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Several days ago I got the best news of my life. I learned that Jennifer Lopez was getting divorced. I’m ecstatic. Finally I will be able to live out my fantasy of hot sex with this hot babe. I don’t know where she lives but I know it is nearby. I’ll be ready and waiting at the local Wendy’s for the moment when she walks in the door. (Hopefully I won’t gain too much weight as I sit all day eating Spicy Chicken Sandwiches.) Oh. There is a problem. I’ve already got my sight set on another recent divorce, Patricia Arquette. Now what the hell am I supposed to do.

. . . . .

Don’t we realize that we are headed back to the same old times we had 100 years ago? We have no sense of the sweep of history. We are so fucking egocentric, so fucking deluded with our own self-importance, that we think nothing bad can really happen to us, only to other people. But, damn it, look at it! The New York Times has a book review on a book about the transcontinential railroads. Those railroad barons were fucking bastards and they didn’t care who they had to step on, who they had to crush, to get what they wanted. Is there any difference between that and what Wall Street did to the entire country and the entire world economy? Now all of us can experience those good ol’ days when there were no unions (and if you tried to form one you’d probably be killed), no health insurance, no social safety net, no nothing. And the irony of ironies? Now we ALL get to work for coolie wages and now the coolies have our entire economy and all our fucking jobs and they are doing just great with it, thanks for asking.

. . . .

I swear I can’t get a fucking thing done. I’m off my meds for almost a month and, shit, you mean to tell me this is a gift? This is the thing that people think is so fucking wonderful that they think every kid should have it for Christmas? Well, fuck you! This is no fucking gift. This ADHD shit is maddening, it’s psychosis on steroids. It drives you nucking futs!

. . . .

Anyone else fantasize about having alternate lives? Isn’t that the source of frustration, what drives some ADHDers to do crazy things because they think that Patricia Arquette is really really gonna take notice of them so they get divorced so they can be ready for her phone call?

. . .

What a fucking gift, eh?

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Precise neuroscience evidence dramatically changes health delivery, health applications. Dr. Charles Parker, ADHD Medication Rules: Paying Attention To The Med For Paying Attention

Six years ago I read Driven to Distraction and diagnosed myself as being ADHD. I shared my findings with a psychiatrist. He handed me a small card that had five questions on it. I answered the questions, we talked about my answers, we talked some more and then he agreed with my diagnosis. He prescribed Wellbutrin™. From that time to the present, I visit his office every three months. He asks, “How are you doing?” I say, “Fine.” I then pay his fee and he hands me a prescription. That’s it. Does he do any tests? Blood? Brain? Reflexes? I.Q.? Anything? No. He performs the “typical” diagnosis, makes an assessment within minutes and prescribes medication. The effectiveness of the medication is determined by my answer to the single question, “How are you doing?” This method of diagnosis may have made sense prior to the explosion of knowledge in brain functionality and neuroscience. However, it no longer makes much sense. It ignores too much and thereby misses too much. Charles Parker, neuroscientist and psychiatric consultant, wants to supplant this overly simplistic diagnostic methodology with one that integrates some of the latest work done in neuroscience, psychopharmacology, and brain studies (e.g., SPECT scans). In his book – ADHD Medication Rules: Paying Attention To The Med For Paying Attention – he shows how diagnosis and treatment can be based on precise measurements, how medications can be precisely targeted and how this will result in better results, providing what he has termed personalized, customized medicine.

Parker’s New Methodology

Note: The following description is a simplified version of Parker’s methodology and, therefore, it is important to read his book in order to fully understand the richness of the methods and diagnosis.

Once it is determined that the patient has ADHD,¹ the doctor uses a set of diagnostic categories that maps the observed behaviors to specific brain functions. This is a crucial point. Both the current and proposed new DSM categories take a broad-stroke view of ADHD. These categories do not correlate observed behaviors to specific brain functions. They point in a general direction but lack precision. Parker’s alternate set of categories makes up for this shortcoming. His three major categories and eleven subcategories make possible a finely tuned diagnosis and treatment because each subcategory corresponds to specific brain functions and specific medications that can affect these brain functions. Therefore prescribed medications based on this finely tuned diagnosis are much more effective than a broad-stroke approach.²

Figure 1: The Parker Causal Chain: Parker's diagnostic categories/subcategories map to specific brain functions that, in turn, are affected by specific medications. Changes in observable behavior make it evident whether the medication has or has not been effective.

Parker’s Methodology In Action: Inattentive Type vs Thinking ADHD

The current Diagnostic & Statistical Manual has the category Inattentive Type³ that is based on behaviors indicative of inattention and a lack of hyperactivity. But once a patient is diagnosed as Inattentive Type, what does that really mean? What deep neurological functions correspond to this category and, therefore, what medication should be prescribed? The problem is that we do not precisely know based on DSM categories.⁴  Of course we know the locus of activity (or inactivity) is in the frontal lobe but there are many different neurological processes taking place that create different types of observable behavior. The DSM categories are not specific enough to correlate behavior with brain functions at the neurological level which is the level at which medications work. Consequently, treatment based on broad categories becomes a matter of let’s try this and see how it works.

For Parker, there is no inattentive type but, instead, a much richer category called Thinking ADHD, which is “thinking without subsequent action” and without evidence of hyperactivity.⁵ This category is broken into four subsets: Physically restricted (“thinking, not doing”); Emotional overthinking (“worrying, fretting”); Cognitive overthinking (“mind-stuck, unable to decide”); Compulsively decisive (acts immediately in order to avoid thinking). These subsets, in turn, correspond to specific brain functions. Once a proper diagnosis has been made and the correct subset has been determined, we know which brain functions are involved and, therefore which medication to prescribe (see Figure 1 above). Subsequent visits with the doctor determine the effectiveness of the treatment and whether the initial diagnosis was correct. There could be other factors that only become evident later on and which require a change to the diagnosis. Therefore, these visits are not a simple “How are you doing?” The doctor engages the patient in detailed discussions to determine how the medication is metabolized, whether it works for the correct duration and effectively during that duration, and so on.

Brain Optometry & Personalized Medicine

Viewed as a whole, what Parker has accomplished with these new categories, the large number of subsets, the mapping of subsets to specific brain functions and medications, and the detailed follow up analysis, is what he calls brain optometry. It moves the practice of medicine away from cookie-cutter diagnosis and treatment (“What’s your height and weight? How do you feel?”) to personalized, customized medicine. In the same way that an optometrist tailors each prescription to the patient’s specific needs, Parker believes that doctors can provide a diagnosis  and treatment that is as precise as the optometrist’s prescription. His book lays out the basic methodology required to make this a reality in the world of ADHD medications.

Figure 2: A pictorial representation of Dr. Parker's diagnostic methodology

Additional Thoughts & Comments

Who Is This Book For?

Both doctors and patients will find something of value in this book. It is not written like a medical textbook so the layperson should have no problem understanding the concepts. Doctors will find that the later sections of the book provide methods and guidelines that may be integrated into their practice.

Misdiagnosis and Suicidal Thinking

In addition to laying out a new diagnostic methodology, Parker also examines the potential for misdiagnosis which can lead to suicidal thinking. This information is of vital importance to both patients and doctors. This information alone is reason enough to purchase this book.

A Sea of Metaphors

Parker has, to a large degree, moved into somewhat uncharted medical territory. In numerous sections of the book he strains to find the right metaphor to explain particular behaviors or diagnoses. The reader may find the frequent change in metaphors to be disconcerting. However, this should not be allowed to detract from his vital work. Parker is trying to describe the multidimensional nature of ADHD using three categories and eleven subsets. The metaphors go a long way in helping the reader understand the underlying concepts and the many ways in which ADHD can manifest itself.

A Note About The Diagrams in this Review

The diagrams were created by me and NOT by Dr. Parker. They are based on my understanding of the concepts.

Other Posts of Interest

• ADHD’s Genetic Basis Old News! Recent Research: “First Direct Genetic Link” (Maybe) (ADHD Roller Coaster: “Is It You, Me, or Adult A.D.D.?”)
• New Evidence of Genetic Basis for ADHD (psychcentral.com)
• Filling in the Gap: Some Thoughts on Dr. Parker’s “Psychiatric Diagnostic Labels: Functional or Static?” (Jeff’s ADD Mind)
• Does ADHD Medication Ruin Creativity? (Jeff’s ADD Mind) Be sure to read Dr. Parker’s comment

Click here to purchase a copy of Dr. Parker’s book.

1. It is possible that further tests and discussions point to a different diagnosis and Parker notes the issues of misdiagnosis.
2. My post, Filling in the Gap, which was a reflection on one of Dr. Parker’s posts, examines the issue of mapping the observed to the neurological.
3. “314.00 Attention-Deficit/Hyperactivity Disorder, Predominantly Inattentive Type: if Criterion A1 is met but Criterion A2 is not met for the past 6 months” where Criterion A1 describes behaviors associated with inattention and Criterion A2 describes behaviors associated with hyperactivity. See: http://www.dsm5.org/ProposedRevisions/Pages/proposedrevision.aspx?rid=383#
4. If one were to speak in Freudian terms, for example, what does Oedipus Complex mean? What part(s) of the brain are involved? What medications are there that would alleviate this condition?
5. Interestingly, Parker notes that being smart is detrimental to those with Thinking ADHD since being smart means the ADHD patient can discern more variables that need to be dealt with which makes decision making that much more difficult.

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Transcription

Dear Jeff,

I like this theory of quantum consciousness but I get worried when it kind of seems too perfect, to fit too well. I did manage to get the library – not an easy trip from where I am staying. Anyway, once I see Deepak Chopra’s name even tangentially associated with something (he interviewed Hameroff), my bullshit meter goes right off the scale and I run in the other direction.

But, though I like the theory I still have questions. First, do we really know how quantum events translate to macro level events? Have we bridged that gap yet? I’m not sure. Second, Hameroff talks about microtubules within the neuron that, voila, are just the thing needed to have quantum states exist in an unreduced state. This gets a 2.7 on the Chopra B.S. scale. But let’s go with it. What does it really mean? To my mind (no pun intended) it means nothing. Well, no. Not really. It just points in an interesting direction for research. It’s when they – researchers – reach too far with the metaphors that I have a problem, when science slips into salesmanship. I think Hameroff should drop the word consciousness and instead use the term self-awareness or self-referential. That will get away from the religious Chopra bullshit.

Dom

P.S. Carmen says “Hi” and sends her love.

Note to the Reader

Here are the links to the previous two letters in this series.

1. What Is The Physiological Basis Of Consciousness?
2. The Physiological Basis for Consciousness: A Reply to Dom’s Letter

Related articles by Zemanta

• Deepak impact (blogs.discovermagazine.com)
• China has a quantum teleporter and we don’t [Beam Me Up] (io9.com)

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Transcription

Dear Dominic,

Thanks for your letter. Despite the crappy stationary I was still able to read it. Now I know what to get you for Christmas though I’m sure you would prefer another one of those beers of the month things.

Your ideas about consciousness definitely got me thinking and, of course, googling. I found a fascinating website that you’ll need to check out when you are state side. The author – Hameroff – co-authored some pieces with Roger Penrose, the guy who wrote “The Emporer’s New Mind.” And I apologize for the pun but the concepts are mindblowing. It basically goes into greater depth on the concept you touched on, namely the role of quantum mechanics as it applies to consciousness.

Consciousness kind of bubbles up from quantum states and once they reach a point a reduction, that is, they are no longer existing as set of probabilities, as a set of coexisting opposites (like the cat that was dead and alive at the same time) a sufficient amount of reductions bubble up from the quantum world to the “classical” world we are familiar with, namely neurons firing and chemicals doing their thing. But by the time we see the neurons fire, a gazillion quantum states have gone from superpositon – existing as contradictory states – to a reduced state.

I’m kind of botching the concept especially since physics is not my field but think back to that document I found, where Ledbetter is in search of a vocabulary to describe these phenomena. Though he spoke in terms of saturation points, it’s kind of analogous. Various forces reach a kind of tipping point which results in something on the macro level that is, for us, say, a thought. But by that time all these unseen events have taken place. But there’s an important implication here. With all this stuff – this preconscious stuff – existing under the dictates of quantum mechanics – it can’t be reproduced by some computer. By the time it reaches the point of consciousness where maybe, just maybe, these processes could be reproduced by a computer, there are all of these other processes that are not reproduced so what the computer is reproducing is a hollow[ed] out simulacrum of a conscious state but it’s missing the secret “quantum” sauce.

We’ll talk more about it when you get back from your trip. And please give Carmen a kiss for me.

Jeff

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Note to the Reader: I received this letter a few weeks ago from a good friend. Perhaps he will flesh out the ideas in greater detail at another time but I was so excited to read this that I wanted to scan it and share the letter with you right away. I hope you find it interesting. – Jeff

Transcription

When we look at the matrix of neurons in the brain we see the physicality of the brain yet, no matter how much we look, we can’t see consciousness. We know that it is in there. We know it exists in a particular region(s). When we look closely we see movement of chemicals, we see various electrical potentials but we don’t see consciousness. The reason why we don’t see it is because we can’t see it. I don’t mean that it is “spirit” and therefore non-corporeal. What I mean is that it exists in a dimension that we have not yet learned to “see.” In the same way that Flatlanders could not see the third dimension and Linelanders could not see the second dimension, we cannot (yet) see the dimension in which consciousness exists. This is not as bizarre as it may seem. Current science has shown that all matter can be reduced to its smallest constituent which is not an object at all but really just a force, an energy. At the level of quantum physics, we do not see particles anymore but instead we see energy as waves. This energy seems to exist in another dimension, a dimension that we are not accustomed to seeing but which we know exists. It is possible that within these other dimensions, within the waves of energy and their interactions, that that is the basis of consciousness. There are no “consciousness” neurons or “memory” neurons. That is why we can locate regions within the brain where, for example, memory exists, but we cannot point to the memory neuron. By the time we get to the neuron, we have already lost sight of the energy fields that are the underlying quantum manifestation of the memory. In other words, our scale of reference – the neuron – is really much too large to “see” the quantum nature of memory.

Additional Information

• Flatlander

Dr. Quantum Visits Flatland

Quantum Physics Simplified

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Note to the reader: While cleaning out my attic I stumbled across some items from my college days when I spent a lot of time in the stacks of the Bobst Library. Always fascinated by old books (and, I must admit, the aromatic allure of old paper) I would search out the dark corners of the stacks where some of the oldest items were stored. A few times I found typed documents folded between the pages of a book or bound volume of periodicals. Silently invoking the law of “finders keepers,” I took these documents as souvenirs, put them away in a box and forgot about them. But now, having rediscovered them, I felt that they would be of interest to this blog’s readers. Therefore, on a periodic basis, I will post the scanned pages. (You can see another scanned document here and here.)

Transcription

Dr. Ledbetter  …………………………………………………………………………………………. Page 1

Mapping Clinical Manifestations of Psychiatric Disorders to the Underlying Neurophysiological Lattice: Towards a Vocabulary of the Ecology of Mind by Dr. Phineas Ledbetter.

My esteemed colleagues who have studied with the great Dr. Freud and his disciples, have resisted any discussion of the underlying physiological layer that must, by definition, exist and be an integral part of any explanation of psychological phenomena. After all, it has already been established that the brain is the seat of all thought and emotion. Therefore, as a physical entity it must be the explanation of the psychiatric disorders that we see on a daily basis. What is missing, and what I am proposing in this paper, is the beginning of a vocabulary that can be used to discuss the transcription of the physiological to the psychological. After all, we have learned to talk about ordinary objects around us – that table, that chair – NOT in terms of molecular lattice but in terms of its aesthetics – it is light or dark wood, hard or soft, shiny or dull – and to speak about it meaningfully even though we know that there is an entire universe ‘within’ that table which we cannot see with the naked eye.

We currently have the vocabulary to speak about, say, manic depression, as it is experienced by the patient. We recently started to create a vocabulary for speaking about the underlying physiology so that, in the case of depression, we speak about neurotransmitters and various ‘receptor’ sites.¹  What we now need to do is create the conceptual schema that goes between the ‘clinical’ and the ‘physiological.’ That is, how does neurotransmitter activity (or lack thereof) become depression.

1 – Advances in the Understanding of the Physiology of Depression. Paper presented at the 1943 Vienna Conference of Psychiatry. Written by Dr. Wilhelm Heidelberg.

Dr. Ledbetter …………………………………………………………………………………………. Page 2

Part I: Basic Physiology of Depression

We currently believe that the hippocampus is somehow involved in depression, with the major activity going on at the level of the various neurons found there. A number of experiments performed at the Pilgrim Psychiatric Hospital in Long Island, New York, which employed the use of electrodes inserted into the brain of the patients and then stimulated through an advanced electrometer, showed that such stimulation seemed to have lessened the patient’s depression.² We do believe that there are other factors involved which we do not yet understand, however, we know that something is occurring on the physiological level and that this region of the brain plays a role in depression.

2 – The Beneficial Effects of Electrostimulation on the Hippocampus of Several Depressed Patients. Am. Jrnl of Psych., 24:3(1946) 116-123. Written by Drs. Pickering and Schwarzschild.

Dr. Ledbetter …………………………………………………………………………………………. Page 8

therefore, based on the understanding of the hippocampus as an electrical region, analogous to the static electricity experiments performed by Nikola Tesla, an electrical field (remember, this is only an analogy and not necessarily a description of how it truly works) reaches a saturation point, at that time we can say that the brain (the mind, really) has gone from a state of depression to a state of relative happiness. Further, the opposite is true, namely that the absence of such electrical saturation results in depression.

A graph of this phenomenon can be seen below. We see that a saturation point is reached where, once reached, the mind flips from depression to happiness.

We do not know, at this time, if this saturation point is universal or subject to differences in race. We suspect the latter since that would explain why some races of people are ‘naturally’ happier than others. Based on this understanding of the phenomenon, the saturation point would have to be different for the ‘happy’ people as opposed to everyone else. This requires further study.

Dr. Ledbetter …………………………………………………………………………………………. Page 9

Part V: Approaching a Vocabulary

We must alter our conceptual apparatus and think, not in terms of physiology but in terms of eco-logos, the study of living relations, hence, ecology. Thus we can describe, on a physiological level, that an elation saturation point is reached and, at that time, one goes from a depressive state to a general state of happiness.

Dr. Ledbetter …………………………………………………………………………………………. Page 14

elation saturation: the point at which the electrical potential within the hippocampus has reached the tipping point, so that the patient feels happy as opposed to depressed.

attentional web: as one’s attention focuses on a sea of objects and then selects a particular one to focus on, we see, physiologically, what looks like a growing web of electrical potential that begins in the frontal lobe and then fans out across the hemispheres. It is as if the mind was creating an actual web in the same way the attention creates a web and ensnares an object.

moral lines of force: morality acts as magnetic lines of force. When we perform the standard high school experiment of placing a magnet[ic] under a piece of paper, sprinkling iron filings on top and watching those filings align alone the magnetic lines of force, we find something similar happens physiologically when a person is making a moral decision. It is as if ‘good’ and ‘bad’ were represented by the poles of a magnet and the stronger pole prevails. We believe that this pattern of electrical activity may be susceptible to manipulation through the user of a strong magnetic field.

Dr. Ledbetter …………………………………………………………………………………………. Page ??

the demonstrations showed an interesting effect that I think may help to build this vocabulary, this eco-logos of the mind. It involved the use of high voltage and photographic plates. When applied to an object, the photographic plates displayed an aura, a corona, that emanated from the object. Professor Kirlian showed how this even works with human beings. The voltage used need not be very high, that is, it is at non-fatal levels, when used on a human being.

What I am proposing is that something analogous to this effect is taking place within the brain. What I’ve described as ‘saturation points’ are, essentially, those electrical potentials wherein such a corona may exist. That corona is, from the perspective of the human being, the particular feeling, such as elation, depression, etc. Physiological……has

An Interpretation of the Manuscript

Modern science has supplanted many “beliefs” with its own explanations for the same phenomena. For example, illnesses are not seen as the result of an imbalance of the humors in the body but are, instead, a result of various germs or interactions of substances (e.g., toxic chemicals; radioactive material, etc.) with the human body. The table analogy, noted in the manuscript, is relevant here. The table (i.e., the household object) is really composed of various molecules held together in such an arrangement that we have the characteristics of hardness, color, etc. We know that if we examined the table using increased magnification that we would find a lattice of molecules that bears no resemblance to the ordinary object known as “the table.” Further magnification, to the subatomic level, brings the laws of quantum mechanics into play. However, we can certainly describe, with great accuracy, the characteristics of the table without ever having to discuss the molecular structure of the table.

Dr. Ledbetter is trying to define the conceptual framework needed to understand the “mind” (analogous to understanding “the table” in terms of hardness, color, etc.) and the underlying mechanism, namely, the “brain” (analogous to understanding the table’s molecular and quantum mechanical dimensions) without reducing the former to the latter. (See Filling in the Gap which touches on the conceptual intersection between mind and brain.) Too often we confuse our metaphor for reality (See I, Human: Part I. See this and this where I discuss the issues/dangers of metaphor). Metaphor can illuminate but it can also obscure. It can be a “signpost” on the road to understanding but it is not “understanding” itself. We need to be aware of the mesmerizing effect a metaphor can have so that we are not tempted to take the metaphor as being a literal description of the reality.

Current Research

Related articles by Zemanta on current research

• Critical brain chemical shown to play role in severe depression (newswire.ca)
• Solving the Riddle of Melancholia (oup.com)

Other Information

The following comes from Dr. Parker via Twitter: Brain Series, co-hosted by Eric Kandel, and now posted in full online: http://bit.ly/1Wb29p

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——————–

Sample Entry (edited) That Appears on DrugWatch.Com

Biaxin

Generic Name:
Clarithromycin

Brand Names:
Biaxin, Biaxin Filmtab, Biaxin XL, Biaxin Granules

Drug Description:

Clarithromycin or Biaxin is an antibiotic used to kill bacteria and stop infections in various parts of the body, including the sinuses, tonsils, ears, skin, airways, stomach, and intestines. The drug works by hindering bacteria’s ability to make protein on the molecular level, keeping the bacteria from growing and multiplying. [...]

Conditions Treated:Biaxin is indicated in adults for the treatment of bacterial infections that cause strep throat (Streptococcus pyogenes), sinusitis, tonsillitis, pharyngitis, middle ear infections, and pneumonia. The drug is also approved for use in children over the age of 6 months who have strep throat, tonsillitis, sinus infections, ear infections, or pneumonia.[...]

Typical Dosage Recommendation:Biaxin is available in 250 mg and 500 mg tablets and also in an oral suspension. Dosages depend on the type of infection, the severity, the bacteria causing the infection, and the patient’s weight. [...]

Missing a Dose:If you miss a dose of Biaxin, take the missed dose as soon as you remember. If it is almost time for your next scheduled dose, skip the missed dose and wait to return to your regular dosing schedule.

Overdosing:

Overdoses of clarithromycin or Biaxin can cause nausea, vomiting, abdominal pain, and diarrhea.

FDA Approved:

December 23, 1993
Recall/Black Box Warning Information:

There have been no recalls or Black Box warnings for Biaxin.

Other Warnings

Women who are pregnant should not use Biaxin, as it can have an adverse effect on pregnancy. Clostridium difficile-associated diarrhea has occurred in patients using anti-bacterial medications. A mild form of diarrhea may also occur with Biaxin use.  [...]

Biaxin Side Effects

Common side effects of Biaxin include:

* Cough
* Hoarseness
* Painful urination
* Abdominal tenderness
* Nausea and vomiting
[...]

Some of the uncommon symptoms of Biaxin include:

* Blurred vision
* Chest pain
* Abdominal pain
* Anxiety
* Increased appetite
[...]

Things to Know, Precautions, Things to Ask Your Physician:

Talk with your doctor if you have any allergies to medications or food.

Pregnant women or those who become pregnant during the course of the treatment should be informed about the adverse effects the drug will have on a fetus.

Patients suffering from kidney disorders are at a greater risk for adverse reactions with Biaxin.

Be sure to note that Biaxin cannot be used to treat viral infections, the flu, or a common cold caused due to viral infection.

[...]

Drug Interactions:Use of the following drugs may alter the effectiveness of Biaxin:

* Terfenadine
* Ranitidine bysmuth citrate
* Zidovudine
* Didanosine
* Fluconazole
* Erithromycin

[...]

What to Avoid When Taking the Drug:

Additional Drugs

Using Biaxin for treatment may cause watery diarrhea, but you should not take medications to stop diarrhea without first consulting a doctor about possible interactions.

Food/Alcohol

Any food that might cause an allergic reaction should be avoided.

Certain activities

Avoid getting pregnant and avoid breast feeding if you are taking Biaxin.
Other Interactions that May Affect the Drug:

Other drugs that may cause an interaction with Biaxin or clarithromycin are hexobarbital, valproate and phenytoin.

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1. There is no cure for A.D.D. because there is nothing to cure. This is the crux of the A.D.D. deniers argument. There is no A.D.D. to cure because there is no A.D.D. The underlying problem here is really the word “cure.”Commonly, when we think of the word “cure” we think in terms of eliminating “something,” that something being a germ. A.D.D. is not caused by a germ, therefore, A.D.D. cannot be cured. For those few who still deny the existence of A.D.D., they are looking for a cause – a germ – that does not exist.¹

2.  There is no cure for A.D.D. because A.D.D. is a brain “wiring” problem. This is why A.D.D. is so difficult to “cure” because it is not a simple, straightforward medical problem. There is nothing to see under a microscope. There is no obvious point of entry. There is no singular cause. (We know that there is a genetic component but we also know that there are additional risk factors involved.) Compare it, for the moment, to cancer. We have the means of curing  cancer or, to be more precise, we have the means to greatly diminish, if not eliminate, its existence in the body for long periods of time. It is entirely possible to be rid of cancer for a period of time. Unfortunately for A.D.D.ers, there is no such thing as getting rid of it for a period of time. We can ameliorate its effects but it is always present.

3. We Are Getting Close But Don’t Break Out the Cigars Just Yet. We are on the cusp of learning – in depth – about the “wiring” of the brain. We understand about the plasticity of the brain; we understand how chemicals are acting at the inter- and intra-cellular level within the brain (and the body in general); we understand there are “functions” that are localized within particular areas of the brain; we understand that some functions must exist in order for other functions to exist and also the inverse, that the absence of some functions means the absence – or diminution – of other functions. However, our understanding of the brain is still at an early stage and, therefore, it is still very much a black box. Therefore, therapies to “treat” A.D.D. (it’s difficult not to use metaphors that imply a disease to be treated) such as Cognitive Therapy (see this recent comment to the blog) may have a beneficial effect but the effectiveness is limited – in part because there are degrees of A.D.D.ness – and also because we don’t know exactly how (at least, not yet and certainly not in the minutest detail) this therapy “translates” into alterations in the brain “wiring.” We know that for some people it works and that there are discernible changes. (These changes may be visible through various brain scan technologies.) We also know that biofeedback works and we even know that having a positive outlook can work. (Note that I am not making any statement about the long term effectiveness of these techniques.) We know that the brain does, indeed, respond and change as a result of many things.

4. Mission Control, We Still Have A Terminology Problem. In the previous paragraph I referred numerous times to the “wiring” of the brain. Further, I always put the word “wiring” in double quotes. The problem is that the term “wiring” reduces the complexity of the brain to a metaphor we can (currently) comprehend. However, take all the spools of wire you want and create all the complex wiring you want and you still will not have a brain and, most importantly, you won’t have a mind. Here lies another dimension of the terminology problem. The “brain” and the “mind” are not really synonymous. You need to have a brain to have a mind and having a mind assumes the existence of a brain. However, no matter how you physically dissect the brain you will never find the mind. The brain must exist within a living body in order for there to be a mind but, also, the body must have a minimal level of functioning for there to be a mind.

5. The “Cure” For A.D.D. Will Be Found Once We Have A Paradigm Shift. We do not have the words, the concepts, the terminology for describing the mind. We can, it seems, only reduce it to things that it is not in order to be able to understand it (or, at least, fool ourselves into thinking we understand it). At one time we used the steam engine as the metaphor for understanding the mind; the Id, Ego and Superego; various forms of behaviorism and existentialism; and currently, the computer.² Once we have figured out how to understand and describe a phenomenon – the mind – that is not reducible to a brain then we will be able to truly understand A.D.D. and how it might be “cured.”

{ ====== //\ ====== }

Miscellanea

- We don’t really have the vocabulary for describing the mind which is a spatio-temporal-(self)conscious phenomenon that is not reducible to its components. Was it the brain or the mind that said Cogito Ergo Sum?

- The etymology of the word “metaphor”: Middle English methaphor, from Middle French or Latin; Middle French metaphore, from Latin metaphora, from Greek, from metapherein to transfer, from meta- + pherein to bear. Source: http://www.merriam-webster.com/dictionary/metaphor The danger is that we tend to forget that metaphor implies “transfer” and, instead, move from “transfer” to “is.” See this recent post on “like” and “is.”

1. I wonder if these same people deny we landed on the moon. For a good chuckle see this.
2. Here is a  review of “Why the Mind Is Not A Computer”. The major point of the entire book can be summarized and, admittedly, reduced and bastardized to “Beware (and be wary of) metaphors because you may confuse the metaphor for the thing it stands for and begin to believe that the metaphor IS the thing it stands for.”

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See: Consumer Reports on Vacuum Cleaners? Maybe. On ADHD Medications? Definitely Not!

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You can read more about this concept at Disorderly Genius: How Chaos Drives The Brain

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