Author: Dr. Jeffrey Rubin

Jeffrey Rubin grew up in Brooklyn and received his PhD from the University of Minnesota. In his earlier life, he worked in clinical settings, schools, and a juvenile correctional facility. More recently, he authored three novels, A Hero Grows in Brooklyn, Fights in the Streets, Tears in the Sand, and Love, Sex, and Respect (information about these novels can be found at http://www.frominsultstorespect.com/novels/). Currently, he writes a blog titled “From Insults to Respect” that features suggestions for working through conflict, dealing with anger, and supporting respectful relationships.

Treating ADHD: If Not Drugs, Then What?

Post author By Dr. Jeffrey Rubin
Post date January 7, 2015
3 Comments on Treating ADHD: If Not Drugs, Then What?

Some children, when asked to attend to certain tasks, do so for shorter periods than most. Some are also more energetic. Such children are often said to have Attention Deficit/Hyperactivity Disorder (ADHD).

Although many doctors recommend placing children believed to have ADHD on drugs such as Ritalin and Adderall, many parents refuse to go that route. The evidence that the drugs do not lead to lasting improved academic and social outcomes are major reasons (see my post titled “The Myth of Ritalin’s Effectiveness” for a review of the effectiveness studies). Other major reasons have to do with concerns about known negative side effects and possible long term harm to such young developing brains.

Parents who have a child viewed as having ADHD typically face two challenges–disciplining their child and responding to concerns from their child’s teacher. For parents who choose the drug approach, they may come to believe that at least by drugging their child something is being done to deal with the challenges. They may thus become less motivated to take some other steps because what can be done is being done. If the child misbehaves, the parent may come to believe that the cause is due to the drug not doing what it’s supposed to be doing. Maybe the child needs to go back to the doctor to get the dose tweaked, or another drug needs to be added or substituted.

But for parents who refuse drug treatment, they don’t get confused about all of these drug issues and a clearer path lies before them. As a school psychologist for many years, I’ve walked with parents down this non-drug path on numerous occasions, and here are some suggestions that I found most helpful.

My Four Favorite Suggestions for Parents Concerned about a Child’s Attention Span or Energetic Behavior

1. Search the internet with the following search terms–“ADHD without drugs.” If you do so, you will find many suggestions on how to address your concerns. A daily running program and meditation were just a couple of excellent ideas that I found quickly in a recent search of this sought. Many of the suggestions indicate that they have research support demonstrating that they are effective (see for example APA’s article titled “Easing ADHD without Meds“). What I particularly like about having parents search the internet in this way is that they get to select from a wide range of ideas the ones that make the most sense to them. Moreover, there are always new ideas coming out, and these types of internet searches are regularly updated.

2. Get a copy of The Kazdin Method for Parenting the Defiant Child by Alan Kazdin. Dr. Kazdin is director of the Yale Parenting Center and Conduct Clinic and is a former president of the American Psychological Association. His approach has been well tested in solid research programs with impressive results.

If you can’t afford to buy Dr. Kazdin’s book, you can get a copy at your local library. If your library doesn’t have a copy, walk over to the the librarian and ask to get it through inter-library loan. If you have trouble reading books, it is also available on CD. Listen to these CDs while you are driving, cleaning the house, and washing dishes. You’ll find a goldmine worth of information.

3. Ask your child’s teacher to provide you, each week, a list of the main topics that will be covered in class the following week. Then view at home with your child a lesson on each topic on the Kahn Academy website.

This website is a resource that provides free lessons on all the topics that teachers teach in school. By having your child review each lesson before hearing it for the first time from the teacher, when the teacher actually presents the lesson in school, your child will now be at least somewhat familiar with the topic. This is called “priming” and it has been demonstrated to increase the interest level for learners and increase the likeliness that the topic will end up being mastered. Moreover, once you show your child how the Kahn Academy website works, your child, before each test, can go back to the lesson and make sure he or she has really mastered it.

If you do not have the time to do this with your child, see what you can do to get someone at least four years older than your child to carry out this activity. You may have to pay a young teenager a little, but it will be better than paying for pills.

This approach leads to real learning. Once your child starts to make better academic progress in school, he or she will feel better about school in general.

4. “Casino for teaching calculation fluency” is a card game that I have found works great for kids who have difficulty learning math skills in the usual manner. You can find the rules for the basic casino card game on line by typing in your search engine, “Casino card game rules.” Once you learn the basic rules it will be easy to learn how to apply the game to improve a wide range of math skills.

Basically, the game is played as follows. The dealer deals four cards to each player and four cards face up in the center (these center cards are laid out separately so that all are visible). The aim is to capture cards from a layout on the table, by playing a card from your hand which matches in number a table card or the sum of several table cards. When it’s your turn, if you can’t capture any cards, you have to throw into the center, face-up, one of the cards from your hand. The cards that each player captures are accumulated in his or her pile. The player who ends up with the most captured cards (in the simplest form of the game) is the winner. After each player plays the four cards that are originally dealt, each player is dealt four more cards. The game is over when all the cards in the deck are used up.

To win, a player must learn to do basic addition. Consider this example. Suppose it is my turn and I have in my hand a 9, and on the table, face up, is a 6 and a 3. If I know 6 plus 3 equals 9, I can use my 9 to capture the 6 and the 3. The more cards I capture, the more chances I have of winning. If I am a bit clumsy at addition, this game can motivate me to increase my fluency.

Once your child has learned to add smoothly, you can change the rules of the game to learn more advanced math skills. For example, you can make the new rule as follows: the only way to capture cards is by using subtraction; or multiplication.

The game can be played in groups of 2, 3, or 4. Besides a deck of cards, it will help to learn math if you will get an abacus. Any student having trouble with learning basic arithmetic should be taught how to use an abacus, and should get a great deal of experience using it. It visually displays how our system works, with the ones line, the tens line, and the hundreds line. The manipulations are fun, and they begin to make conceptual sense after regular use. You can buy an abacus on line for just a few dollars and they come with directions.

The abacus is used as follows. Suppose Sue, who is playing Casino with Jill, attempts to use a 7 in her hand to capture a 6 and a 2. She can use the abacus to see if 6 and 2 equals 7. In a short period of time, Sue will learn to add without the abacus.

An interesting psychological aspect of playing this game is that even when it is not the turn of the other players, all the other players are motivated to do the calculation of the person whose turn it is in order to make sure she or he does not cheat. Moreover, whenever a player can’t make a capture, and therefore throws a card from her or his hand onto the table, all the other players start to make calculations in their heads to figure out how the new card can be utilized. Consequently, there is an enormous amount of additional calculations going on than one might think by watching the player whose turn it is. This is a large reason why this game is so effective.

Now, once your child learns the basic rules of the game, usually within a half hour of playing time, the rules can be changed so that your child begins to work on learning fluency of the math facts at his or her level. So, if Sue is learning to be fluent in learning single digit addition facts, the group plays the game in the standard manner.

If Sue is learning fluency in mastering two digit addition facts, the game is changed so two decks of cards are combined. Both decks get a little doctoring. The parent takes out the four jacks from one of the decks and crosses out their J, and writes beside it the number 11. In a similar fashion, queens, and kings have respectively, the numbers 12, and 13 written on them, replacing their Q and K. For the cards in the second deck, their numbers are changed so that they are given numbers that range from 14 to 27. Both sets of cards are shuffled together, and the game is played like the basic version of the game but there is far more addition facts that can be employed in order to capture cards.

For students learning fluency in mastering single digit subtraction facts, the same rules are applied as the single digit addition form of the game but players can only capture cards by applying a subtraction fact. For example, if Fred has a 2 in his hand, and there is an 8 and a 6 faced up on the table, if he recognizes that 8 minus 6 equals 2, he can capture with his 2 both the 8 and the 6.

For students learning fluency in mastering two digit subtraction facts, the same rules are applied as the two digit addition form of the game but players can only capture cards by applying a subtraction fact.

In a similar manner, the game can be played as well so it is designed to teach fluency in basic multiplication or division.

$math is fun$ Math is often a stumbling block for children who have trouble paying attention to topics that bore them. By making learning these skills fun, these skills are quickly learned. When your child then goes to school, his success in math class will greatly improve his or her overall school experience.

Okay then, those are some ideas to help children thought to have ADHD. There are of course far more options to discover.

Until you join us again, have a great week.

Jeff

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Some people will enjoy reading this blog by beginning with the first post and then moving forward to the next more recent one; then to the next one; and so on. This permits readers to catch up on some ideas that were presented earlier and to move through all of the ideas in a systematic fashion to develop their emotional intelligence. To begin at the very first post you can click HERE.

Tags Adderall, ADHD, ADHD Treatment, Alan Kazdin, Kahn Aademy, Learning strategies, Ritalin, The Kazdin Method for Parenting the Defiant Child

Albert Einstein anger conflict resolution criticism Name calling negative criticism providing criticism wisdom

Einstein and Stupidity

“Two things are infinite, the universe and human stupidity, and I am not yet completely sure about the universe.”–Albert Einstein

In the spring of 1914, Albert Einstein left his home in Switzerland to take a job at the University of Berlin in Germany’s capital. He was then, 35.

He took the job with much misgivings. When he was a young boy living in Germany, Einstein had been deeply repelled by the authoritarians, militarism, and bigotry he found all around him. And as a young man, he was appalled by the prejudices, injustices and reactionary ideas found in the heart of many Germans in those days. Nevertheless, working in Berlin provided an opportunity to pursue his research without teaching and administrative obligations and to have ready access to many brilliant fellow scientists and mathematicians.

Einstein’s Name-Calling During World War I

Months after Einstein moved to Berlin, in August 1914, the first world war broke loose, creating wholesale death, misery, and hunger. And then, many people with whom he was working signed a manifesto denying that Germany had any responsibility for the war. Instead, the blame fell entirely on Germany’s enemies. The concluding paragraph states:

We cannot wrest from our enemies’ hand the venomous weapon of the lie [that Germany is responsible for the war]. We can only cry out to the whole world that they bear false witness against us. To you who know us, who have hitherto stood with us in safeguarding mankind’s most precious heritage–to you we cry out: Have faith in us when we say that we shall wage this fight to the very end as a civilized nation, a nation that holds the legacy of Goethe, Beethoven and Kant no less sacred than hearth and home.

This type of document along with all that was happening in the world was pretty rough on Einstein. In a letter to Paul Ehrenfest, a physicist and one of his closest friends, he wrote:

The international catastrophe has imposed a heavy burden upon me as an internationalist. In living through this “great epoch,” it is difficult to reconcile oneself to the fact that one belongs to that stupid, rotten species which boasts of its freedom of will. How I wish that somewhere there existed an island for those who are wise and of good will! In such a place even I should be an ardent patriot. (From Einstein on Peace, p. 2)

We see in this quote that Einstein, in his anger, chose to refer to the human race as stupid. And yet, some of the people that were supporting the war were among the smartest people of their day, at least in terms of their academic accomplishments.

Of course, Einstein is not the only one to use the word stupid upon becoming angry:

Apparently, for Einstein, the word stupid was meant to mean something different than an inability to master challenging subject matter. What then did he mean?

Such terms are often used broadly, meaning the same thing as other words and phrases thrown at someone in anger, such as “crazy,” “mentally ill,” “jerk,” “piece of trash,” “rotten,” etc. When used like this, they all mean nothing more than the angry party strongly doesn’t like what the other party did. They serve as a type of exclamation point.

For Einstein, I think stupid might have had an added meaning; something like not being able to see something that seems so plainly reasonable to him. War is a terrible thing, Einstein believed, and the justification that Germany used to enter into it clashed with his sense of what was so plainly reasonable.

Einstein’s Approach to Providing Negative Criticism After World War I

Soon after the end of the first world war, Germany saw the rise of Hitler and Einstein fled to America, taking a position at Princeton University. As World War II got underway, Einstein did support military intervention. As he explained it when declining an invitation to prepare a presentation of the pacifist point of view,

I am not what you might call a religious pacifist. Besides, I consider it preferable for men to fight rather than allow themselves to be butchered without lifting a finger. That was just about the alternative in the case of Hitler’s Germany. (Einstein on Peace, p. 553)

But when America became involved in the Korean War, Einstein again experienced anger about a military intervention. Korea had not attacked any country, let alone the United States. Korea was engaged in an internal fight about what type of government it chose to have. US military intervention, Einstein believed, would serve to dramatically increase the loss of life. How did Einstein express his disagreement in his adopted country where most were fierce supporters of the war?

When writing to a trusted friend he would allow himself to let out his raw emotions about what was going on in the world. This occasionally included utilizing words like stupid, idiot, and rotten. But at least in the many public statements that I’ve read of his, it was extremely rare to see him utilizing anything that strikes me as name calling. Typical is a 1953 quote taken from Einstein’s review of a book on Gandhi. The author was Gene Sharp, a 25-year old graduate of Ohio State University who had just received a two-year sentence for defying the draft law during the Korean War. Einstein wrote:

How is it possible that a young man was able to create such a mature piece of work? The author’s preface tells us how it was possible. He feels the profound obligation to serve, with all his energies and with unlimited readiness for sacrifice, a purpose which is clearly personified in Gandhi’s unique example: to overcome through an awakening of moral strength the danger of self-destruction which confronts mankind as a result of explosive technological developments. The collapse which threatens mankind is characterized in the volume by the words depersonalization, regimentation, total war, while its salvation is characterized by the words personal responsibility, in conjunction with nonviolence and service to human beings in Gandhi’s sense.

I believe the author is completely right in asserting that every human being is compelled to come to a clear decision with regard to this important matter: there is no middle ground.

In the Nuremberg trials the following principle was laid down: Personal moral responsibility cannot be set aside by national laws. Let us hope that we may soon come to the point where the Nuremberg principle will not only be enforced upon citizens of vanquished nations! (Einstein on Peace, p. 544)

Here, Einstein, rather than calling those who support war insulting names, he instead expresses admiration for two people who had acted to resist participation in military activities–Sharp and Gandhi. He then places their activities in the context of a moral principle that was articulated by the judges at the post World War II Nuremberg trials. These judges convicted Nazi leaders who presented a defense that they were just following orders.

I like this approach of letting people know, by use of a narrative, what actions you do respect. It goes beyond just saying what you don’t like. It adds specificity, and I think people learn ideas better through narrative rather than principles alone. It is this very approach that I tried to create in my three novels.

Okay, there’s my post for this week. Until next time, here’s hoping we all find some helpful ways to bring about a more peaceful world.

Jeff

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Tags Albert Einstein, anger, Einstein on Peace, name calling, negative criticism, promoting peace, stupidity

ADHD conflict resolution DSM Ritalin The Diagnostic and Statistical Manual of Mental Disorders

The Myth of Ritalin’s Effectiveness

Post author By Dr. Jeffrey Rubin
Post date December 21, 2014
25 Comments on The Myth of Ritalin’s Effectiveness

In a recent post titled ADHD and Psychiatric Name Calling, I reviewed studies documenting how much is currently being spent annually on ADHD drug treatments. Here are some new numbers provided by Healthline: What are we getting for this? In this post I hope to clarify this issue. As you read it, you will see phrases in blue. By clicking on each, you will be taken to the actual research article that documents my statement.

For students placed on Ritalin or other stimulant drugs, in short term studies teachers and parents report some improvement in behavior. However, even in the short term, the vast majority of research indicates that there is no improvement on academic functioning. At the end of 14 months, drug treatment was not superior than no-drug treatment on the following measures: classroom observed behaviour, parent- and teacher-rated social skills, parent-rated parent–child relationships, peer sociometric ratings, and academic achievement. By the end of three years there was no significant effects of the drugs on any measure. stomach and head pain And yet, parents who undeniably care about their children, regularly expose their children to the side effects of these drugs, as well as potential long term risks. Why? Because they are convinced that the helpfulness of the drugs outweigh those negatives.

What is it about these drugs that create the myth that the drugs are really helping their children? To understand how this myth is created, it will help if we first take a quick look at how people come to believe smoking cigarettes helps them to deal with stress, and drinking caffeinated coffee helps them to be more productive.

The Myth that Cigarette Smoking Reduces Stress.

In a study published in the American Psychologist, researchers found the following:

Smokers often report that cigarettes help relieve feelings of stress. However, the stress levels of adult smokers are slightly higher than those of nonsmokers, adolescent smokers report increasing levels of stress as they develop regular patterns of smoking, and smoking cessation leads to reduced stress. Far from acting as an aid for mood control, nicotine dependency seems to exacerbate stress. This is confirmed in the daily mood patterns described by smokers, with normal moods during smoking and worsening moods between cigarettes. Thus, the apparent relaxant effect of smoking only reflects the reversal of the tension and irritability that develop during nicotine depletion. Dependent smokers need nicotine to remain feeling normal. The message that tobacco use does not alleviate stress but actually increases it needs to be far more widely known.

This paragraph just provides a summary of the research article that leads to its conclusion. In my view, the whole article lays out a very convincing argument that the relief from a drug withdrawal reaction that occurs each time a person ingests the drug can create the illusion that a drug is helpful. Moreover, I believe that this same argument can also be used to explain how a stimulant such as Ritalin can appear to be helpful even when it is not. Before we get to Ritalin, however, let’s first turn our attention to America’s favorite stimulant, caffeine.

My Personal Experience with Caffeine

When I was 18, I started college. My first class began at 8 a.m. Ugh! That meant waking up around 6 a.m. so I could wash up, have breakfast, and take the hour train ride.

Sitting down for breakfast, I decided to have my first cup of coffee. Both my parents drank coffee in the morning and throughout the day, too. I had heard that it gave you a boost when you were tired, and man, I was tired.

My first sip tasted rather bitter, so I dumped a couple of teaspoons of sugar in. Much better. Then came a little pleasant “up” sensation, but it was accompanied with a little stomach distress. Oh, well. Off I went and it wasn’t long after that I was drinking coffee regularly.

coffee3 As I entered into my twenties, I began to notice that in the morning before I got my first cup, I was irritable and struggling with sleepiness. With the first sips, ahhhh, relief.

In addition to my morning cups, I’d have a cup typically around 10 a.m., a cola with lunch, which has some caffeine in it, and a couple of cups after supper with dessert.

During my thirties, I began to develop headaches. I attributed them to stress.

coffee2 By the time I was forty, the headaches became so bad that I went to a physician who prescribed some pills. I don’t like taking pills, but the headaches were so bad that I thought maybe I should give them a try.

Before filling the prescription, I looked up information about it and found the prescribed pills were made entirely of caffeine. Then, I looked at the side effects and found that one of them was headaches. This surprised me.

Since I was already consuming caffeine throughout the day, and a side effect of caffeine was headaches, I thought maybe instead of taking the pills, the first thing I should try was to stop consuming caffeine.

Wow! Giving up coffee was not easy. For several days I went through a very rough period of headaches, feelings of depression, difficulty sleeping, and my brain seemed to be meandering through thick mud.

In retrospect, perhaps I should have tried tapering off coffee, reducing each week one cup at a time. But I did make it through the morass, and in a couple of weeks I was fine. And ever since, I no longer get any headaches.

More surprising is that when I wake up in the morning, by the time I wash up and sit down for breakfast, I’m every bit as awake as I used to become when I had finished my morning coffee. It is now clear to me that the exhausted, irritable feelings that I used to have before I gave up coffee was due to a caffeine withdrawal effect from going a whole night without having any. Throughout the day, I now find that I have a smoother ride and I am every bit as productive as I used to be when I was a coffee drinker.

The Myth of Ritalin’s Effectiveness

Ritalin, and most other drug treatments for “ADHD” are stimulants. And just as I came to mistakenly believe coffee helped me to be more productive, I think Ritalin’s effects lead to the same mistaken conclusion. And just like I didn’t attribute the side effects of caffeine to my coffee drinking, I think parents don’t realize how much of their child’s sleeping problems, headaches, late afternoon miseries are due to the drugs. And when parents try to withdraw their children from the drugs to see if it is really helping, as the withdrawal effects begin to become worse and worse, parents come to think that this is how their children naturally are when they don’t take the drugs.

Now, there is more to this story than I can reveal in a single post. For example, other factors that lead to parents thinking these drugs are more effective than they actually are is the clever advertisement of the drug companies. Moreover, in some cases, children, as they become older, typically mature at a certain pace. Thus, some children viewed as having ADHD problems completely grow out of these problems without any drug treatment. If this growth in maturity occurs shortly after a child begins to take the drugs, the improvement from natural maturity growth can be easily attributed to the effects of the drugs. When this happens, parents rave to their family members and friends that Ritalin saved their child, and they push other parents to do what they did–get their children on Ritalin.

And so, this is how I think the myth of Ritalin’s effectiveness is created. An initial improvement in behavior once the drug treatment begins; a slow tolerance develops to the drug so it becomes less and less effective, but this occurs over a period of time during which the child is naturally maturing. As a result, some parents don’t notice that the drug is becoming less effective. When parents do notice the decreased effectiveness of the drug, they often take the child to the doctor to get an increased dose. Again there is a boost in apparent improvement. As tolerance to the drug once again begins to occur, more time goes by, and of course there is more growth in the child’s natural maturity. This may lead to less attention problems, but the improvement is attributed to the drugs, rather than improved maturity. Whenever parents try to see if their child can do just as well without the drugs, the withdrawal reactions convince them that their child really needs the drug. Negative side effects of the drugs are attributed to other causes. Couple all of this with the clever advertisement campaign of drug companies, and we end up with a pretty impressive myth.

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Tags Adderall, ADHD, ADHD Treatment, caffeine's side effects, Coffee's side effects, drug treatment, DSM, mental illness, Myths, parenting, psychiatry, Ritalin

conflict resolution criticism John F. Kennedy Lyndon B. Johnson Responding to Criticism

Responding Maturely to Criticism: A John F. Kennedy Example

Post author By Dr. Jeffrey Rubin
Post date December 18, 2014
No Comments on Responding Maturely to Criticism: A John F. Kennedy Example

Responding to negative criticism with lower developmental level skills can lead to an escalation of conflicts, violence, and the loss of valued friends. Among the benefits of utilizing higher developmental level skills are increases in how much people like and respect us.

To encourage readers of this blog to think about the most helpful ways to respond to criticism, I presented a post titled “Responding to Criticism: Four Levels of Maturity.” A few weeks later, I presented a post describing the fifth level of maturity, which I believe is the most mature level.

In both of those posts, I give examples of people using each of the different levels. In subsequent posts, I provided some additional examples (see here, here, and here). Readers seem to enjoy these, so with that in mind, I offer you a John F. Kennedy example.

John F. Kennedy at the 1960 Democratic Convention

In 1960, the Democratic Convention was held in Los Angeles. In addition to Kennedy, other democratic candidates for president that year were Lyndon Johnson, Hubert Humphrey, and Wayne Morse.

On day two of the conference, Johnson and Kennedy had an exchange in front of the entire delegation. Below, is the transcript of part of that exchange, which I obtained from a YouTube video that you can see and hear for yourself at this link, https://www.youtube.com/watch?v=6gefp6OHLns

The actual exchange begins 4 minutes into the Youtube video. There, we see Lyndon Johnson criticizing Kennedy in front of several thousand delegates. Thus, he says:

For six days and nights we had 24-hour sessions, six days and nights I had to deliver a quorum of 51 men on a moment’s notice to keep the Senate in session to get any bill at all. I’m proud to tell you that on those 51 quorum calls Lyndon Johnson answered every one of them, although some men who would be president on a civil rights platform answered none.

On the roll call on that bill there were 45, Lyndon Johnson answered all 45. Admittedly, I didn’t have the problem that some of my people had of opposing Senators Humphrey and Morse in the primaries. But some senator missed 34 of the 45. And I point this out only so those of you who may have been not fully understanding of my entry into the race. That it is my considered judgment that my people had sent me to the Senate to perform the duty of a United States senator for which I was paid $22,500 a year. And my colleagues, including Senator Kennedy and Senator Symington, and 62 other beloved Democrats had selected me as their leader. And I did not think you would reward negligence. I did not think that you would reward me for inattention, nor did I think, as Al Smith put it, that you would penalize me.

Now, if former president, Donald Trump had been criticized in this way, I think we all have a pretty good idea of how he would have responded–probably by throwing nasty insults at Senator Johnson, like crying out that he is a horrible person.

Here’s Kennedy’s reply, which begins about six minutes into the YouTube recording:

I’m glad we are not going to put these speeches to a vote, after looking at Massachusetts’s and Texas’s delegates today. Let me just say that I appreciate what Senator Johnson had to say. He made some general reference to perhaps some shortcomings of other presidential candidates, but as he was not specific I assume he was talking about some other candidate and not me.

Kennedy then breaks out in a huge smile because he knows, and everyone present knows that Senator Johnson’s comments had indeed been directed toward criticizing Kennedy’s record. The crowd clearly appreciates Kennedy’s humor, and then, after the laughter subsides, he continues:

I, uh, found it extremely beneficial serving in the Senate with Senator Johnson as leader. I think if I emerge as successful in this convention it would be as a result of watching Senator Johnson proceed around the Senate for the last eight years.

Kennedy, now turns to Lyndon Johnson and says:

I have learned the lesson well, Lyndon, and I hope it will benefit me in the next twenty-four hours.

Kennedy has now turned back to the larger audience.

It is true that Senator Johnson made a wonderful record in answering those quorum calls, and I want to commend him for it. I, uh, was not present on all of those occasions, uh, no one, I was not majority leader. Lyndon knows I never criticized, in fact on every occasion I said that I thought Senator Johnson should not enter the primary. That his proper responsibility was as majority leader and that if he would let Hubert, Wayne and I to settle the matter we could come to a clearcut decision.

So, I come to you today full of admiration for Senator Johnson, full of affection for him, strongly in support of him for majority leader, and in that position we’re all going to work together. Thank you.

Now, after this reply to Johnson’s criticism of him, Kennedy does something else that we don’t actually see in the YouTube video. Kennedy, behind closed doors, informs Johnson that his criticism, in addition to the issue he explicitly stated, involves two others issues: First, Johnson wants to some day be president, and, second, he also wants to get several bills passed that were close to his heart, especially the civil rights bills. Kennedy explained that right now he, Johnson, was well known in Texas and the Senate, but the public in other regions around the country knew nothing about him. Kennedy then informed Johnson that he had decided to select him to be his running mate if he succeeds at obtaining the nomination. As vice president, Johnson would get to be known throughout the country. This would put him in a better position to seek the presidency in the future. Moreover, as vice president, he would preside over the Senate, and together with Kennedy as president, he could have a much better chance of getting his favorite bills enacted into law. In this way, Kennedy steered in the direction that he felt Johnson’s criticism suggested.

Okay, so that is how Kennedy responded to Johnson’s negative criticism. I shall now present the outline of all five developmental levels of responding to criticism. If you will, look them over and see what level best matches Kennedy’s response.

Five Levels of Responding to Criticism

1. This level requires displaying one or more of the following:

Weeps or sobs with tears or pouts
Physically attacks the criticizer
Damages property

2. This level requires displaying one or more of the following:

Insults the criticizer (either with words, hand gestures, the sticking out of a tongue, the rolling of the eyes, or smirks)
Glares at the criticizer
Threatens the criticizer
Punches, kicks, or throws an object without physically hurting someone or damaging anything
Criticizes the criticizer without first fully addressing the original criticism.

3. This level requires displaying one or both of the following:

Displays defensiveness without directly insulting the criticizer (raising voice’s volume or pitch)
Displays a lack of interest either by verbally indicating this, or with nonverbal cues, or complete silence.

4. Level 4 individuals listen to the criticizer in a supportive, warm, friendly style, and then make it clear that they fully understand what was said. Moreover, they put the criticizer at ease by making statements that indicate that the wise learn from criticism. Some time is spent on showing that they are thinking about the criticism. If, after thinking about the criticism the criticism is deemed to be correct, they make a statement frankly indicating, “I can see your ideas have merit and I intend to use them in the future.” If they are not sure if they agree, they make a statement indicating that they are very interested in what was said, plan to think a little more about this over the next few days and then they will be ready to discuss this further. If, after thinking about the criticism, the criticism is deemed to be incorrect, a statement is made designed to disagree without being disagreeable. More specifically, a sense of humor, some listening in a caring way and a few smiles help to traverse rough terrain. As the episode winds down, the criticizer is encouraged to feel comfortable communicating suggestions in the future.

5. In addition to actions consistent with level 4, people responding to criticism in a manner consistent with level 5 seek ways to use, whenever they disagree with the criticism, a technique known as steering in the direction the criticizer would prefer to go. That is, rather than just disagreeing without being disagreeable, the criticized person seeks to find a new choice of action that creatively utilizes some aspect suggested from the criticism. Steering cannot be incorporated into all situations, but it is an additional goal of the most mature individuals.

Now that you have had a chance to look over the descriptions of the 5 levels, which level do you think best matches Kennedy’s response? Moreover, regardless of what level Kennedy’s response matches, I encourage you to think about whether it is better to utilize Kennedy’s approach, or Trump’s approach, to responding to criticism. My guess is that if you want to get more hits on social media platforms and you don’t mind increasing hate in the world, the approach that Trump tends to use will work better for you; however, if you want to be better respected by family members, friends and people at work, Kennedy’s approach is the way to go.

Thanks for visiting today, and I hope you join us back here soon.

Jeff

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Tags criticism, Five levels of responding to criticism, John F. Kennedy, Lyndon B. Johnson, negative criticism

ADHD Attention Priority Difference attention problems conflict resolution DSM psychiatry Ritalin The Diagnostic and Statistical Manual of Mental Disorders

ADHD or Attention Priority Difference?

Post author By Dr. Jeffrey Rubin
Post date December 8, 2014
14 Comments on ADHD or Attention Priority Difference?

A few years ago I worked as a school psychologist. One day the mother of a 12-year old boy, who we’ll call Pete, explained to me that upon the urging of one of his teachers, she took him to his pediatrician to be evaluated for ADHD. The pediatrician asked this mother a few questions, diagnosed Pete as having ADHD, and then wrote him a prescription for Ritalin. After reading the possible side effects of the drug, the mother became concerned and spoke to Pete’s father.

Pete’s father and mother were divorced. Pete lived with his father on weekends, and the rest of the time he lived with his mother. Upon hearing about the prescription for Ritalin, Pete’s father was very much opposed to his son taking any drug for treating this concern. And so, now the mother wanted to know what I thought should be done.

I explained that before I could make any recommendations, I would have to carry out an evaluation. As a student in the district that I served, there would be no cost to the family. Pete’s mother agreed to the evaluation.

First, I requested that the mother, father and each of Pete’s teachers fill out standardized questionnaires. The results indicated that Pete’s physical education teacher, art teacher and his father viewed his activity level and ability to pay attention as falling within the average range. Pete’s mother and academic class teachers generally saw him as having some problems paying attention. His math teacher, who had been the one to urge Pete’s mother to take him to the pediatrician, rated Pete’s ability to attend to his assignments as being way below average.

After looking at the results of the standardized questionnaire, I spoke to Pete’s father. He confirmed that it was his impression that Pete had no difficulty with either his activity level or paying attention.

“Do you mind describing a typical day that you have with your son?” I asked.

“Well, let’s see. Last Saturday, when we woke up, we went to play golf.”

“Do you walk the course, or ride in a cart?”

“We walk.”

“Pete doesn’t mind?”

“Not at all. He loves doing physical stuff like that.”

“After golf, then what did you do?”

“We went back to my place, I made some sandwiches, and then I read the newspaper while Pete worked on his drawing. He loves to draw, and he’s pretty good. Then we went in the backyard. I have a basketball hoop set up there and we shot around for a while. Then we started to get supper together.”

“Does Pete help you with that?”

“Yes.”

“Does he get distracted in any way when you two work on supper?”

“Not at all. He’s very helpful. Then we ate supper, went down to the basement and played ping pong for maybe an hour. Then we went upstairs and watched a movie.”

“When he watches a movie with you, does he appear to have difficulty sitting through it?”

“Not usually. Occasionally, the movie strikes him as boring. After the movie, he went to bed.”

“Does he have any trouble sleeping when he stays with you?”

“No. We do a lot of physical stuff that tuckers him out, and he ends up sleeping soundly.”

I then spoke with Pete’s mom. Consistent with how she filled out the standardized questionnaire, she confirmed that it was her impression that Pete did have difficulty paying attention.

“Do you mind describing a typical day that you have with your son?” I asked her.

“Well, yesterday, I got him up at 7 so he could catch the school bus on time. He complained the whole time he got ready. He hates the ride to school.”

“How long a ride is it?”

“An hour, and he says he doesn’t get along with the kids he rides with.”

“I see. He has to sit on the bus for an hour with kids he doesn’t like, then he’s in school sitting most of the time doing school work. Then he takes the bus home, sitting for another hour with kids he doesn’t like. For a boy his age who loves to do physical activity stuff, I could see how this could be hard for him.”

“Yeah, but other kids do it.”

“Most do. Please tell me what happened when he got home.”

“Well, I got home a little after he did. I started preparing supper, and that’s when I have him doing his homework. I sit him at the kitchen table where I can keep an eye on him while I prepare the meal. And he gets very distracted. He starts an assignment one minute, and I look over and I catch him doodling. Over and over again he gets distracted.”

“I see. After sitting most of the day, you have him sit and do his homework?”

“Yes. That’s when I can best keep my eyes on him.”

“How about the rest of the evening?”

“He’s fine then. Besides doing his homework, the only other time I have trouble with him is when I try to get him to clean up his room. He starts to do it, but when I look in a few minutes later, he has become distracted with something else.”

Next, I interviewed Pete. After some pleasant discussion I said, “Your math teacher says you have trouble paying attention in class. What’s up with that?”

“Aaaaa, he makes us fill out these worksheets doing the same problems over and over again. If I know how to do it, why do I have to keep doing 20 more of them? It’s so boring.”

“I see. Say, I hear that you like to draw. Would you mind drawing something for me.?”

Pete’s eyes light up. “Sure. What do you want me to draw?”

“Anything you like.”

Pete begins, and I notice he appears to become completely absorbed in the task. I start to try to distract him by making some extraneous sounds. He glances up to see what the commotion is all about, sees it’s nothing serious, and resumes work on his drawing.

A half hour later, he shows me what he has created. It’s an imaginative otherworldly drawing with spaceships and fascinating creatures. There is an excellent sense of shadowing. It’s far superior to anything I can create in the drawing department.

When I finished my evaluation, I informed the parents that in my opinion it is not in Pete’s best interest to view the concern that has been expressed about his attention as due to ADHD. A more apt description is to view Pete as having an “Attention Priority Difference.” School work was not a huge priority for him. He much preferred to draw and do more physically active tasks than is currently provided at school. These preferences may turn out to be his greatest values. He may someday find work that he truly loves in a field where his artistic interest and talent are crucial. And his interest in physical activity may keep him far more healthier than the many sedentary Americans who are at an increased risk of a number of real illnesses.

“Well,” said the mother, “will Ritalin help Pete with his Attention Priority Difference?”

To which I replied, “Consider an analogous situation. Suppose we identified a group of children who are not doing as well as most kids in physical education. Would it make sense to make up a pathological sounding term for these low-performing students, such as “Muscular Deficit Disorder” and then have doctors prescribe steroids for them?

“In my view, people have different interests and talents. This is a wonderful thing, not something that should be pathologized. We don’t just need every person in America sitting in ivory towers. We need, as well, artists, computer experts, magnificent athletes, hairdressers, and on and on.

“When I hear of a child placed on Ritalin, I become concerned about the child’s stomach, nerves, and brain. Drugs that have been said to be safe have turned out to be far more toxic than anyone ever dreamed of. I become concerned about the social misery that goes along with being singled out as a child that must take a pill to fix him. More than a few kids have told me that this became a dreaded experience.

“I believe that teaching children to turn to drugs when they are dissatisfied with their behavior or mood runs counter to a healthy lifestyle.

“I prefer to put forth a view that encourages us to teach our youth about the blessings of keeping our bodies in lifelong possession of its full youthful state by keeping their blood free of stimulants and narcotics. I wish to teach our kids that it is possible that the morning sun, air and dew can be sufficient powerful intoxicants. Doing something that puts a smile on the lips of a loved one, accomplishing a valued challenging task, providing assistance to another human being—these are the directions I wish we would point to when we guide a child toward a more fulfilling life.”

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Some people will enjoy reading this blog by beginning with the first post and then moving forward to the next more recent one; then to the next one; and so on. This permits readers to catch up on some ideas that were presented earlier and to move through all of the ideas in a systematic fashion to develop their emotional and social intelligence. To begin at the very first post you can click HERE.

Tags ADHD, ADHD Treatment, Attention Priority Difference, attention problems, DSM, paying attention, pediatrician, Ritalin

Albert Einstein conflict resolution desire dig for the conflict happiness interpersonal conflicts psychiatry respect wisdom

The Desire for Happiness

Dealing with the frustration that goes along with challenging conflicts has some similarities to sailors dealing with stormy seas—it is best to utilize a well-rehearsed plan.

For dealing with conflicts, one such plan begins with thinking of the word “DIG.” With a little practice, we can use this word to remind us of a simple way to summarize the conflict even in the midst of swirling frustration.

The letters of the word “DIG” aids us to remember the words, “Desire,” “Interference,” and “Guilt.” Once we recall these words, we use them in a particular way.

First, we state what our desire is in the conflict, then, what is interfering, then, why we believe the other party in the conflict is guilty of doing something wrong. After doing this from our perspective, we then go through the same process from the perspective of the other party.

If we are thoroughly practiced in using this skill, the word “DIG“ not only helps us to create this concise description of the conflict even while in the midst of rising anger, it also helps us remember to dig a little to consider not just the most obvious desire that is involved in the conflict, but also what might be other desires that are involved.

Of course, in simple, low frustration conflicts none of this is necessary. There are times, however, that you will find that when all of those around you are beginning to get lost in a storm, your even-tempered, systematic guidance will calm the waters and lead to inviting harbors.

Conflicts in Which Happiness is the Desire

Now, sometimes when we describe a conflict it takes the following form:

“I desire to be happy, but the other party is interfering. The other party is guilty of making my life miserable.”

The desire to be happy has a special place in the life of many of us. Nevertheless, today I would like to advocate that you think twice whenever you, or the other party in a conflict, describes the desire part of the conflict as “to be happy.”

What’s wrong with Happiness as a Desire?

Describing a desire in a conflict as “to be happy” is too vague. With a little effort you can usually dig a little deeper and find a more specific description. Typically, it is better for a boss to say something like, “I desire that you come to work by 9 A.M. at least 95% of the time than, “I desire that you make me happy.”

Another reason to avoid happiness in your descriptions of your desire has to do with earning respect. If you are like so many of us, you probably want to avoid coming off as shallow or having superficial desires. To explain a little more of what I mean by this, I’m going to discuss a little of what Albert Einstein said on this topic and then present a little parable.

Albert Einstein on Happiness

In a book titled, Living Philosophies: A Series of Intimate Credos, the first chapter is by Albert Einstein. There he states:

The ideals which have always shone before me and filled me with the joy of living are goodness, beauty, and truth. To make a goal of comfort or happiness has never appealed to me; a system of ethics built on this basis would be sufficient for a herd of cattle. (p. 4)

When I read the rest of Einstein’s chapter, I came away with the following image. He kind of viewed happiness as one-half of an oscillation process, with sadness and happiness going back and forth, thrusting his ship forward, and where he chose to steer his ship was in the direction that led to goodness, beauty, and truth.

This is a deeper way to view the nature of happiness, and for those of us who want to be respected for being deep, in contrast to shallow, I think that there may be some value in meditating on this.

To further challenge you to think more deeply about the nature of happiness, please consider the following parable.

The Parable of Probliss

Once upon a green-blue planet, a scientist invented Probliss, a super powerful happiness pill. It made people as happy as anyone ever dreamed of. In fact Probliss was so effective in improving the happiness in people’s lives that a group of psychiatrists developed a plan that would have all of the people on the planet lie down on gurneys in sanitized rooms and then be hooked up intravenously so nourishment and Probliss could be directly delivered into the veins of everyone. If at any point people felt a little less than perfectly happy, all they had to do was press down with a fingertip and wonderful Probliss would soar into their lives creating pure, pure happiness.

Some didn’t like this plan. “What, no music, no love, no friends? Man, that sounds bleak!”

“True, none of that,” said the psychiatrists, “but far more happiness.”

And it came to pass that studies were done. The results proved indisputable–those on these gurneys who were attached to these machines that provided nourishment and Probliss developed far fewer diseases. They lived over ten years longer, and they were less of a danger to themselves or others when compared to those who lived their lives going out in the world without Probliss. Those who chose to live their lives in the old way, were much more likely to die in car crashes, accidental falls, and homicides. People on Probliss never died from these types of causes because all they did was lie on the gurney in a completely sterile, happy, and healthy state.

Once these results came in, the psychiatrists decided that everyone, from now on, would be tied down to gurneys, even if it was against their will. “It was for their own good,” the psychiatrists explained.

Now some men and women did manage to escape into a deep, green forest, experiencing anguish and tears, love and creativity, but not perfect happiness.

The End

Conclusion

And so, whenever you think you want to seek happiness, consider the value that goes along with identifying a more specific desire. You’re still likely to experience some happiness while seeking this newly identified desire, and some sadness too as setbacks tend to occur. These alterations of happiness and sadness are part of the process that keeps our lives moving forward. Choose wisely in what direction you truly wish to head. And learn to appreciate that there are deeper values in life than happiness.

My Best,

Jeff

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Some people will enjoy reading this blog by beginning with the first post and then moving forward to the next more recent one; then to the next one; and so on. This permits readers to catch up on some ideas that were presented earlier and to move through all of the ideas in a systematic fashion to develop their emotional and social intelligence. To begin at the very first post you can click HERE.

Tags Albert Einstein, conflict management, conflict resolution, desire, DIG Conflict Model, dig for the conflict, dispute management, frustration, happiness, psychiatry, respect, wisdom

conflict resolution crazy DSM The Diagnostic Manual of Mishegas

Crazy, Mentally Ill, and Meshuga

Post author By Dr. Jeffrey Rubin
Post date November 24, 2014
7 Comments on Crazy, Mentally Ill, and Meshuga

Followers of this blog seek to become experts in a branch of personal interactions referred to as name-calling. Among the words and phrases used in these interactions are “crazy,” “mentally ill,” and “meshuga.” In today’s post, I hope to weave a little narrative around their use in a manner that might take the sting out of them.

The Broad Use of These Words

These terms are often used so broadly that they mean the same thing as other words and phrases thrown at someone, such as “jerk,” “piece of trash,” “stupid idiot,” etc. When used like this, they all mean nothing more than the angry party strongly doesn’t like what the other party did. They serve as a type of exclamation point.

“I don’t like what you did,” is not as emotionally packed as, “Listen, you crazy idiot, I don’t like what you did!” Nor is it as emotionally packed as, “You must be mentally ill to do something like that, you jerk!” Nor is it as emotionally packed as, “Oy veh, you putz, you got to be meshuga to do something like that!!”

Of course, it is perfectly possible to convey emotionally packed exclamations without the use of these words. My mother was a master at this. Her abilities to clearly define what she objected to and to vary her tone of voice were all the tools she required to amply communicate to people where she stood on an issue.

The Special Similarities of Crazy, Mentally Ill, and Meshuga

Now, in addition to being used as general insults, “crazy,” “mentally ill,” and “meshuga” can also be viewed as falling into a group of ideas that have more similarities than most of the other insults that might be picked at random. That is, I would guess that “crazy” and “mentally ill” are viewed by most people as being more alike than “crazy” and “jerk,” even though each could be used as general insults.

It is important to note that there are people in our communities that have adopted a particular narrow use of the term “mentally ill.” To illustrate this, Margaret believes she has a mental illness and values that she has come to accept that about herself. For her, conflicts spring up when she hears someone use the term, “mentally ill” in its more broad, general insult manner. For example, let’s say Margaret is sitting in her backyard, and she hears that her neighbor, Tim, has gotten into a conflict with Ron. Suddenly she hears Tim shouting at Ron that he is a no good mentally ill idiot!!! Even though the conflict has, in a sense, nothing to do with Margaret, she becomes angry with Tim for using the term “mentally ill” in this broad, general insult manner. There is actually no law requiring that Tim adopt the narrower meaning that Margaret uses, but she is still outraged at him.

Who Should Get to Decide When it is Proper to use Terms Such as Crazy, Mentally Ill or Meshuga as a general Insult or in Some Particular Narrow Sense?

The actress, Marlene Dietrich, when asked if she believed in God, replied, “If there is a supreme being, he’s crazy.” In some religious communities, she would have been viewed as crazy for saying this. Meanwhile, Dr. Sigmund Freud, who is thought of by many as having been a great expert on mental illness, believed that all religious people suffer from a mental illness. Dr. Carl Jung, an equally great expert on the subject, disagreed with Freud, believing instead that religious people, even people today viewed as psychotic, may be in touch with deep and ancient truths.

When I was a young boy growing up in the Brooklyn neighborhood of Brighton Beach, I heard people from time to time being called a “meshugana,” which I was told means in Yiddish, “a crazy person.” What was unique about how the Yiddish term was used in Brighton Beach, is that as soon as someone was said to be a meshugana, it was very common to have someone stick up for that person with the words, “Hey, everyone has their own mishegas.” Loosely translated, this means that we all have a little craziness within us, so let’s not pretend to be so high and mighty by putting someone down like this.

Now, for people who want to know if they are really mentally ill, they can get the latest version of the DSM (Diagnostic and Statistical Manual of Mental Disorders), which was developed by the American Psychiatric Association. I happen to have a copy of it, and as I’ve been studying its pages, it has become apparent that with little imagination we can all be viewed as having some mental illness. That works out pretty good for psychiatrists because this way they never have to turn away any customers who come to their office seeking to become their patients.

But what if we really want to find out if we really, truly are crazy? Fortunately, there is now an alternative to the DSM, which can finally set us straight. It’s called the Diagnostic Manual of Mishegas (DMOM), and as the ad for it explains, the authors divide

all mental disorders into two realms: mishegas major and mishegas minor. And for each of the sub-categories it analyzes… yenta, kvetch, alter kocker, shnorrer, dementia-with-benefits, etc…THE DMOM will enable readers to transform ordinary tsuris and mishegas—the glooms, blues, angsts, and general chazzerie of their lives—into transcendent and easy-to-understand categories. It will turn kvetching into kvelling and guilt into gelt, so that readers will learn to live at peace with their inner mishegas and to treasure its precious and life-giving absurdities.

Well, I have nothing that can top that, so until we meet again, don’t let the insults get to you.

My Best,

Jeff

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Tags Carl Jung, crazy, DSM, mental illness, Mentally ill, Meshugana, Mishegas, sigmund freud, The Diagnostic Manual of Mishegas

conflict resolution Mental Illness psychiatrists psychiatry Thomas Szasz

Dr. Thomas Szasz and Psychiatric Name Calling

Post author By Dr. Jeffrey Rubin
Post date November 17, 2014
1 Comment on Dr. Thomas Szasz and Psychiatric Name Calling

On this blog, one of the main topics of discussion is name calling. And, from time to time, some people have asked me what I think of the types of names psychiatrists use to talk about their patients.

In response, I wrote a post titled Name Calling by Psychiatrists: Is it Time to Put a Stop to it? It stirred up a great deal of interest, and the various comments led me to write several follow-up posts. While all of this was going on, several people asked what I thought of the psychiatrist, Thomas Szasz. And so, today’s post at least begins my reply.

It was 45 years ago when I first heard of Dr. Szasz. I was about 19 years old, it was the late 1960s, and I was taking an Abnormal Psychology course as an undergraduate student at Brooklyn College. Professor Meyers presented a whole class on Dr. Szasz’s recent book, The Myth of Mental Illness. It was a time when many of us were raging against the Vietnam War. Questioning all authority went right along with that, and so Szasz’s position, for me, fell right into that general mindset.

Labeling a child as mentally ill is stigmatization, not diagnosis. Giving a child a psychiatric drug is poisoning, not treatment.--Dr. Thomas Szasz. — Labeling a child as mentally ill is stigmatization, not diagnosis. Giving a child a psychiatric drug is poisoning, not treatment.–Dr. Thomas Szasz.

After the course had ended, I really didn’t think much about Szasz’s ideas again until about 15 years later. I was working with youth in the Corning, New York area, when I began to notice a dramatic increase in the number of young children and teenagers being prescribed psychiatric drugs. At one point, five straight foster children that were brought to me for counseling not only were taking a psychiatric drug, but were taking several of them. Those students typically were unhappy about this, complained about serious side effects, and when I went to the library to check out the various risks associated with their use, I became very concerned.

To address my concern, I began to organize a debate on the use of these drugs, and the first person I thought to call was Dr. Szasz. He was very helpful, agreed to debate the topic, and the debate created so much interest that other people began to ask me to help organize similar debates in their communities. In the end, that single debate turned into a series of seven debates.

I learned a great deal from all of the participants, but it was Dr. Szasz who most challenged my thinking. Although I disagree with some of his ideas, I admire his guts for standing up for what he believed, his humor, and his extraordinary intelligence.

Thomas Szasz passed away a couple of years ago at the age of 92.

A great deal of Szasz’s writings and ideas are readily available on line (see for example the article on Wikipedia). Nevertheless, to give my readers a little sense of his ideas, I am providing below a little snippet of his opening remarks from one of the debates that I helped to organize. It is slightly edited because he was not the first speaker during the debate and some of his comments alluded to remarks that someone else had said earlier during the proceedings. Without having heard these other remarks, Szasz’s comments would be hard to follow, so I edited them out. This gives his comments a slight disconnected feel at times, so I ask that you not blame him for that.

And so, without any further ado, I give you, Dr. Thomas Szasz:

Portrait of Dr. Szasz that hangs in the medical library at the SUNY Upstate Medical University

Ladies and gentlemen…. I would like to take this time to present my views of psychiatry ….

I believe…ideas have consequences. Words only mean what we do about them. They do not have abstract meaning. So the question is what do we mean when we say something is a disease?

Now to me, psychiatry doesn’t have to do with diseases at all. Just like, to me, communism doesn’t have to do with ideas.

Communism was symbolized by a bunch of stones called the Berlin Wall. But what it actually meant is that if you lived in a communist country, you can come in, everything was fine and you were told everything was wonderful for you, but if you tried to leave you found that they shot you, that you couldn’t get out. This is what happens in a mental hospital. You can get in, but you can’t get out….

Psychiatry is a branch of the law, it has alway been, and always will be… To me, psychiatry is coercion. I have always said, I support psychiatry between consenting adults… I am only interested in involuntary aspects of psychiatry.

For the sake of the argument, I don’t believe this, but for the sake of the argument, to make my argument clear, let’s say schizophrenia is a brain disease, just like cirrhosis is a disease of the liver. If we accept this and treat it like other diseases, then psychiatry disappears. It would then be treated by a brain doctor. The insanity defense disappears. Involuntary psychiatry disappears. If somebody kills somebody they are tried like everyone else. There are no psychiatrists lining up to testify to say Prozac causes murder, or mental illness causes murder, or everything causes murder except free will.

Ok,… let me give you two English sentences. The statement Jones is bleeding, is a statement about his body. The statement that Jones is boasting is a statement about Jones. They sound like the same type of statement, but they are not. The question, what do we mean by schizophrenia. Do we mean that they are a type of lesion, or do we mean, behavior. How does someone first diagnose someone with schizophrenia—from his body, or his behavior?

Let’s assume the person has a disease. The person is still behaving, the person is still a moral agent. Patients, from a moral, legal point of view, are exactly like non-patients. If I have asthma, Parkinson, etc., I can still behave. When people have Parkinson and they shoot somebody, they are responsible, if they are nice to their wives, they get along, if they are not so nice they get a divorce and so on.

Now we come to some more issues. Supposing someone claims that someone has a disease. On whose authority do we take this? In my lifetime, great authorities have maintained homosexuality was a disease. When I was in the US Navy 30 years ago, that was one of the major ideas of the service was to single out homosexuals, who were then given diagnoses by psychiatrists. This was viewed as a serious disease. Now, on the cover of Time we find that they are entitled to civil rights. What happened to their disease?

Not only was homosexuality a disease, so was being black according to an early psychiatrist, Benjamin Rush. According to him, blacks were blacks because they had a form of leprosy. On whose authority did he claim this? On the authority that he is a doctor?

Now we are shown pictures of brains and told that they prove that schizophrenia is a disease. On whose authority? The fact is that no pathologists diagnose anyone as schizophrenic based on any pictures of someone’s brain, or any other medical test. Even on postmortem, when the patient said to be schizophrenic dies the pathologist says no disease was found. The same thing with depression…

The discussion of who has a mental illness is based on judgements of a person’s behavior. So this idea that you can have a brain disease, like schizophrenia, is a little strange. Let me just give you a few questions to stimulate you. What would asymptomatic depression look like. Now we know what asymptomatic hypertension is, or asymptomatic leukemia,… but what is asyptomatic depression? Better yet, what is asyptomatic schizophrenia? What would that be. Or asymptomatic Judaism, or Christianity. These are behaviors. If the behavior is not there it is not here….

My time is nearly up, so let me leave you with a couple of questions. Please listen carefully because this is a question and a joke. If somebody has a delusion of having cancer, then he has a mental illness, right, because he doesn’t have cancer? What would it mean if he has a delusion of being mentally ill?

Okay, now to the issue of saying someone has a mental illness which is due to some biological basis. This is nonsense because everything we do has a biological basis… The most ordinary things are biological bases, namely eating and sex, called hunger and lust. These are not diseases. And just because they have a biological basis that doesn’t mean that you have to act. Urination and defecation have a biological basis. These are powerful impulses that have a biological basis but that doesn’t mean we have to do it in the middle of the living room…. Life begins with responsibility and ends with responsibility…. Psychiatry is a discipline that undermines responsibility. Thank you.

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Tags free social intelligence and emotional intelligence curriculum, insults, mental disorders, mental illness, name calling, negative criticism, psychiatry, Thomas Szasz

ADHD conflict resolution meditation William James wisdom

ADHD and the Wisdom of William James

Post author By Dr. Jeffrey Rubin
Post date November 10, 2014
6 Comments on ADHD and the Wisdom of William James

Last week’s post, titled ADHD and Psychiatric Name Calling, criticized the prevalent practice of converting concerns about a person’s ability to pay attention into medical lingo. There was a great deal of interest in the post so I decided to present another for your consideration.

As I began to craft this, my thoughts went back to my most popular post, Teaching Children How to Deal with Criticism. Since the major reason for its great success is that its ideas largely relied on those of William James, I went back to the great philosopher’s writings to see what he had to say on the ADHD subject.

There is unquestionably a great native variety among individuals in the type of their attention. Some of us are naturally scatterbrained, and others follow easily a train of connected thoughts without temptation to swerve aside to other subjects. This seems to depend on a difference between individuals in the type of their field of consciousness. In some persons this is highly focalized and concentrated, and the focal ideas predominate in determining association. In others we must suppose the margin to be brighter, and to be filled with something like meteoric showers of images, which strike into it at random, displacing the focal ideas, and carrying association in their own direction. Persons of the latter type find their attention wandering every minute, and must bring it back by a voluntary pull. The others sink into a subject of meditation deeply, and, when interrupted, are ‘lost’ for a moment before they come back to the outer world.

The possession of such a steady faculty of attention is unquestionably a great boon. Those who have it can work more rapidly, and with less nervous wear and tear. I am inclined to think that no one who is without it naturally can by any amount of drill or discipline attain it in a very high degree. Its amount is probably a fixed characteristic of the individual. But I wish to make a remark here which I shall have occasion to make again in other connections. It is that no one need deplore unduly the inferiority in himself of any one elementary faculty. This concentrated type of attention is an elementary faculty: it is one of the things that might be ascertained and measured by exercises in the laboratory. But, having ascertained it in a number of persons, we could never rank them in a scale of actual and practical mental efficiency based on its degrees. The total mental efficiency of a man is the resultant of the working together of all his faculties. He is too complex a being for any one of them to have the casting vote. If any one of them do have a casting vote, it is more likely to be the strength of his desire and passion, the strength of interest he takes in what is proposed. Concentration, memory, reasoning power, inventiveness, excellence of the senses,–all are subsidiary to this. No matter how scatter-brained the type of a man’s successive fields of consciousness may be, if he really care for a subject, he will return to it incessantly from his incessant wanderings, and first and last do more with it, and get more results from it, than another person whose attention may be more continuous during a given interval, but whose passion for the subject is of a more languid and less permanent sort. Some of the most efficient workers I know are of the ultra-scatterbrained type. One friend, who does a prodigious quantity of work, has in fact confessed to me that, if he wants to get ideas on a subject, he sits down to work at something else, his best results coming through his mind-wanderings. This is perhaps an epigrammatic exaggeration on his part; but I seriously think that no one of us need be too much distressed at his own shortcomings in this regard. Our minds may enjoy but little comfort, may be restless and feel confused; but it may be extremely efficient all the same. (quote from William James’s Talks To Teachers)

Here we see a true master at work. His sublime summary of the concern, placed in the context of other faculties working together, always lead me to vivid images of the many students I worked with over the years who had little ability to sustain their attention on school work and yet far outperformed outstanding students in such areas as music, athletics, art, computer technology, business, etc. Rather than framing the concern as a disabling mental disorder, James paints a vision that inspires the hope of finding a way to create a life filled with substantial value.

The one assertion that I tentatively disagree with James is that a person’s attention span is probably a fixed characteristic of the individual.

I have regualarly seen children who had a below average ability to attend to school work who, as they grew older did much better. Some of them got over a particularly stressful period in their life. Others learned the value of more physical activity which tired them out, and they began to sleep more soundly. Others seemed to improve for no other apparent reason than becoming more mature.

From my own experience, I found that when I learned to meditate, my ability to sustain my attention on a number of subjects distinctly improved. There are some excellent research studies that back up my own personal experience. For an example, that also reviews several of the other available studies, check out “Intensive Meditation Training Improves Perceptual Discrimination and Sustained Attention” (Psychological Science, Jun 2010; 21(6): 829–839.) Readers of my blog can find a simple to learn, absolutely free, form of meditation in my post “Anger, Rumination and Meditation.”

Let me add here, that in our society there is a push by the pharmaceutical companies to get people viewed as having ADHD to take stimulant drugs like Ritalin or Adderall. These have a number of negative side effects, and in a fairly short period of about a month or two the initial positive effects wane, and those using these drugs are left with the illusion that the drug continues to be helpful. The illusion occurs because once the positive effects wane after a few month of regular use, when the stimulant users don’t take the drug, they begin to have a withdrawal reaction that is uncomfortable and reduces their ability to pay attention. When they then again take the drug, the relief they experience from the withdrawal reaction convinces them that the drug is helping them. Instead, they are left with no better ability to pay attention while experiencing the various side effects of the drug.

Okay, so there are a few more ideas about concerns that come up about someone’s attention. I hope you find them to be helpful.

As always, I encourage readers to join the conversation by making comments in the “Comment” box at the very bottom of this page.

My very best,

Jeff

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Tags A.D.H.D., ability to pay attention, ADHD, meditation, William James, wisdom

ADHD conflict resolution psychiatrists psychiatry Ritalin

ADHD and Psychiatric Name Calling

Post author By Dr. Jeffrey Rubin
Post date November 3, 2014
13 Comments on ADHD and Psychiatric Name Calling

Recently I published a post titled “Name Calling by Psychiatrists: Is it Time to Put a Stop to it?” Among the points that I had tried to make is that psychiatrists falsely claim that the names they use to describe patients are “diagnoses.” In actuality, all that they do is convert someone’s expressed concerns into medical jargon.

I soon followed with a post titled “Psychiatric Name Calling: Is it Helpful?” Having thus raised some questions concerning the whole range of psychiatric labeling practices, today I’ve decided to focus in on just one of its most popular so called diagnosis–ADHD.

ADHD: A Huge Loss to Society

Gambling institutions well know that it is not hard to disguise losses as wins. For example, it is common in modern video slot machines that players are encouraged to bet on multiple play lines and follow any winning combination with flashing lights and high-fidelity audio, even when the amount won is less than the amount wagered. There are, of course, some who catch on to this gimmick. As one man noted, “I eventually realized that if I kept on winning, I was going to go broke.” A similar disguise is occurring with the ADHD situation.

In the spring issue of The Journal of Mind and Behavior, I found a relevant article by Lincoln Stoller titled “ADHD as Emergent Institutional Exploitation.” It documents that an estimated $3.6 billion was spent annually on ADHD drug treatements with the hope that this would help those students with an ADHD label do better in school. The drugs do create some flashing lights and audio sounds of delight from short-term effects of the drugs. And yet in terms of real life important outcomes for the students who are being placed at risk of a number of serious side effects, in the long term the drugs lead to more losses than gains. I well understand that many fine, well-meaning and intelligent people strongly disagree with me on this. Let’s look at the research.

The NIMH Multimodel ADHD Treatment Study (see HERE) is the largest study ever carried out, involving 6 study sites, millions of dollars, nearly 600 elementary school children, ages 7-9, randomly assigned to one of four treatment modes: (1) medication alone; (2) psychosocial/behavioral treatment alone; (3) a combination of both; or (4) routine community care. The results were initially written up as a big success for the ADHD drugs because in the short term, those taking the drugs did appear to do somewhat better on some outcome measures. But by the end of 14 months of treatment, no significant differences were found between those who had taken the drugs and a similar group who did not take them in terms of improved behavior and academic achievement.

In a recent Canadian study, those who took the drugs actually did significantly worse than those who didn’t. And other studies (see this article for review) indicate that by the time ADHD-labelled students reach the age that most students graduate high school, they do no better if they had taken ADHD drugs than a similar set of students who had not taken the drugs. High school average, high school graduation rates and performance on achievement tests were the same for both groups. But for each student taking the drugs, side-effects were endured and thousands of dollars spent on prescriptions.

And so, at some point it makes sense to start asking if a temporary improvement in school, which washes away by 14 months, is worth $3.6 billion? The pharmaceutical industry, like gambling institutions, well know that it is not hard to disguise losses as wins.

A Recent New York Times Article

Not long ago in the New York Times an article by Dr. Richard A. Friedman appeared titled “A Natural Fix for A.D.H.D.” There, the author states, “people with A.D.H.D. may not have a disease, so much as a set of behavioral traits that don’t match the expectations of our contemporary culture.” To defend his position, Dr. Friedman points to the fact that in schools, which tend to be regimented, require a great deal of sitting time, and lack much choice at what someone wants to be doing at any given time, the attention problems are far more prevalent than with adults who often have some choice at what career they go into.

For example, a patient of his, a 28-year-old man,

was having a lot of trouble at his desk job in an advertising firm. Having to sit at a desk for long hours and focus his attention on one task was nearly impossible. He would multitask, listening to music and texting, while “working” to prevent activities from becoming routine.

Eventually he quit his job and threw himself into a start-up company, which has him on the road in constantly changing environments. He is much happier and — little surprise — has lost his symptoms of A.D.H.D.

My patient “treated” his A.D.H.D simply by changing the conditions of his work environment from one that was highly routine to one that was varied and unpredictable. All of a sudden, his greatest liabilities — his impatience, short attention span and restlessness — became assets. And this, I think, gets to the heart of what is happening in A.D.H.D.

Although Dr. Friedman does a good job questioning the value of viewing ADHD as a mental disorder, he does throw in a plug for using ADHD drugs on children. Thus he says:

What are the implications of this new research for how we think about and treat kids with A.D.H.D.? Of course, I am not suggesting that we take our kids out of school and head for the savanna. Nor am I saying that we should not use stimulant medications like Adderall and Ritalin, which are safe and effective and very helpful to many kids with A.D.H.D.

In actuality, the effectiveness of these types of medications are very much in question because, as I have already pointed out, their effects soon wash away as tolerance to them develops. Meanwhile a great deal of money has been wasted.

As far as his statement that these drugs are safe, among the common side effects are high blood pressure, chronic trouble sleeping, feelings like throwing up, upper abdominal pain, and head pain. Moreover, there are a number of far more serious problems that, although rare for any individual child, nevertheless, because of the current policies that lead to several million children being placed on these drugs, thousands of our youth end up experiencing awful tragedies.

The world benefits from having people with a variety of interests, skills and talents. Schools tend to push people into too limited an environment despite the diversity of people who come through its doors.

Additional Research

There is research that demonstrates that many students who are given the ADHD label do far better if they are given opportunities to run around a few extra times during the school day, but most schools are cutting out more and more recess time to squeeze in more seat time for learning. Many kids given the ADHD label tend to be the youngest in their class. Because everyone in a class is expected to do the same level of school work in any given class, the youngest begin to stand out, and are identified more as “ADHD” kids.

Other research indicates a strong association between an ADHD label and sleep problems. These problems occur in part because some people are not morning people and like it or not, school begins early.

Should being a person who doesn’t function as well in the morning be considered a disease? In some settings, the fact that there are people who would prefer to work a later shift is an enormous plus, but for those in school, name calling and drugging is viewed by the authorities as making sense.

Some people who have sleeping problems have other real problems that contribute to their sleeping woes such as parents fighting, stress from community violence, bullying, serious financial problems, and on and on. In such cases, doesn’t it make sense to view the students as having difficulty coping with difficult environmental conditions rather than having a mental disorder?

Are Genetics the Cause?

The pharmaceutical companies love to promote genetic studies that appear to demonstrate that ADHD is a real disease. Since they fund so much of the media’s advertisement business they greatly influence what gets coverage in newspapers, TV and internet stories. Results are initially exaggerated and splashed all over the headlines. Then, when the real facts start to appear, you have to dig into the bowels of research libraries to find them.

A great example of this occurred when a 2010 study was heralded as being the first to find direct evidence that ADHD is a genetic disorder. As Lincoln Stoller tells the story:

Thapar, who is one of the authors, is cited in a press release preceding publication of the article as saying: “Now we can say with confidence that ADHD is a genetic disease and that the brains of children with this condition develop differently to those of other children” (Walsh, 2010)…. Thapar implies that those who differ from the norm are necessarily inferior.

Once the study was actually published it showed that 85 percent of those labelled as having ADHD had no discernible genetic difference from those without ADHD. Shortly after the study was published, it was found that it did not control for differences in IQ. By removing from the study students who had IQs below 70, the results indicated that about 90 percent of students with ADHD in the study had no discernible genetic difference. Finally, in a subsequent paper, two of the original authors of the study stated, “gene variants still explain only a small percentage of the inherited component of ADHD.”

Although the original press released got a great deal of attention in the media, the press was silent as the more accurate information surfaced.

Conclusion

Because people have differences, whether genetic or otherwise, this does not mean they have a disease. For example, if great singers have a genetic difference than the rest of us, this doesn’t mean they have some sort of disease. And for those of us who perhaps have some genetics that has led us to sing less than average, we need not view ourselves as diseased. We can, instead, seek to find other situations in which we can make ourselves useful. The same holds true for those who find that in some situations their minds wander more than others.

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Tags A.D.H.D., Adderall, ADHD, ADHD Treatment, mental disorders, mental illness, psychiatric disorders, Ritalin