Medicating Normal - an Interview

I was interviewed today on the Facebook page for a movie called "Medicating Normal" about the current problematic state of psychiatry - such things as malignant polypharmacy, the over-diagnosis of bipolar disorder and other b.s. diagnoses, doctors spending too little time with patients for a good evaluation, and such.

It can be seen at:

https://www.facebook.com/watch/live/?ref=watch_permalink&v=1479833659217305

ACE’s, Brain Changes, and Likelihood of Diseases

As mentioned in my post of January 31, there are many studies showing a correlation between Adverse Childhood Experiences (ACE's) and a wide variety of psychiatric and physical conditions. This is probably also true of the effects on offspring of certain parental behavior problems.

Correlation does not mean causation. Answering the question of whether two characteristics that correlate are also involved in a causative relationship depends on a number of factors. How strong is the correlation? A weak correlation can be a statistical fluke, If there is a lot of natural variation in the characteristics being discussed, the found relationship may just be a coincidence. 

Are there other variables that are not controlled for that create the correlation?  In order to verify any relationship seemingly uncovered in any given study, repeated experiments that lead to the same result become necessary. And even if causation is involved, we may not know which variable was the causative factor and which the result.

The metrics I tend to use also include my answers to the following questions: If A and B are indeed causally related, what else would I have to believe? Can I think of a third, uncontrolled-for variable that could account for both A and B? Can I come up with any logical and known facts or data that might be the explanation for an apparent causative relationship, or does it seem inexplicable or even off the wall?

Last, is this result consistent with what I have seen clinically in my 40 plus years as a psychiatrist, or does it fly in the face of it? Now here it is possible that I might be looking at only confirmatory evidence of my opinions and discounting disconfirming evidence (confirmation bias), although I like to think I have at least a modicum of objectivity. 

So I also ask other psychiatrists and therapists if they’ve seen the same things I have in their clinical experience. When I do that, I have to take into account that I asked my patients a lot of questions that most therapists never even think about asking – for example, “What does your mother-in-law think about this problem your daughter is having?” So they might or might not be able to give me any relevant information.

Many studies showing the same thing makes for a stronger case for causation. When it comes to ACE’s and later illnesses, both psychological and physical, they usually pass most if not all of the tests above with flying colors. And they keep on coming in. Here’s some recent additions:

 

1.    Childhood Adversity Tied to Race-Related Differences in Brain Development

In this study, exposure to trauma was linked to lower gray matter volume in key brain regions in black kids. Among children ages 9 to 10 years, white kids showed greater gray matter volumes compared with black kids in the amygdala, hippocampus, frontal pole, superior frontal gyrus, rostral anterior cingulate, pars opercularis, pars orbitalis, lateral orbitofrontal cortex, caudal middle frontal gyrus, and caudal anterior cingulate (all p<0.001).

Compared with white children, black children had experienced more traumatic events, material hardship, and family conflict and lived in more disadvantaged neighborhoods, while their parents/caregivers had lower income and educational attainment and were more likely to be unemployed.

This analysis provides evidence that contradicts claims about inherent race-related differences found in the brain.

Dumornay N.M., et. al., "Racial disparities in adversity during childhood and the false appearance of race-related differences in brain structure." Am J Psychiatry 2023

 

2.    Childhood Adversity Tied to CVD in Early Adulthood

Children who experience adversity ― including serious family illness or death, poverty, neglect, or dysfunctional and stressful family relationships ― are at increased risk of developing cardiovascular disease (CVD) in early adulthood, a large Danish study of patients aged 16 – 38 has found. Compared to young adults who experienced little adversity in childhood, peers who experienced high levels of childhood adversity had about a 60% higher risk of developing CVD, the researchers found.

 

Bengtsson J. et al. “Childhood adversity and cardiovascular disease in early adulthood: a Danish cohort study.” Eur Heart J. 2023 Feb 14;44(7).

 

3.    Adolescents’ positive perceptions of their relationships with both their parents are associated with a wide range of favorable outcomes in young adulthood.

In this study of more than 15,000 adolescents, higher levels of adolescent-reported parental warmth, parent-adolescent communication, time together, academic expectations, relationship and communication satisfaction, and maternal inductive discipline were all associated with favorable outcomes in young adulthood.

Participants rated their depression, stress, optimism, nicotine dependence, substance abuse symptoms (alcohol, cannabis, or other drugs), unintended pregnancy, romantic relationship quality, physical violence, and alcohol-related injury.  

This was done while controlling for age, biological sex, race and ethnicity, parental educational level, family structure, and child maltreatment experiences.

Ford, et. al. “Associations Between Mother-Adolescent and Father-Adolescent Relationships and Young Adult Health.” JAMA Netw Open. 2023;6(3)