Wednesday, January 26, 2011

Yet Another Drug Company Strategy for Parting You From Your Money?

Syndicated newspaper health columnist, Dr. Peter Gott, had an interesting column the other day (  A question had arisen about the so-called "expiration date" posted by the pharmaceutical companies on bottles and packages of their medications. 

Apparently, people are throwing out a lot of very safe and potent medication that is "expired," and replacing it with a new purchase.

Dr. Peter Gott

Dr. Gott wrote: "The FDA conducted one of the largest-known studies for the U.S. military 15 years ago, and it was subsequently reported in the Wall Street Journal in March 2000. The military stored $1 billion worth of drugs for a test program to determine whether it could extend the lifetime of its inventories, which had traditionally been updated every two to three years (at great expense and much effort with disposal). More than 100 drugs were tested, including OTCs and prescription meds. At the end of the test period, almost 90 percent of the drugs were found to be both safe and effective — 15 years after the posted expiration date."

Fifteen Years!!!!  The drug company estimates, written on the bottles, of how long the meds are still going to work are just a wee bit conservative, don't you think?  (There are exceptions: certain drugs do deteriorate much more rapidly such as nitroglycerin, some liquid antibiotics, tetracyclines and insulin).

Could it be that the drug companies are doing using expiration dates to make more money at your expense?  Hard to prove; easy to believe.

Friday, January 21, 2011

Of Hormones and Ethnic Conflict

In my new book, I pose the following question: "If people are basically selfish and our biological imperative is to survive in order to pass down our genes to future generations, how do we explain the willingness of so many people to die for their country or their clan in a war? Throughout history, hundreds of thousands of men have marched headlong and almost without flinching into enemy spears, arrows, gunfire, and bombs, all the while watching their friends and comrades killed or maimed right beside them...

Mothers who send their sons off to war are also honored. In the United States, women whose sons die in war are hailed as 'Gold Star Mothers'... The idea that maybe one should not always be willing to do that was rarely questioned on a large scale anywhere in the world until wide-scale opposition developed to the Vietnam War in the United States in the mid-1960’s."

I go on to explore a theory which may explain the paradox of humankind's willingness towards self sacrifice and the sacrifice of their own children (for example, honor killings in the Middle East, and female infanticide in China) through an evolutionary biological concept called kin selection: "Darwin actually addressed this issue. At first the characteristic of altruism, the willingness to sacrifice oneself for the seeming good of one’s ethnic or kin group, seemed to him to be at odds with his theory of natural selection.

He then realized that this paradox would disappear if he changed his focus from the individual with a good genetic adaptation to the group to which the individual belonged. A single individual with a genetic mutation that is highly desirable and adaptive may still die before reproducing. If a group such as a family, a herd, or a tribe has many individuals who share the adaptation, then the propagation of that gene becomes far more likely."

This could lead to a situation in which genes that predispose individuals to be willing to sacrifice themselves for the kin group, and which cause the kin group to be willing to sacrifice individuals, would be more likely to survive and be passed down from one generation to the next and therefore selected for.

So a tendency towards self sacrifice for the good of the tribe may be in our genetic loading. A lot of evolutionary biologists do not accept the concept of kin selection primarily because they worry it might be used much like the concept of eugenics was in the last century - as an excuse for killing off the weakest members of society. (Some of today's legislators do not seem to need such an excuse). Nonetheless, the potential misuse of a scientific concept is not proof that the concept is invalid.

Now comes some new data which might lend further creedence to the concept of kin selection: (

Oxytocin is a hormone which does a number of things, such as helping cause the contractions of the uterus which expel a fetus during birth. It is also commonly found in the brain, where it has been found to be central to the process of attachment between a new mother and her new baby. As the New York Times article explains, "This tiny chemical, released from the hypothalamus region of the brain, gives rat mothers the urge to nurse their pups, keeps male prairie voles monogamous and, even more remarkable, makes people trust each other more."


Well, not trust everyone, as it turns out: "The love and trust it promotes are not toward the world in general, just toward a person’s in-group. Oxytocin turns out to be the hormone of the clan, not of universal brotherhood. Psychologists trying to specify its role have now concluded it is the agent of ethnocentrism." In an ingenious series of experiments, Dutch psychologist Dr. Carsten K. W. De Dreu found that Oxytocin may "...create intergroup bias primarily because it motivates in-group favoritism and because it motivates out-group derogation.”

The author of the New York Times article describing the experiments raises another interesting question, and gives Dr. De Dreu’s answer: “Early religions were also involved in establishing group cohesion and penalizing offenders. Could oxytocin be involved in the social aspects of the religious experience?” Dr. De Dreu sees oxytocin’s effects as being very general, and no more likely to be associated with the religious experience than with soccer hooliganism. ‘When people get together with others who share their values, that drives up the level of oxytocin,’ he said.”

Still, I often wonder why so many people are so ready to profess to believe transparently and obviously preposterous religious dogma. Perhaps that is a price they are willing to pay in order to maintain in-group status and group togetherness.

Monday, January 17, 2011

Does One Need to Forgive Abusive Parents in Order to Heal?

One of the most frequent questions I get when I start working with patients on altering ongoing dysfunctional family dynamics with previously abusive parents or other primary caretakers is, "Do I have to forgive them?"

"Well, no, you do not have to...," I answer,"...but if this goes well you will probably want to." Forgiveness is not an end in itself but a byproduct of the process of reconciliation.

My patients also tell me, when I am encouraging them to re-establish contact with abusive parents, that they do not want their parents in their lives.  I reply, "That's because of the way that they treat you now. I don't blame you.  However, if they stopped treating you like that, you probably would want them in your life."  Having no loving family to call our own is not a predicament that we are naturally built for.

As I described in my June 11 post, How Can You Be Empathic With a Child Abuser, the most difficult and time-consuming part of doing the type of psychotherapy I do, called Unified Therapy, is convincing my patients that it is in their interest to find a way to metacommunicate with their family of origin members. That means attempting to get past everyone's formidable defensiveness, denial, and resistance and talk about their family dynamics.  This reluctance is especially acute - and understandable - if the parents had been severely abusive to the patient when the patient was a child.

Patients think I am asking them to somehow change the past.  That is obviously impossible.  However, we can change the effect the past has on us. The goal of the process is to change how things are right now, in the present.

The problem is, in fact, not in the past at all.  Dysfunctional family patterns, in modified forms, usually keep going on long after children grow up. Unless something is done, they have a strong tendency to go on and on until the parents die, although the patterns often do mellow somewhat as time goes on.

Although we may not want to or be able to forget past misdeeds, most of us could readily find it in our hearts to forgive family members for bad past behavior if only they would let us.

But if the offending family members are still mistreating you, acting as if the abuse never even happened, or are in some other way invalidating you if you even bring it up, how can you possibly forgive them?  If they blame you for their past misdeeds, how on earth can you possibly forgive them?  If they demand you leave your children in the care of an abuser and act as if you are unreasonable for refusing to do so, ditto.  Again, this is a problem not in the past but in the present.

In order to "get over" the abuse and move forward without passing on negative family interactional patterns and conflicts to future generations, I believe it is extremely important to come to a mutual understanding with major family of origin members.  Whether you want to continue having a relationship with them after metacommunication is successful, or whether or not you decide you want to forgive them, is in a way besides the point. But you probably will.

Wednesday, January 12, 2011

How to Disarm a Borderline Part V: You ARE Helpless

Before reading this post, particularly if you are going to try this at home with a real adult family member with borderline personality disorder (BPD) (which is not recommended without the help of a therapist), please read my previous posts Part I (October 6), Part II (October 29), Part III (November 24), and Part IV (December 8).  The countermeasures described in this post do not work in isolation but must be part of a complex, consistent, and ongoing strategy. 

This post will continue with specific countermeasures to the usual strategies in the BPD bag of tricks used by them to distance and/or invalidate you, as well as to make you feel anxiously helpless, anxiously guilty, or hostile. 

Today we discuss #2, countering escalating demands on you to do more and more.

Back in the days of the Vietnam War, protesters used to recommend that the country just "declare victory and then get out."  To paraphrase this for our purposes, the advice here is to declare helplessness and get out. 

Remember, the individual with BPD is not only trying to make any potential "helpers" feel helpless, but also to make them feel upset about being helpless.  If you are fine with being helpless when you are in fact helpless, this goal of the BPD individual will be frustrated.  Of course, you have to remain fine with it consistently.

This point was driven home to me back when I was in private practice in California and was covering for another psychiatrist who was on vacation.  One of his patients with BPD frantically called, seemingly in crisis.  Of course, I knew absolutely nothing about her case.

"I've missed so much work that if I am out sick any more, I'll be fired," she told me.  "But I'm so depressed I can't do the job, and my boss says if I screw up again, I'll be fired!" she quickly added.  "What should I do?"

I'm no Klaatu

The way she described her plight, she was going to be fired for sure.  No doubt about it.  Too late to do anything about it now. That ship had sailed.  It did not take a genius to see that, and she was not a stupid woman.  If I even attempted to suggest a solution for her, she would immediately know that I was full of sh*t!

There was nothing I could do to help her save her job.  Nothing anyone could do, for that matter.  If she was speaking the truth, the whole truth, and nothing but the truth, that is.  What to do?  Declare helplessness and get out?  But how do you do that without invalidating her?
The first thing I did was to be empathic with her horrible dilemma.  "What an awful bind you're in!" I said in a warm voice.  "It sounds like you're going to be fired no matter what!" 
"A lot of help you are," she replied sarcastically.  Then she hung up on me. 

Oh well.  She was right.  I was no help. 
It did not bother me at all.  If she had been my patient, I'm guessing that she would still have shown up for her next appointment.  Although she sounded like she was upset with me, she knew that I would not be a help to her all along.  The importance of listening to words and not reacting to tone and body language will be a subject of a later post.
But what if she had still pressed me for a solution to her bind?  What if instead of hanging up on me she said, "Yeah, but I need you to tell me what to do.  You're a psychiatrist!  There must be something I can do!"
Well, there wasn't.  Sorry.  Reality and all that.  I was absolutely, incontrovertably, and in all ways helpless to solve her conundrum.  I'm supposed to be upset about that?  Hits me right in the God, you know.
Of course, if I said that to her, it would have sounded sarcastic, and that would be a hostile response.  That's one of the three no-no's in dealing with BPD.  In response to hostility , she would continue to find new and ingenious ways to infuriate me.
Time to declare helplessness outright:  "I sure wish I knew of a way to solve this for you."  I can say that with deep sincerity, because it is true.  I really do wish I could quickly solve impossible dilemmas for people on the spot.  I would love to be able to get people out of bad situations after they have already made it impossible to dig themselves out.  If I could, people would be willing to pay me thousands of dollars to give them advice.  They would  come from all over the world to see me.  I would be famous and wealthy beyond belief. 

But alas, it is not to be.
If  BPD individuals are in a stubborn mood, however, they might come back with a statement that strongly implied that I really knew of a solution, but was refusing to share it with them because I was being an A-hole.  Or they could accuse me of being incompetent, because surely other psychiatrists would know what they should do. 
To the first, I would say, "I'm glad you have such faith in me, but I really don't know what to tell you."  And refuse to argue further.  To the second, I would say, "Maybe you're right."  In order to continue to sound as conciliatory as possible, you must be willing to concede that maybe someone else could be smarter than you are in this situation, and not be threatened by that possibility.  Who really knows? 
An individual with BPD could also respond with, "Well, then, I might as well just kill myself."  I'll have to leave what to do about that one for a future post about how to handle suicide threats.
Trying to be helpful when doing so makes you miserable is another potential pitfall.  The best example of this is the middle-of-the-night phone call.  The BPD person just had, say, a spat with his or her lover, and wants to cry on your shoulder about it.  All night long.  For hours. 
I used to handle this with a declaration of helplessness: "Well there probably is not going to be any way I can make you feel better over the phone, but what happened?"
Sometimes they would reply, "I guess you're right.  I'll talk to you later."  Quite often actually.  Alternatively, they might just go into their spiel, rambling on and on about their latest crisis.  If so, I would interrupt them and say, "Is there anything I can do for you right now?"  They would often agree that there was not. 
If they still kept on, I would say, "I wish I could talk to you longer, but I really have to go."  No explanations, no alibies, just, "I have to go."  "OK then, GOODBYE!" they might shout in response, and then wait expectantly to see what I'll do next.  Works for me.  Getting them off the phone was my goal, and I achieved it. 

I knew they were not really all that angry about it.  It was merely a ploy to get me to say, "But please don't go away MAD."   Do not bite.  Just say goodnight to them and hang up.  But do say goodnight.  Otherwise you are being rude, a sure sign of hostility.
Later I came up with a much better response to the late night phone call.  I would say, as earnestly as possible,  "Hey, could you do me a really big favor and call me back after 9 AM?  I'd really appreciate it."
They would say, "OH! Did I wake you?"  I'd reply nicely, "Well, yes."  I'd then hear, "I'm sorry.  I'll call back later."  Worked like a charm.  A lot of times, they never even called me back the next day.

Saturday, January 8, 2011

Live Television Interview

I will be talking about my book.
Memphis WREG Channel 3 "Live at 9." (CBS affilliate). 
Wednesday, January 12th, 9 AM CST.

Thursday, January 6, 2011

ADHD: Now You See It; Now You Don't

Headline in the December 2010 Edition of Clinical Psychiatry News:

"ADHD Diagnosis 'Extremely Transient' Over 1-Year Period." 

The article describes what J. Blake Turner, Ph.D. found when he analyzed serial assessments of 8,714 children and adolescents.  At the annual meeting of the American Academy of Child & Adolesent Psychiatry, he reported that, "Generally, the loss of the diagnosis" was more likely than its persistence over a relatively short period of time. 

Roughly 1,200 total cases were identified initially - a fairly astonishing percentage of the sample in and by itself.  In the four studies looked at, loss of the ADHD disgnosis occured  in 55-75% for the "inattentive" type of ADHD, 55-65% for the "hyperactive" type, and 18-35% for the "combined" type during the year the subjects were studied. 

The disappearance of the diagnostic criteria did not usually result from a small change in those kids who barely met the criteria in the first place - the kids described in the study lost on average five different ADHD symptoms.

Do neurodevelopmental disorders disappear like this?  I think not.  Are the majority of children diagnosed with ADHD merely reacting to stressful environments?  I am sure the reader can guess my opinion on that question.

But did we not just hear a story in the news a couple of months ago about a study that was reported to be proof positive that ADHD was a genetic disease, and therefore could not possibly ever be a behavioral problem resulting from dysfunctional family interactions? 

The study that was widely reported under a headline implying this genetic "proof" of ADHD and disproof of family problems was published in a medical journal called the Lancet on September 30.

In the study's genome-wide analysis, 366 children 5 to 17 years of age who met diagnostic criteria for ADHD but not schizophrenia or autism and 1047 matched controls not diagnosed with the condition were studied. Researchers found that compared with the control group without the ADHD label, children with the disorder were twice as likely — approximately 15% vs 7% — to have copy number variants (CNVs).

CNVs  are sections of the genome in which there are variations from the usual 2 copies of each chromosome, such that some individuals will carry just 1 (a deletion) and others will have 3 or more (duplications).

Of course, even if the presence of CNV's were serious proof that ADHD is invariably a genetic disorder - and it is not  for reasons I will mention shortly - this would mean that a whopping eighty five percent of kids diagnosed with ADHD did not have the disorder!  That is one hell of a rate of misdiagnosis.

The presence of CNV's do not prove genetic origins for most cases of ADHD at all, although they may quite possibly predispose some individuals to develop deficits in the neural networks of their brains.  As you can see from the above data, 7% of normal kids have them. 

Second, a high percentage of the kids diagnosed with ADHD who did have increased rates of CNVs also exhibited learning disabilities.  In ancient times when I was in training, problems with attention were thought to be a side effect of learning disabilites such as dyslexia.

 Last, the presence of higher numbers of CNV's in the regions of chromosomes the study authors found them in is not specific to ADHD, but is also seen in autism and schizophrenia.

This study should win the Oscar for Most Highly Exaggerated Claims of Significance of Data in a Research Study.  Shame on the press for going along with the ruse.

Wednesday, January 5, 2011

Author Appearance and Book Signing

I'll be speaking about my book and signing copies on:

Tuesday, January 18th, 6 p.m


Davis-Kidd Booksellers
387 Perkins Road Extended, Memphis TN
(near Perkins & Poplar in East Memphis)

Sunday, January 2, 2011

A Former Freddie the Freeloader Speaks Out

By far the most frequently read post on this blog has been the one entitled Freddie the Freeloader and Minnie the Moocher from August 10.  According to my blogpost stats, it has outdistanced the next most read post by almost 70%.  No doubt some of these viewings were from people merely doing Google searches looking for the image of the Red Skelton character that is in the post.  Nonetheless, I get the feeling that there are a lot of Freddies and Minnies out there and that people who see it happening want to know what they can do to help.

Letters about this subject are also very common in the advice columns of the columnists listed in my previous post.  Lots of siblings and in-laws fretting about parents who were enabling a freeloader, or from parents themselves who think their freeloading child is just intrinsically incompetent and wondering what to do about him or her. 

One recent letter caught my eye, however (  A former Freddie reported that his parents finally got wise and cut off the money flow.  The former Freddie expressed his appreciation for that.  He really hit the nail on the head:

"I am a 28-year-old male who was spoiled growing up. My every wish was entertained. No surprise that when it came time to spread my wings, I failed to launch. I was terrified of growing up and its attendant responsibilities. I tried moving out a few times, but never took it seriously because I knew my safety net (my parents) was always there to bail me out.

When I lived with them, I was a disrespectful and lazy slob who never contributed to the household. My loving parents, especially my mother, put up with it for many years, but they finally put their collective foot down. Because they stood up to me, I can proudly say that I am a man. I now live in a luxury apartment with my wife. We take pride in our place and keep it spotless. Money is tight, but I manage my finances and work hard.

I can now say no to myself because my parents finally did. And I have a better relationship with them and the rest of my family now than I did before. Please, parents, don't be afraid to say no to your children. They will thank you for it later."

Most of the parents of freeloaders have been told by a lot of people that they are enabling their children and causing them to act in an impaired fashion, but they refuse to listen.  They don't seem to believe that it is true.  In fact, their typical response is to get angry at the person giving the sage advice, as well as to become extremely defensive.

Readers: Why do you suppose that is?  I provide my own theory in Chapter Two (Don't Blame Us) of my new book.