavioral problems.

The 1930s also saw the first use of stimulant drugs to treat behavioral problems, by American psychiatrist Charles Bradley (7). Bradley had been treating children who suffered post-pneumoencephalography headaches with Benzedrine, speculating that the stimulant would spur the production of more spinal fluid. The Benzedrine did not do much for the headaches, but teachers noticed that some of the children taking the stimulant experienced a striking improvement in their schoolwork (23). Bradley, looking to replicate these findings in children with behavior problems, set up a controlled trial with 30 such children. The results of the study, published in the American Journal of Psychiatry (1937), showed that 14 of the 30 subjects exhibited a “spectacular change in behavior (and) remarkably improved school performance,” during one week of treatment with Benzedrine (23). These landmark results established the utility of psychostimulants in the treatment of behavioral problems, while lending further credence to the disease (biological) theory of attentional problems.

The 1939 German invasion of Poland marked the beginning of World War II (1939-1945), and the coming of widespread social changes across Europe, America, and throughout the world. The fighting and instability in Europe drove many psychoanalysts to flee the continent, most of whom settled in England and America (24). Naturally, this migration had a major affect on American psychiatry. Freud’s 1909 visit to Clark University had already planted psychoanalytic seeds that had been growing for decades. Now there were more gardeners. By the 1940s the majority of the world’s psychoanalysts lived in America (25), and psychoanalysis was growing increasingly popular and influential within American psychiatry, and within the American cultural landscape. More on this later.

The end of World War II (1945) ushered in an era of unprecedented economic growth in the U.S., and of course, more social change. While the war cost over 400,000 Americans their lives, it also mobilized the American workforce, cut unemployment, and increased commercial productivity. A surge in jobs and manufacturing, together with newfound disposable income and rising consumer confidence, made for an economic boom (as well as a “baby boom”). Of course, the two main industries leading America’s post-war economic charge: cars and television.

Television was formally launched in July 1941 when the FCC authorized the first two commercial TV stations (26). By January 1942, Pearl Harbor had been attacked, America had entered the war, and nearly all television broadcasting worldwide had come to a screeching halt (27). By the time the war had ended in 1945, nine commercial TV stations were authorized, but only six of them were on the air. Early television, constrained by poor picture quality, a lack of quality programming, and a relatively high price tag, showed only modest public interest. In 1946 only 0.5% of U.S. households owned a television set (27).

As the number of TV stations and quality programs continued to grow, and the price of TV sets continued to drop (as a result of mass production and technological advances), the demand for television steadily increased. In 1950 8.8% of U.S. households owned a TV.28 By 1954, the year color TVs hit the market, the percentage of households with a TV had risen to 55.7% (27). By 1962, the year the Beatles first appeared on TV, 90% of American homes owned at least one television set (27) Television was no longer a luxury item, it had become an integral part of the culture, an American way of life.

The TV boom of the 1950s was largely fueled by TV ad revenues (29), the money behind increases in production, technological advances, and station expansion. The effectiveness of TV ads, vis-à-vis merchandise sales, in turn fueled the rapid growth and influence of corporations. Naturally, as the popularity and influence of TV and TV ads rose, so did the cost of air time, which of course resulted in shorter and more frequent commercial spots (29). TV had become the center of American attention, commercials gave them much more to attend to. Which brings us back to our previously scheduled program.

In the late 1940s neuropsychiatrist Alfred E. Strauss and colleagues at the Wayne County Training School in Northville, Michigan, had been studying the psychological effects of brain injury in a group of mentally retarded children (7). Based on their findings, Strauss and his colleagues isolated a number of behavioral characteristics, such as aggressiveness, impulsivity, distractibility, and hyperactivity, which they believed could discriminate between groups of mentally retarded children with and without brain damage. Hyperactivity was seen as the most valid indicator (30). Strauss generalized these findings to all children displaying these characteristics, presuming that they too had what he called “minimal brain damage.” For Strauss, children with “MBD” were essentially overstimulated, due to their inability to filter out extraneous stimuli, and therefore acted out (30).

Around the same time the American Psychiatric Association was busy working on the Diagnostic and Statistical Manual of Mental Disorders (DSM). The purpose of the DSM was to create a common nomenclature based on a consensus of the contemporary knowledge about psychiatric disorders (31) The APA sent questionnaires to 10% of its members (who were mostly analysts), asking for comments on the proposed categories. The final version, which assigned categories based on lists of symptoms, was approved by vote of the membership and published in 1952 (31). The DSM-I included three categories of psychopathology: organic brain syndromes, functional disorders, and mental deficiency. These categories contained 106 diagnoses. Only one diagnosis, Adjustment Reaction of Childhood/Adolescence, could be applied to children (31). There was no mention of “hyperactivity.”

Throughout the 1950s the concept of “minimal brain damage” gained considerable popularity and influence, at the same time, its rise to prominence was met by widespread criticism. Strauss had no hard evidence to support his theories, and needless to say he was taking quite a leap by assuming that children had brain damage simply by looking at their behavior. In 1963 the Oxford International Study Group of Child Neurology released a publication which stated “that brain damage should not be inferred from behavior alone” and suggested replacing the term minimal brain damage with “minimal brain dysfunction” (32). And so it was. “Minimal brain dysfunction” became the latest in a growing line of fashionable terms for hyperactivity, only to be supplanted, like its predecessors, a few years later.

In 1957 American psychiatrist Maurice Laufer, a student of Charles Bradley, coined the term “hyperkinetic impulse disorder” to describe children who presented with a hyperactive pattern of behavior. Based on his work with emotionally disturbed children, Laufer concluded that hyperactivity was not a result of childhood disease or brain injury, but rather a symptom of developmental delay of the central nervous system (33). Laufer, like his mentor, asserted that stimulant drugs were the treatment of choice for this “disorder.”

Three years later, in 1960, an article published by eminent child psychiatrist Stella Chess (also an American) furthered the notion that hyperactivity, or what she called “hyperactive child syndrome,” was biological in nature, rather than the result of an injury. Although seemingly more concerned with classification and clinical descriptions than etiology, Chess believed that this “syndrome” was genetically inherited, and relatively common. Chess described a child with hyperactive child syndrome as “one who carries out activities at a higher than normal rate of speed than the average child, or who is constantly in motion, or both” (34). Evidently, Chess’ hyperactive child syndrome was a bit more benign than what George Still described as a “defect in moral character,” or what Alfred Strauss thought was “minimum brain damage.”

It was around this time, the 1950s and 60s, that the perspective on hyperactivity taken in the U.S. began to diverge from that taken in Europe, particularly in Great Britain (34). As you can see in the work of Laufer and Chess, American psychiatrists increasingly saw hyperactivity as a relatively common behavioral disturbance of childhood, not typically associated with symptoms of brain damage. Laufer shrewdly acknowledged that most normal children display some degree of hyperactive, impulsive behavior, asserting that hyperactivity was but an extreme degree of such behavior.

Most European psychiatrists, on the other hand, continued to see hyperactivity as an extreme state of excessive activity that was highly uncommon, and that usually occurred in conjunction with other signs of brain damage (such as epilepsy or retardation) or insult (such as trauma or infection) (34). This divergence in views led to large discrepancies between American and European psychiatrists and psychologists in their estimates of prevalence rates, diagnostic criteria, and preferred treatment modalities, discrepancies which remain (although to a lesser extent) even today.

In 1968 an eight-member committee of the American Psychiatric Association developed and revised the DSM, publishing the DSM-II. The main goal of the DSM-II was compatibility with the International Classification of Diseases , 8th edition (ICD-8), to further facilitate communication among professionals (35). After the “revision,” which borrowed heavily from the ICD-8, the DSM contained 11 major diagnostic categories, and 182 diagnoses (31). The DSM-II, like its predecessor, described disorders as “reactions,” reflecting the psychoanalytic view that mental disorders were reactions of the personality to biological, psychological, and social factors (while also reflecting the enduring popularity and influence of psychoanalysis within the APA).

The DSM-II also paid increased attention to the problems of children and adolescents, adding the category Behavior Disorders of Childhood/Adolescence. This category included “Hyperkinetic Reaction of Childhood,” the DSM’s first recognition of hyperactivity, thought by many to be the precursor to A.D.D.7 The diagnosis was based, as ADHD is today, on behavioral criteria, particularly activity level, with little emphasis on symptoms of inattention (36). Hyperkinetic Reaction of Childhood immediately became the standard psychiatric term for hyperactivity, with terms like minimum brain dysfunction, hyperkinetic impulse disorder, and hyperactive child syndrome virtually disappearing from the psychiatric landscape (31).

Although psychoanalytic thought was very much a part of the DSM-II, the 1960s and 70s saw a rapid decline in the popularity and influence of psychoanalysis within the U.S. The psychopharmacological revolution ushered in by the development, widespread use, and effectiveness of pychotropic medications such as benzodiazepines (like Valium), anti-psychotics (like Thorazine), and lithium, brought with it increasing doubts about the effectiveness of “the talking cure” (37). Neuroscience was uncovering increasing evidence relating brain functioning, in this case malfunctioning, to neurosis. Psychoanalysis had nothing to offer in the way of biological evidence. Biological psychiatry (i.e. psychopharmacology) appealed to American pragmatism, was compatible with the increasingly popular and influential field of Behaviorism, and it “worked.” For these reasons, biological psychiatrists rapidly grew in number and in influence, taking over many leadership positions in the field of psychiatry (37), and within the APA.

In 1969, America experienced another revolution, in children’s television. Children of the sixties had been enjoying shows such as Romper Room, Captain Kangaroo, and Mr. Rogers’ Neighborhood, all in black and white until the mid 1960s. These shows were characteristically simple and calm, centering on interpersonal (and inter-“puppetal”) relations and relationships. They emphasized creative thought over comprehension, life lessons over vocabulary lessons, and they did it all with little or no animation.

In 1969, Sesame Street made its television debut. This innovative children’s show intermixed humans, puppets, and animation, within small, rapidly changing skits designed to be like commercials- quick, catchy, and memorable. It utilized bright colors, flashy graphics, and catchy phrases and songs (i.e. constant visual and auditory stimulation) to grab and hold the attention of America’s children (which for busy parents was, as you can imagine, a godsend). Needless to say, Sesame Street was an instant success, reaching more than half of the nation’s 12 million 3 to 5 year-old children in just its first season (38), quickly becoming the model for children’s television.

Sesame Street could not have been introduced at a more opportune time. In the 1960’s and 70’s the divorce rate in the U. S. rose dramatically (39), and with it, so rose the number of single parent homes. To make matters worse, the 70s also saw a dip in the economy and a dramatic rise in the cost of living (40), making dual incomes an increasing necessity. Many parents had to return to work, work harder and longer, or even take second (or third) jobs to make ends meet. Understandably, parents had less and less “quality” time to spend with their kids. America’s children, as children do, needed stimulation and attention (which the TV characters provided). Busy, overwhelmed parents needed a babysitter. Shows like Sesame Street offered both.

While Sesame Street helped children learn to spell, to count, to do math, even to sign, it also created the expectation that learning should be fun, all of the time. In neurological terms, sustained exposure to highly stimulating shows like Sesame Street develop areas of the brain that scan and shift attention at the expense of those that focus attention (41), conditioning the brain to generally expect such stimulation and variety. Now imagine a child who has (literally) grown up with shows like Sesame Street being asked to sit at uncomfortable desks for hours at a time, listening to monotone lectures in monotonous environments, where the child is no longer the center of attention (as they are when they watch Sesame Street). Given what these kids are used to, is it not understandable why they would be restless and easily distracted at school?

In 1971, Canadian psychologist Virginia Douglas, in a Presidential address to the Canadian Psychological Association, presented her theory that deficits in sustained attention and impulse control were more likely to account for the difficulties of these children than hyperactivity. Based on her research, Douglas argued that hyperactive children were not necessarily more distractible than other children and that sustained attention problems could emerge under conditions where no distractions existed (42). Douglas’s research and ideas were published the following year (1972) in the landmark article Stop, look and listen: The Problem of Sustained Attention and Impulse Control in Hyperactive and Normal Children, an article that almost single-handedly shifted the focus of research within the field from hyperactivity to attention issues. By the end of the 1970s there were over 2,000 published studies on attention deficits (7).

In 1980 the DSM was revised again, largely to address growing concerns about the manual’s reliability and validity (43). Work began on the DSM-III in 1974, and by the time it was finished, what started out as a revision had turned into a major overhaul. Gone was any semblance of psychoanalytic thought (including the term “reaction,” which was replaced by the term “disorder”), a casualty of the growing supremacy of the biomedical model. The DSM-III was purportedly based on research and empirical evidence, and “atheoretical” (43) (although it was widely criticized, especially by psychodynamically-oriented clinicians, as being inherently biased) (35). To improve reliability and validity, the DSM-III included a more descriptive approach, specific diagnostic criteria, differential diagnoses, and the benchmark multiaxial system (43).

The DSM-III contained 265 diagnoses (compared to the DSM-II’s 185), one of them being the newly termed “Attention Deficit Disorder” (notice the move towards disease model terminology). What had been known as a “hyperkinetic reaction” was thus redefined as primarily an issue of inattention, rather than of hyperactivity (reflecting the work of Virginia Douglas and others). To account for the pervasiveness of hyperactivity in those with “ADD,” the DSM-III further delineated two types of attention deficit disorder: ADD with hyperactivity and without it (34), a move that was immediately met with criticism and question marks. Not only was the relegation of hyperactivity to a secondary symptom criticized by many as hasty and empirically unfounded (especially considering that it was the primary feature of the disorder for decades) (36), many argued that what the APA termed “ADD without hyperactivity” (i.e. inattentiveness) was itself a separate and distinct disorder (34), an argument that continues today.

Criticisms aside, the DSM-III was widely used and accepted (43), although it continued to be a work in progress. In 1987 the APA published a revised edition of the DSM-III, with the goal of expanding coverage, increasing reliability, and to update research (44). The DSM-III-Revised Edition, or DSM-III-R, contained over 100 changes in its diagnostic criteria (45), as well as changes in its multiaxial system of diagnosis (44). Diagnostic categories were added (raising the number of diagnoses to 297), some were removed, some were renamed. One of those renamed was, of course, ADD. In response to growing research evidence that ADD rarely occurs without hyperactivity (1), the name of the disorder was changed to Attention Deficit Hyperactivity Disorder (ADHD), thus reversing the trend Virginia Douglas had started. The diagnostic criteria for ADHD included symptoms of hyperactivity, impulsivity, and inattentiveness, with no subtypes, thus doing away with the possibility that an individual could have the disorder without being hyperactive (45). To account for individuals presenting with attention deficits without hyperactivity, the DSM-III-R included the term Undifferentiated Attention Deficit Disorder (UADD), with the specification that insufficient research existed to establish diagnostic criteria for it at that time (34).

In retrospect, the APA’s decision to eliminate ADD without hyperactivity as a diagnostic category might have caused more problems than it was intended to solve. Because the DSM-III-R limited clinicians to two choices (in regards to diagnosing attentional problems), either Attention-Deficit Hyperactivity Disorder or Undifferentiated Attention Deficit Disorder (of which there were no diagnostic criteria), many children who did not present with symptoms of hyperactivity were inappropriately diagnosed as having ADHD (46), while others were just not diagnosed at all. It took the APA seven years to identify and correct this oversight. Meanwhile, countless children received the wrong kind of help (e.g. unnecessary medication), or worse, no help at all.

By the time the DSM-IV was published in 1994, the term Undifferentiated Attention Deficit Disorder had been scrapped, and the diagnostic category ADHD had been completely made over. Although the disorder was still called ADHD, this time the disorder had two separate symptom lists (inattention and hyperactivity-impulsivity), and was split into three subtypes. Children who presented with at least six out of nine symptoms of inattention (like being “easily distracted”), “to a degree that is maladaptive and inconsistent with developmental level,” would be considered as having ADHD, Predominantly Inattentive Type. Children who presented with at least six out of nine symptoms of hyperactivity/impulsivity (such as “often talks excessively”) would be considered as having ADHD, Hyperactive-Impulsive Type. Children who met criteria for both of these subtypes would be diagnosed with ADHD, Combined Type (46). For good measure, the DSM-IV also included a diagnostic category for children who met some but not enough criteria for ADHD. These children would be diagnosed with ADHD, “Not Otherwise Specified.”

As you can see, the DSM-IV’s version of ADHD was exceedingly, and perhaps excessively, comprehensive. The DSM-IV provided a laundry list of what the APA determined to be symptoms of pathology, including “often interrupts or intrudes on others,” or “often does not seem to listen…,” or my personal favorite, “often runs about or climbs excessively…,” all of which are common, dare I say normal, childhood behaviors (especially for boys). Since it is unlikely that a child would present with six or more (if any) of these “symptoms” in a doctor’s office, the diagnosis was, as it is now, largely based on second or third party (word-of-mouth) reports, usually from parents or teachers (generally the ones most affected by hyperactive or inattentive children).

With six or more diagnostic criteria in tow, it is then up to the clinician to determine if these symptoms are “persistent” and “maladaptive,” criteria so vague that the DSM-IV basically leaves the diagnosis to discretion of the clinician. With such broad criteria, with so much open to interpretation, the DSM-IV made it so that just about any child could be diagnosed with ADHD. Surely it is no coincidence that the diagnosis of ADHD skyrocketed shortly after the DSM-IV was published (22).

You might be thinking, “If the diagnosis is so flawed, why has it been so widely used and accepted, while remaining practically unchanged, for over ten plus years?” To answer that question, we must first ask, Who benefits from a child being diagnosed with ADHD? First and foremost, pharmaceutical companies have benefitted immensely from the sharp increase in the diagnosis of ADHD. Pharmaceutical companies collect hundreds of millions of dollars annually from the sale of stimulant drugs, such as Ritalin (methylphenidate), used to “treat” ADHD (7). The more children diagnosed, the more drugs prescribed, the greater the profits. And yes, the use of Ritalin skyrocketed shortly after the DSM-IV was published (47).

Proponents of stimulant drug treatments like Ritalin contend that these drugs are safe and effective at treating symptoms that would otherwise disrupt a child’s ability to stay on task, and to learn. While stimulant drugs may be “effective” at reducing hyperactivity and improving attentiveness in some children, these short-term gains come with serious short-term and long-term risks. Most readily observable are the side effects, which can include nervousness, decreased appetite, insomnia, headaches, stomachaches, dizziness and drowsiness (7). Lesser-known but more serious side effects include cognitive impairment (e.g. inhibited range of affect, diminished ability to perform complex and abstract thinking), which occurs in over 40% of all children taking stimulant drugs (22) and temporary growth suppression, due to the fact that stimulant drugs directly lower the production of growth hormones (7). There is also evidence suggesting that stimulant drugs impair the body’s immune system (21), the body’s sexual system (47), and even precipitate substance abuse (7).

Despite all the well-known risks, American physicians continue to widely prescribe Ritalin, while the rest of the world’s physicians hardly use the drug. In fact, American pharmacists distribute five times more Ritalin than the rest of the world combined (48), leaving one to two percent of all children (that would be about one million) and 10% of school-aged boys in the U. S. on the drug (49). So why do American physicians, and especially American parents, continue to give children stimulant drugs? One need only look across the American cultural landscape to find that answer.

America, founded on the Protestant ethic, has always valued hard work and delayed gratification, and we expect as much from our kids. American children are supposed to obey their parents and be “seen, not heard.” When children are less than compliant, when they become disruptive, many parents figure there’s got to be a reason why their children aren’t behaving as they “should.” And so they take their child to a doctor to find out what’s “wrong.” Now it is quite possible that such behavior is a result of poor parenting (poor limit setting, neglect, abuse, etc.), but I doubt a parent would readily accept such an explanation, even if it was true. Blaming parents, no matter what they have or haven’t done, also goes against the all-too-American value of individual responsibility, and is generally frowned upon in our “get-over-it” culture. Needless to say, the poor parenting road is rarely taken, and if a clinician does, they tread lightly.

On the other hand, a clinician could sit the parent(s) down and demonstrate how recent sociohistorical developments, such as rising divorce rates, the breakdown of the nuclear and extended family, the quickening of American lifestyles, and the shortening of American attention spans have affected the psychosocial development of American children. Of course, the clinician would also have to explain cognitive development and how social experiences directly affect neural development, particularly gene expression. The clinician could cite studies, such as the one done by pediatric researcher Dr. Dimitri Christakis, demonstrating how TV viewing in young children contributes to attention problems later in life,50 or the American Academy of Pediatrics’ recommendation against television for children age two or younger (51), as clear evidence that TV viewing can and does affect cognitive development.

The clinician can even refer to any number of controlled studies linking diet, especially food additives and coloring, to childhood behavioral problems (52). The clinician could do all this, but do parents really want to hear all this scary stuff? Do they want to hear about the breakdown of America and American families? Do they want to hear that TV, food additives, even pollution (52) may be influencing their child’s behavior? We Americans are known for our social apathy, for many, hearing about such serious, deeply entrenched social problems triggers feelings of helplessness and despair. These issues can be equally overwhelming for clinicians, who in an effort to help are trying to isolate and treat problems. But how do you treat a problem that is deeply rooted in and reflects the very framework of our country and culture?

I propose that for many Americans, myopia is a defense against the painful realities of our world. A simple answer (like faulty genes or haywire neurotransmitters are to blame for our children’s anxieties), with a simple solution (like stimulant drugs), is a lot more comforting than the aforementioned alternatives. A single, albeit theoretical “truth” (ADHD) is a lot less anxiety provoking that the world of possible causes for our children’s difficulties, to which we as Americans are all accessories. And so we accept this unsubstantiated disorder, this “disease” that was once relatively uncommon (and still is in countries like England), that now affects an estimated 3 to 7% of all American children (1), because it is easy to accept. The spirit of our times has made it so. We the pill-popping, “quick-fixers” of the world then give our children stimulant drugs (and usually very little else), which for some yet unclear reason makes them more docile and compliant, and we consider this problem “treated.” Yet the prevalence of ADHD continues to rise.

If we are to have any hope of reversing the growing problem of ADHD, we need to open our hearts and minds to what these somatic messages are telling us. Children are hyperactive (act-out) or inattentive (act-in) for a reason, if not for many reasons. Maybe these symptoms are telling us that their world is moving too fast, that they are over-stimulated (and increasingly pressured), and that we need to slow their world down a bit. Maybe they are telling us that our children need to be eating better, and exercising more. Maybe these symptoms are a cry for more attention, more love. Perhaps they are a way of telling us that they are being physically or emotionally abused, and that they need our help. Whatever the reason(s), these kids need love and attention, they don’t need to be labeled as different or defective, and they don’t need dangerous, mind altering drugs. We can do better.

Nearly 140 years ago, adults with not enough energy were told that they had a disease called neurasthenia, and treated with electroshock. These days children with too much energy are being told that they have a disease called ADHD, and are being treated with amphetamines. No one listened to the somatic protests of increasingly oppressed, 19th century women, instead they were labeled “hysterical” and silenced. I can only hope that we as a culture can take a break from our ambitious, fast-paced lives to listen, to really listen to what these children are trying to tell us, consciously or otherwise. ADHD is not a road sign to a mental disorder, but a road sign to a social one. It is about time we paid attention.

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©Copyright 2009 by Matthew Carter, MFT. All Rights Reserved. Permission to publish granted to GoodTherapy.org. The following article was solely written and edited by the author named above. The views and opinions expressed are not necessarily shared by GoodTherapy.org. Questions or concerns about the following article can be directed to the author or posted as a comment to this blog entry. Click here to contact Matthew and/or see his GoodTherapy.org Profile

The prevalence of anti-depressants and other psychiatric medications has experienced a great increase recently, and many concerns are rising in response to the growing dependency on such substances. While there are some medications that have proven to be helpful in improving the quality of life for pregnant mothers and young children, some in the mental health professions remain skeptical over the ultimate utility and safety of such medicines. Adding support to this camp, a study at Georgetown University Medical Center has recently suggested that medicines indicated for mood issues, pain, and epilepsy, when administered to pregnant women or to infants and young children, may cause mental health concerns at a later age.

The study focused on animal models, specifically working with rats in a laboratory setting, but suggests that the issue is likely a prominent one for humans, as well. After administering various modern treatments for mood issues, as well as those indicated for pain and for epilepsy, researchers monitored laboratory rats, finding that those animals which had been treated with the medication were more likely to exhibit signs of mental health complications as adolescents and adults.

The researchers suggest that identifying different drugs for the treatment of young children and pregnant women is vital, and the idea that psychotherapy and other non-invasive approaches may be highly preferable to treatments involving medications is certainly supported by the study. Through focusing on collaborative and therapy-based treatment models, pregnant women and young children may receive the help they want and need without risking harmful situations in the future. The study is one of several that have recently been launched exposing serious problems with the psychiatric medication model.

The use of anti-depressant medications is steeply on the rise, with many mental health professionals concerned about the frequency with which people experiencing mental health difficulties rely entirely on pharmaceuticals to relieve symptoms. Part of this concern stems from the fact that for many clients, anti-depressants simply don’t work, a problem that a recent study conducted at Northwestern University has suggested can be explained in the preoccupation with treating symptoms of stress. The research provides evidence for clear genetic distinctions between stress and depression, noting that the latter is an entirely different phenomenon within the brain and suggesting that it should be treated differently, as a result. The study may help wean Americans and concerned clients worldwide from modern dependency on psychiatric medications.

The fact that general practice physicians often prescribe anti-depression medication to their clients is well known, but the extent of the prescriptions, which account for over 50% of all prescriptions nationally, is not as renowned. Neither is the fact that general practice physicians account for a considerable amount the total prescriptions of other psychotropic drugs, such as anti-psychotics, stimulants, and anti-mania medications. But the recent creation of a research report by Thompson Reuters and SAMHSA, the federal Substance Abuse and Mental Health Services Administration, is likely to increase the notoriety of its statistics on general practice prescriptions, which highlight a departure from traditional psychiatrist roles.

Rampant on the news both specific to the mental health community and delivered to the public at large, over-prescription of psychiatric medications has been developing as a major problem for several years. With scores of reports highlighting suspicious links between high-prescribing and endorsing individuals and pharmaceutical company pay-offs, a growing mistrust of the eagerness with which some medications are prescribed is largely responsible for a surge in interest in non-invasive therapies such as psychotherapy. Over-prescription remains an issue in America and many parts of the world, however, and is especially disturbing in the case of children, who are often subjected to drugs that combat ADHD, depression, and other issues even when a clear need has not been established. In response to such activities, a conference on the psychiatric abuse of children has been organized for the venue of Syracuse, New York from the ninth to the tenth of October.

The conference will examine the ways in which children are subjected to needless drugs, and how these drugs create additional problems both during childhood and later on in life. Encouraging participants to take action against over-prescription in their own communities and professional fields, the conference is sure to inspire new ways to help families overcome uncertainty over medications when emotional and behavioral issues are present.

With the recent approval of an arsenal of anti-psychotic drugs, the need for more widespread understanding about the potential for harm presented by psychiatric drugs is steeply increasing. The conference welcomes both professionals and the public to attend, with the ultimate aim of educating and encouraging participants with straightforward and accurate information in the face of an industry that is not always perfectly honest.

Most people familiar with the substance LSD probably associate the drug with the psychedelic counter-culture of the 1960’s and 70’s, when recreational use was popular. But the drug and its maker had other hopes for LSD as well, hoping to see it prove useful medically –especially in terms of the mental health field. After several decades of reluctance to return to the scientific study of the substance, researchers in Switzerland and at the University of California have begun conducting and publishing studies on the use of LSD as an aid in feelings of anxiety among the terminally ill. As more scholars and associations turn their attention to clinical uses of the substance, the mental health field may find that this controversial drug holds potential to heal.

Though there are certainly some children who experience developmental, learning, and social difficulties due to symptoms of attention deficit hyperactivity disorder, or ADHD, and who can realize remarkable benefits through the use of prescription medications, it may seem that an excessively large number of youths are diagnosed with the issue and given pills. Concerns about the over-use of drugs geared towards children with symptoms of ADHD has risen in recent years as some parents and mental health professionals note the potential of therapy and other treatment types to provide a more meaningful and long-term solution for kids with difficulties focusing.

This issue has been given its own spotlight recently with the release of a report showing that abuse of prescription medications for ADHD has risen over 75% in the last eight years. The steep incline in abuse may correlate with increasing amounts of prescriptions being written for children who may not truly need the medication. Concerns about proper education about the medications and misunderstandings spread among youths as to potential benefits of taking excessive amounts of the pills are also being voiced in response to the discovery of the surge in abuse. A low number of deaths –precisely four– were connected with the abuse of such medications, but over forty percent of teens who reportedly abused the drugs exhibited moderate to severe side effects, and were prone to receiving hospitalization or visits to the emergency room.

While taking such medications off the market may hinder children who can benefit from their safe usage, greater dialog among psychiatrists, doctors, families, and children is clearly needed in the effort to prevent further potentially fatal use of pills indicated for the treatment of ADHD.

Often, an inability to access or receive meaningful mental health services can lead those experiencing debilitating symptoms to rely on pharmaceuticals and other substances in an effort to self-medicate. Such instances carry great risks, not only for physical and mental health, but for the development of deep addictions, engendering further negative consequences. This situation has been clearly observed recently in Kashmir, where long-term violence and social disorder have led to a growing number of women developing symptoms of mental health difficulties. The creation of accessible mental health care as well as treatment for addiction and substance abuse is needed to help the region recover from its deep-rooted turmoil.

While anti-depressant medications are able to help some clients who experience intense feelings of sadness, and may also help in attaining sleep and realizing greater energy, their use has become alarmingly widespread in the west. Short-term side effects associated with such medications are fairly well known, but as a recent informational piece supplied by the Mayo Clinic to a concerned writer notes, not much is known about the potential long-term effects of such drugs. As use increases and the length of time over which anti-depressants have been taken expands, greater knowledge on the subject is bound to appear –and many mental health professionals hope the news won’t be bad.

Statistics on the prevalence of mental health concerns in the modern world may seem staggering, especially with the consideration of rising reports of feelings of depression, anxiety, and other related issues. But equally if not more astounding are the rapidly rising rates of psychiatric medication prescriptions, which have spawned a multi-billion dollar industry intent on treating the full spectrum of common mental health complaints with readily available drugs. Many have cited significant negative elements of the industry, such as a tendency to market medications directly to clients, rather than to mental health care professionals. The connections between product endorsement and prescription and personal bonuses and gifts have also been called into question on several occasions. Recently, a book was published that delivers another blow to the industry. Titled The Emperor’s New Drugs, the book explores the question of whether anti-depressant medications and their next of kin are actually effective in the first place.

Though extensive clinical trials have been performed to support the positive actions of the majority of psychiatric medications, many remain skeptical as to their ability to help treat mental health concerns in a meaningful way. For some people, adjusting chemical balances may prove beneficial, but in his book, Irving Kirsch, who is a professor of psychology at the University of Hull, challenges whether imbalances can really be blamed for the manifestation of mental health issues. Citing the ability of placebos to have similar effects in many cases, Kirsch suggests that it is psychotherapy, rather than silent medication, that holds the greatest potential to heal.

Of course, whether they acknowledge the potential efficacy of psychiatric medicines or not, many people are likely to support the promotion of therapy as a more meaningful and long-lasting treatment option. Whether the millions of Americans currently taking pills for their mental and emotional woes will join this group is as yet unknown.

Anti-depressant medications, which have experienced a sharp rise in popularity in recent years, often fall short of providing a truly meaningful or long-term solution to those experiencing difficult mental health concerns. While many may take anti-depressant medications in an effort to quell suicidal thoughts and behaviors, a recently released study has suggested that the substances provide little if any deterrent to those under the age of twenty five. While adults over the age of sixty-five showed a notable decrease in “suicidality,” based on a review of statistics and literature recently provided to the US Food and Drug Administration, young adults and children exhibited the same increase in such thoughts and behaviors as those not taking the medications. The research supports the need for greater inquiries into the efficacy of anti-depressants, particularly for children and adolescents.