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Clayton Behavioral News & Articles

By Ned Presnall 21 Feb, 2017

Stigma derives from a Greek word that means "sign", "point" or "branding mark". It originally referred to a type of marking or tattoo that was cut or burned into the skin of criminals, slaves or traitors in order to easily identify them as blemished or morally corrupt. Stigmatized individuals were to be avoided and shunned.

It is a common experience among those struggling with mental illness. Stigma can be obvious and direct (someone making a negative comment about mental illness or its treatment) or subtle (when it is assumed that someone with mental illness is dangerous, unstable or violent). Patients may even judge themselves ( self-stigma ), wrongly assuming there are certain goals they can't accomplish, or that they won't get better. Stigma leads to prejudice, discrimination, avoidance and rejection. Those who experience it go through shame, blame, secrecy, isolation and social exclusion.

When properly treated, people with mental illness are no more dangerous than anyone else. In fact,   they are far more likely to be the victims of violence rather than the perpetrators. The media often reports distorted and inaccurate representations of the mentally ill, inviting unwarranted generalizations and widespread prejudice. Every year, there are over 16,000 murders in the US, yet the few involving the mentally ill get disproportionate front-page coverage. Astonishingly, after the Sandy Hook tragedy, louder voices advocated for arming school guards than for education and early detection of mental illness. The shortage of mental health services have turned jails and prisons into the new psychiatric hospitals.   Correctional psychiatry   is, sadly, among the fastest-growing mental health specialties.   A person with mental illness has much easier access to guns than to mental health. That is an ongoing tragedy.

Several public figures are giving their names to the cause of fighting stigma. Former congressman   Patrick Kennedy   and actress   Glenn Close   are among the most vocal ones. Legal efforts to support parity in mental health insurance coverage have also contributed to leveling the playing field between physical and mental illness. The National Alliance on Mental Illness conducts an active   StigmaBusters   campaign to challenge stereotypes portrayed in the media.

What can we do? Prejudice arises from ignorance. People tend to distrust and fear what they don't know or don't understand. Stigma decreases when people meet those afflicted by mental illness who are able to live as good neighbors in their communities. Strategies that include educational interventions and promote inclusiveness of the mentally ill contribute to a better understanding. It is said that the greatness of a society is measured by the way it treats its most vulnerable members:   how well are we doing with the mentally ill?


By Ned Presnall 21 Feb, 2017

Hans Asperger (1906-1980) was a Viennese physician who published the first definition of Asperger's syndrome in 1944. He identified a pattern of behavior and abilities that included "a lack of empathy, little ability to form friendships, one-sided conversation, intense absorption in a special interest, and clumsy movements." Asperger called children with AS "little professors" because of their ability to talk about their favorite subject in great detail. Asperger was convinced that many of the children he identified as having autistic symptoms would use their special talents in adulthood. He followed one child, Fritz V., into adulthood. Fritz V. became a professor of astronomy and solved an error in Newton’s work he originally noticed as a child.

Asperger died before his identification of this pattern of behavior became widely recognized, because his work was mostly in German and barely translated. The term "Asperger's syndrome" was popularized in a 1981 paper by British researcher Lorna Wing, MD, who had an autistic daughter and became involved in researching developmental disorders.

Interestingly, as a child, Hans Asperger appears to have exhibited features of the very condition named after him. He was described as a remote and lonely child, who had difficulty making friends. He was talented in language; he was interested in the Austrian poet Franz Grillparzer, whose poetry he would frequently quote to his uninterested classmates. He also liked to quote himself and often referred to himself from a third-person perspective, typical symptoms of what we now call Asperger's syndrome.

There are many resources to help patients and families better understand this condition. The australian psychologist Tony Attwood has one of the more comprehensive websites ( www.tonyattwood.com.au ). His philosophy (very much like the one supported by Hans Asperger) is to view the patients as differentially abled rather than disabled. A thorough inventory of strengths and weaknesess can help patients become active members of society. Many AS patients have great computer skills and, not surprisingly, a vibrant virtual community exists (for an interesting perspective from patients, visit   www.aspiesforfreedom.com ). You may also want to learn about the   www.aspiequiz.com   or the autism spectrum quotient ( aq.server8.org ).

Overall, kids on the autism spectrum have wonderful potentials and should be given every opportunity to succeed.   They often have a unique way of viewing the world,   which can be surprisingly insightful. They are capable of great accomplishments. Temple Grandin, PhD, is one of the best examples of success within the spectrum. She didn't talk until she was three and a half years old, communicating her frustration instead by screaming, peeping and humming. In 1950, she was labeled "autistic," and her parents were told she should be institutionalized. She tells her story in her book   Emergence: Labeled Autistic , a book which stunned the world because, until its publication, most professionals and parents assumed being diagnosed "autistic" was virtually a death sentence to achievement or productivity in life.

By Ned Presnall 21 Feb, 2017

Ever since its beginnings, AA has struggled with the issue of God and a Higher Power. Bill Wilson, the iconic AA founder (and one of TIME magazine's 100 most influential people of the 20th century) was himself an agnostic and an atheist at various points in his life. Those struggling with alcoholism who refuse to attend AA because "it's too religious" may be missing the point.....

Bill W. and Dr. Bob started what is now known as AA in 1935 in Akron, Ohio. Shortly thereafter, Bill W. wrote (with the input of AA's first 100 members) the Big Book of Alcoholics Anonymous, introducing for the first time the Twelve Steps model of recovery. Chapter 4 of the Big Book is titled "We agnostics" and explores the meaning of a Higher Power. In this chapter, Bill W. explains the famously italicized statement that follows the word God in Steps 3 and 11 of the Twelve Steps: "God   as we understood him" . It is clear that the AA fellowship knew since its beginnings that non-believers could also get sober in their program.

Jim Burwell ("Jimmy the atheist") was one of AA's first members. He wrote his personal story, "The Vicious Cycle", for the 2nd edition of the Big Book. He took his last drink on June 16th, 1938. After months of lively discussions with other AA founders on the issue of God, he was the first to conceptualize   the AA group as his own Higher Power. "Those who honestly try to find a Power greater than themselves", he wrote, "were much more composed and contended than I have ever been, and they seemed to have a degree of happiness which I have never known." In his article "Thirty Years Sober" published in 1968 he elaborated on the concept of how the Good all human beings have, deep in their hearts, could serve him perfectly well as his Higher Power. "By meditating and trying to tune in on my better self for guidance and answers, I became more comfortable and steady."

Beyond Belief (BB) is a secular spinoff of AA started by non-believers who didn't feel comfortable in certain AA groups where religious beliefs played a significant role. In their   website   they list several secular versions of the Twelve Steps. Overall, they fully endorse the principles of AA but try to offer a friendlier environment to those firmly rooted in atheism or agnosticism. Quad A (AAAA, AA for Agnostics and Atheists) started in Chicago in 1972. Both of these groups' understanding of the Twelve Steps follow "Ed the atheist": God as a Higher Power is replaced by AA and its members.

Those fulfilling AA's only requirement for membership ( a sincere desire to stop drinking) should have no problems accommodating their religious beliefs to AA, including lack of any religious beliefs. AA (or BB or Quad A) will certainly accommodate them. To date, one of the most successful, consistent and effective long-term ways of staying sober is to embrace both the fellowship of AA (becoming a   friend   of Bill W. ) and to diligently work the Twelve Steps.... one day at a time.

By Ned Presnall 13 Jan, 2017

We all hold (sometimes secretly) certain fears or phobias. For these to be of clinical significance, they need to be severe enough to cause impairment in functioning. Clinically, a phobia is   a persistent fear of an object or situation in which the sufferer commits to great lengths in avoiding. The fear is typically disproportional to the actual danger posed, and is often recognized as irrational. In the event the phobia cannot be avoided entirely, the sufferer will endure the situation or object with marked   distress   and significant interference in social or occupational activities

Coulrophobia   is the fear of clowns.   Astraphobia   is the fear of thunder and lightning.   Taphophobia   is the fear of being placed in a grave while still alive.   Xanthophobia   is the fear of the color yellow (in chinese tradition, if a general lost a battle, the Emperor would send him a yellow scarf, an imperial order to commit suicide).   Triskaidekaphobia   is the fear of the number 13. The term   nomophobia   was recently coined to describe the fear of being out of mobile phone contact

Homophobia or Xenophobia are not real phobias. These terms refer to attitudes and prejudices that involve   hate   rather than   fear. A more proper way of describing hateful beliefs is to use the suffix   misia   instead of   phobia. Homomisia, then, correctly describes the irrational hatred of homosexuality. Iatromisia is, by the way, the intense dislike and hatred of medical doctors and the medical profession.

Phobias can end up being mostly an inconvenience. For example, fear of flying may result in very long car rides. However, they can also be truly debilitating, like social phobia. They are treatable. Often, the best treatment results are obtained with a combination of CBT (Cognitive Behavioral Therapy) and SSRIs (Serotonin-Specific Reuptake Inhibitors: Prozac, Paxil, Zoloft, Lexapro, etc). CBT should be a first-line treatment: after all,   fears are often nothing more than stories we tell ourselves.

By Ned Presnall 13 Jan, 2017
Remember the research from the 1950’s in which lab rats self-administered cocaine and ignored their food supply as they starved to death? These studies help us understand the brain science of addiction and to make sense of the apparent insanity of addictive behavior—of patients and loved ones giving up everything for the sake of drugs or alcohol. We now know what was happening to those rats. Drugs of abuse stimulate dopamine in the survival center of the brain and make continued use so reinforcing that other human “goods” lose their appeal.

Fewer people know of the “Rat Park” study of drug self-administration. In that and related studies, researchers hypothesized that the social environment plays a big role in the rats’ willingness to self-administer addictive drugs. Rat Park was Disneyland for rats—lots of food, lots of tunnels and things to do and play with, as well as other rats to play and mate with. The rats were given a choice of two fluid dispensers: one contained a morphine solution and the other plain tap water.   The rats in Rat Park repeatedly selected the plain tap water by substantial margins. Even rats that were made dependent on morphine and then detoxified chose to avoid morphine self-administration when they were in Rat Park and had opportunities for social interaction. The isolated rats, on the other hand, continued to use morphine when given the opportunity.

So what does Rat Park tell us about human addiction? We know that addictive substances and behaviors are extremely rewarding. But people who achieve recovery don’t just stop using drugs; they find security and connection in healthy, supportive social relationships. Successful treatment must accommodate this social need. When we help patients overcome social anxiety, depression, trauma, grief, family dysfunction and other obstacles to develop and maintain human connection, we help them achieve health and recovery. Addiction is a disease of isolation as well as a disorder of brain function. Recovery necessarily involves social support and connection.


By Ned Presnall 09 Jan, 2017

Panic attacks are common and often debilitating episodes of sudden onset that include a number of symptoms such as palpitations, shortness of breath, a choking sensation, chest pain, sweating, shaking, nausea, dizziness and fear of losing control or dying. Other less common symptoms include derealization (an alteration of the way we see the world so that it seems unreal) or depersonalization (the feeling of watching ourselves act without having control of the situation). In severe cases, many activities of daily living are associated with attacks, and as a result patients become homebound ( agoraphobic ).

Anxious patients tend to monitor (scan) their bodies for trivial background sensations. They fixate on them, magnify their intensity and catastrophize their meaning. We all have occasional "body noises": aches, pains, itches, mild dizziness, etc. The anxious patient will  monitorfocusamplify and  catastrophize these feelings. Consulting "Dr. Google" tends to worsen the problem since it often gives more ammunition to the anxious mind to wrongly conclude that a serious health problem is taking place.

Medications and/or Cognitive Behavioral Therapy (CBT) are excellent treatment modalities for this debilitating disorder. The benzodiazepines (Xanax, Ativan, Klonopin, etc) are effective in aborting an attack and turning off the symptoms once they appear. The SSRIs (Prozac, Paxil, Zoloft, Celexa, Lexapro, etc) and the SNRIs (Cymbalta and Effexor) are very successful in preventing panic attacks from occurring. Often, patients need to combine a benzodiazepine with an SSRI/SNRI at the onset of treatment, since the latter will take a few weeks to work. Once attacks no longer occur, benzodiazepines are rarely necessary and may be used only "as needed" for high-risk situations, like flying on airplanes.

A cognitive approach to panic teaches the patient to recognize its symptoms as inconsequential and not as evidence of a serious disease, such as a heart attack. This  workbook  is a good source of information on how to de-escalate the anxiety that a patient feels upon the onset of symptoms. If, soon after the appearance of the first panic symptoms, a patient's anxiety escalates, the patient becomes convinced that a serious health problem is taking place, and a full attack ensues (hence, a self-fulfilling prophecy). Panic symptoms are mostly the appropriate response we have to a dangerous situation...but they happen when no real danger exists!

By Ned Presnall 09 Jan, 2017

Clinicians routinely see patients self-diagnosed with ADHD. Many adults are now taking stimulants without a convincing reason. Stimulants are highly addictive medications that are not free of potentially dangerous side effects; their use should be limited to those carefully evaluated and properly diagnosed. In reality, most adult patients seen in clinical settings bitterly complain about noticing increasing problems with inattention and distractibility, and assume that they must therefore be suffering from undiagnosed ADHD. ADHD is a neurodevelopmental disorder present since childhood. Nobody develops ADHD as an adult. The following 5 conditions explain the majority of cases of adult-onset inattention and distractibility.

Depression and anxiety. Poor concentration, short-term memory loss, inattention and distractibility are very common symptoms of both mood and anxiety disorders. It is very difficult to diagnose cross-sectionally ADHD in the presence of a major depressive episode or an active anxiety disorder (GAD, OCD, etc.)

Drugs and Alcohol. In the addition of the well-known deleterious cognitive effects of alcohol and commonly abused drugs (including marijuana), clinicians need to be extremely careful when prescribing stimulants to those with potential chemical dependency issues.

Certain prescription medications. Benzodiazepines and sleep medicines (Ambien, Lunesta, Sonata) are well known for causing daytime probems with focus and attention. Statins (medications used to lower blood cholesterol levels) are showing increasing, convincing evidence thay thay can also cause cognitive problems that may be misinterpreted as ADD. Cholesterol is essential for brain functioning. Antidepressants (SSRIs, SNRIs) as well as some mood stabilizers such as Lamictal, Depakote and Tegretol can cause annoying word-finding difficulties that patient could misinterpret as cognitive impairment.

Non-restorative sleep. Patients with certain sleep disorders (typically, obstructive sleep apnea – OSA) suffer from excessive daytime sedation and sleepiness. They find it very hard to concentrate and stay focused. Even when properly trated, OSA may produce residual problems with cognition, short-term memory, inattention and distractibility.

Overwhelmingly busy schedules. How much water can a sponge take? How many computer programs can you open in your laptop before it slows down and makes mistakes? We live such busy, overcommitted lives that is not hard to understand how the multiple demands simultaneously placed on our brains lead to processing mistakes.
Most adults seen in clinical practice complaining of inattention and distractibility are far more likely to suffer from one or more of these five problems than from the complex, multifaceted neurodevelopmental condition that is ADHD. Careful screening for these conditions may guide treatment and avoid long-term, unnecessary use of addictive medications.

Attention-Deficit Hyperactivity Disorder in Adults, by Paul Wender, MD is a classic textbook of what really is (and is not) ADHD in adults: a serious and potentially devastating condition when not properly treated.


By Ned Presnall 07 Jan, 2017

OCD is typically associated with symptoms such as the obsessive fear of germs and contamination and/or ritualistic behaviors such as compulsive hand washing. Other conditions share some of the characteristics of OCD and may represent variants of this disorder.

Scrupulosity arises when OCD has a religious component. Sufferers have pathological guilt surrounding moral or religious issues. They become obsessed about having committed a sin or acted in contradiction to their religious morals and beliefs. This condition appears to have been present in certain historical religious figures. St. Ignatius, for example, described that "after I have trodden upon a cross formed by two straws...there comes to me from without a thought that I have sinned...this is probably a scruple and temptation suggested by the enemy". The Catholic Church provides help for this condition through  Scrupulous Anonymous .

Popularized by the TV show  Buried Alive , Hoarding (pathological collecting) is conceptualized as an OCD variant. Sufferers show inability (or unwillingness) to discard large amounts of typically useless objects. They develop intense anxiety when needing to throw something away, since they feel these objects could be useful in the future. Unlike most OCD sufferers, hoarders do not find their habits problematic, and often appear comfortable and at ease in their overcrowded living environments.

BDD (Body Dysmorphic Disorder or imagined ugliness) also has overlaps with OCD. BDD patients are obsessively and excessively preoccupied with a slight or imagined defect in their physical appearance. They perceived themselves as physically flawed and spent large amounts of time in front of mirrors, trying to cover what they believe is a defect (a facial asymmetry, an unusual head shape, etc). They often seek help from plastic surgeons and aestheticians. BDD can be severely debilitating and cause much suffering and isolation.  This article  shows pictures of the way four women really look versus the way they perceive themselves.

Some patients suffer from what has been called "Sexual Orientation OCD". They are intensely preoccupied with their sexual orientation and identity. This can be seen, for example, among people who are not gay or lesbian, yet have intense doubts that they may not be heterosexual. Homosexuals may also suffer from this disorder, obsessively worrying if they are straight. They will constantly seek reassurances from their loved ones about their behaviors, and will ruminate if the way they act may be perceived as gay/lesbian (or straight, in the case of homosexuals).

By Ned Presnall 07 Jan, 2017

Seasonal Affective Disorder (SAD) is a type of depression that starts in the fall and lasts through the winter months. In addition to typical symptoms of depression (sadness, hopelessness, fatigue, crying spells, anhedonia and problems concentration) SAD often presents with some atypical symptoms: increased sleep, increased appetite (especially carb cravings) and a heavy, "leaden" feeling in arms and legs. These atypical symptoms are also frequently encountered during the depressed phase of bipolar disorder. In fact, many bipolar patients tend to get depressed in the fall and winter months, and get manic or hypomanic during the spring and summer. It is therefore important to screen SAD sufferers to rule out the possibility of a bipolar disorder diagnosis.

The efficacy of light therapy has been scientifically documented since the 1980s, that include over 2,000 sufferers. Numerous carefully controlled studies have shown the potential efficacy of light therapy for SAD. In a 2004 Canadian study (CAN-SAD), for example, light treatment was essentially identical in its efficacy to fluoxetine (Prozac) after 8 weeks of treatment.

Light therapy for SAD consists of exposure of the open eyes to an adequate light intensity, at an adequate distance, and for an adequate time period. Standard recommendations include light boxes that emit 10,000 lux of UV-filtered light. Staring at the light is not recommended; a tilted lamp indirectly bathing open eyes is sufficient. Standard light therapy devices are widely available commercially, and typically emit 10,000 lux. At that intensity, most patients respond to 30-minute daily morning sessions at arm's length. At 2,500 lux, much longer exposure times (up to 2 hrs) may be needed. Light intensity is a critical component of successful treatment.

It is best to concentrate on activities taking place on the surfaces illuminated by the light and not on the light itself. Indoor lamps and ceiling light fixtures are inadequate treatments for SAD, since they fail to reach the eyes at an adequate intensity. Therefore, increased exposure to normal room light tends to be insufficient. Most patients report improvement when sessions are in the morning. During long winter nights, early morning exposure (6:30 am, while it is still dark outdoors) can be particularly helpful. In most studies of light therapy for SAD, improvement may appear as early as after 1 week of treatment. It also takes about 1 week for the benefits to vanish once light therapy is stopped. Therefore, for most SAD sufferers, daily light exposure since the onset of symptoms and throughout the winter seems to be the best option.

In addition to light therapy, other treatment options being explored for SAD include   Dawn Simulation   and   Negative Ion Therapy .

By Ned Presnall 07 Jan, 2017

When assessing a person with depression, how can we tell if their depression is part of Bipolar Disorder? Accurately making this distinction has significant treatment implications: antidepressants can worsen Bipolar Disorder, while mood stabilizers can greatly improve it. Every person with depression should be assessed for a history of symptoms suggestive of mania or hypomania. A good screening tool is the Mood Disorder Questionnaire ( MDQ ). Diagnosing Bipolar Disorder is not always easy. It can have  soft  presentations ( Bipolar Spectrum) rather than present with clear-cut, full-blown episodes of mania. Often, it is necessary to obtain collateral information, since patients are unlikely to report or realize that episodes of feeling extremely good are related to their episodes of depression.

There are several clinical clues suggesting that an episode of depression is part of Bipolar Disorder.  Atypical depression  is often associated with bipolarity, especially when it appears early in life. It is characterized by increased sleep, increased appetite, a feeling of heaviness in arms and legs (leaden paralysis) and hypersensitivity to what others say or think about us. Other hints of bipolarity include having episodes of depression since adolescence, episodes that are more frequent or worse in the winter months (seasonal changes), and/or that appears in the post partum period. Episodes of Bipolar depression tend to be brief (less than 3 months long) and highly recurrent.

Patients whose depression is due to Bipolar Disorder tend to have difficulties when taking antidepressants. They may experience rapid relief followed by loss of efficacy (the "poop-out" effect). They may get paradoxical reactions, and feel more depressed, agitated, wired and irritable when taking them. Often, antidepressants are tried one after the other and none seems to work.  Failure to respond to 3 or more antidepressants is a clinical clue that bipolarity may be present . Bipolar spectrum patients can be extremely creative, artistic and successful. Bipolarity should be suspected in high-achieving, gregarious, engaging and at times flamboyant individuals who keep experiencing repeated bouts of depression.

Bipolar Disorder is treatable. When a patient with depression is properly diagnosed as suffering from Bipolar Disorder, the use of mood stabilizers (lamotrigine, lithium, divalproex, carbamazepine and atypical antipsychotics) is indicated. They greatly improve the chances of adequately controlling the symptoms. Antidepressants may still be needed, but should be used cautiously and in conjunction with mood stabilizers. In addition, several studies have shown that psychoeducation of the bipolar patient significantly increases treatment compliance and decreases relapses and hospitalizations.

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Clayton Behavioral News & Articles

By Ned Presnall 21 Feb, 2017

Stigma derives from a Greek word that means "sign", "point" or "branding mark". It originally referred to a type of marking or tattoo that was cut or burned into the skin of criminals, slaves or traitors in order to easily identify them as blemished or morally corrupt. Stigmatized individuals were to be avoided and shunned.

It is a common experience among those struggling with mental illness. Stigma can be obvious and direct (someone making a negative comment about mental illness or its treatment) or subtle (when it is assumed that someone with mental illness is dangerous, unstable or violent). Patients may even judge themselves ( self-stigma ), wrongly assuming there are certain goals they can't accomplish, or that they won't get better. Stigma leads to prejudice, discrimination, avoidance and rejection. Those who experience it go through shame, blame, secrecy, isolation and social exclusion.

When properly treated, people with mental illness are no more dangerous than anyone else. In fact,   they are far more likely to be the victims of violence rather than the perpetrators. The media often reports distorted and inaccurate representations of the mentally ill, inviting unwarranted generalizations and widespread prejudice. Every year, there are over 16,000 murders in the US, yet the few involving the mentally ill get disproportionate front-page coverage. Astonishingly, after the Sandy Hook tragedy, louder voices advocated for arming school guards than for education and early detection of mental illness. The shortage of mental health services have turned jails and prisons into the new psychiatric hospitals.   Correctional psychiatry   is, sadly, among the fastest-growing mental health specialties.   A person with mental illness has much easier access to guns than to mental health. That is an ongoing tragedy.

Several public figures are giving their names to the cause of fighting stigma. Former congressman   Patrick Kennedy   and actress   Glenn Close   are among the most vocal ones. Legal efforts to support parity in mental health insurance coverage have also contributed to leveling the playing field between physical and mental illness. The National Alliance on Mental Illness conducts an active   StigmaBusters   campaign to challenge stereotypes portrayed in the media.

What can we do? Prejudice arises from ignorance. People tend to distrust and fear what they don't know or don't understand. Stigma decreases when people meet those afflicted by mental illness who are able to live as good neighbors in their communities. Strategies that include educational interventions and promote inclusiveness of the mentally ill contribute to a better understanding. It is said that the greatness of a society is measured by the way it treats its most vulnerable members:   how well are we doing with the mentally ill?


By Ned Presnall 21 Feb, 2017

Hans Asperger (1906-1980) was a Viennese physician who published the first definition of Asperger's syndrome in 1944. He identified a pattern of behavior and abilities that included "a lack of empathy, little ability to form friendships, one-sided conversation, intense absorption in a special interest, and clumsy movements." Asperger called children with AS "little professors" because of their ability to talk about their favorite subject in great detail. Asperger was convinced that many of the children he identified as having autistic symptoms would use their special talents in adulthood. He followed one child, Fritz V., into adulthood. Fritz V. became a professor of astronomy and solved an error in Newton’s work he originally noticed as a child.

Asperger died before his identification of this pattern of behavior became widely recognized, because his work was mostly in German and barely translated. The term "Asperger's syndrome" was popularized in a 1981 paper by British researcher Lorna Wing, MD, who had an autistic daughter and became involved in researching developmental disorders.

Interestingly, as a child, Hans Asperger appears to have exhibited features of the very condition named after him. He was described as a remote and lonely child, who had difficulty making friends. He was talented in language; he was interested in the Austrian poet Franz Grillparzer, whose poetry he would frequently quote to his uninterested classmates. He also liked to quote himself and often referred to himself from a third-person perspective, typical symptoms of what we now call Asperger's syndrome.

There are many resources to help patients and families better understand this condition. The australian psychologist Tony Attwood has one of the more comprehensive websites ( www.tonyattwood.com.au ). His philosophy (very much like the one supported by Hans Asperger) is to view the patients as differentially abled rather than disabled. A thorough inventory of strengths and weaknesess can help patients become active members of society. Many AS patients have great computer skills and, not surprisingly, a vibrant virtual community exists (for an interesting perspective from patients, visit   www.aspiesforfreedom.com ). You may also want to learn about the   www.aspiequiz.com   or the autism spectrum quotient ( aq.server8.org ).

Overall, kids on the autism spectrum have wonderful potentials and should be given every opportunity to succeed.   They often have a unique way of viewing the world,   which can be surprisingly insightful. They are capable of great accomplishments. Temple Grandin, PhD, is one of the best examples of success within the spectrum. She didn't talk until she was three and a half years old, communicating her frustration instead by screaming, peeping and humming. In 1950, she was labeled "autistic," and her parents were told she should be institutionalized. She tells her story in her book   Emergence: Labeled Autistic , a book which stunned the world because, until its publication, most professionals and parents assumed being diagnosed "autistic" was virtually a death sentence to achievement or productivity in life.

By Ned Presnall 21 Feb, 2017

Ever since its beginnings, AA has struggled with the issue of God and a Higher Power. Bill Wilson, the iconic AA founder (and one of TIME magazine's 100 most influential people of the 20th century) was himself an agnostic and an atheist at various points in his life. Those struggling with alcoholism who refuse to attend AA because "it's too religious" may be missing the point.....

Bill W. and Dr. Bob started what is now known as AA in 1935 in Akron, Ohio. Shortly thereafter, Bill W. wrote (with the input of AA's first 100 members) the Big Book of Alcoholics Anonymous, introducing for the first time the Twelve Steps model of recovery. Chapter 4 of the Big Book is titled "We agnostics" and explores the meaning of a Higher Power. In this chapter, Bill W. explains the famously italicized statement that follows the word God in Steps 3 and 11 of the Twelve Steps: "God   as we understood him" . It is clear that the AA fellowship knew since its beginnings that non-believers could also get sober in their program.

Jim Burwell ("Jimmy the atheist") was one of AA's first members. He wrote his personal story, "The Vicious Cycle", for the 2nd edition of the Big Book. He took his last drink on June 16th, 1938. After months of lively discussions with other AA founders on the issue of God, he was the first to conceptualize   the AA group as his own Higher Power. "Those who honestly try to find a Power greater than themselves", he wrote, "were much more composed and contended than I have ever been, and they seemed to have a degree of happiness which I have never known." In his article "Thirty Years Sober" published in 1968 he elaborated on the concept of how the Good all human beings have, deep in their hearts, could serve him perfectly well as his Higher Power. "By meditating and trying to tune in on my better self for guidance and answers, I became more comfortable and steady."

Beyond Belief (BB) is a secular spinoff of AA started by non-believers who didn't feel comfortable in certain AA groups where religious beliefs played a significant role. In their   website   they list several secular versions of the Twelve Steps. Overall, they fully endorse the principles of AA but try to offer a friendlier environment to those firmly rooted in atheism or agnosticism. Quad A (AAAA, AA for Agnostics and Atheists) started in Chicago in 1972. Both of these groups' understanding of the Twelve Steps follow "Ed the atheist": God as a Higher Power is replaced by AA and its members.

Those fulfilling AA's only requirement for membership ( a sincere desire to stop drinking) should have no problems accommodating their religious beliefs to AA, including lack of any religious beliefs. AA (or BB or Quad A) will certainly accommodate them. To date, one of the most successful, consistent and effective long-term ways of staying sober is to embrace both the fellowship of AA (becoming a   friend   of Bill W. ) and to diligently work the Twelve Steps.... one day at a time.

By Ned Presnall 13 Jan, 2017

We all hold (sometimes secretly) certain fears or phobias. For these to be of clinical significance, they need to be severe enough to cause impairment in functioning. Clinically, a phobia is   a persistent fear of an object or situation in which the sufferer commits to great lengths in avoiding. The fear is typically disproportional to the actual danger posed, and is often recognized as irrational. In the event the phobia cannot be avoided entirely, the sufferer will endure the situation or object with marked   distress   and significant interference in social or occupational activities

Coulrophobia   is the fear of clowns.   Astraphobia   is the fear of thunder and lightning.   Taphophobia   is the fear of being placed in a grave while still alive.   Xanthophobia   is the fear of the color yellow (in chinese tradition, if a general lost a battle, the Emperor would send him a yellow scarf, an imperial order to commit suicide).   Triskaidekaphobia   is the fear of the number 13. The term   nomophobia   was recently coined to describe the fear of being out of mobile phone contact

Homophobia or Xenophobia are not real phobias. These terms refer to attitudes and prejudices that involve   hate   rather than   fear. A more proper way of describing hateful beliefs is to use the suffix   misia   instead of   phobia. Homomisia, then, correctly describes the irrational hatred of homosexuality. Iatromisia is, by the way, the intense dislike and hatred of medical doctors and the medical profession.

Phobias can end up being mostly an inconvenience. For example, fear of flying may result in very long car rides. However, they can also be truly debilitating, like social phobia. They are treatable. Often, the best treatment results are obtained with a combination of CBT (Cognitive Behavioral Therapy) and SSRIs (Serotonin-Specific Reuptake Inhibitors: Prozac, Paxil, Zoloft, Lexapro, etc). CBT should be a first-line treatment: after all,   fears are often nothing more than stories we tell ourselves.

By Ned Presnall 13 Jan, 2017
Remember the research from the 1950’s in which lab rats self-administered cocaine and ignored their food supply as they starved to death? These studies help us understand the brain science of addiction and to make sense of the apparent insanity of addictive behavior—of patients and loved ones giving up everything for the sake of drugs or alcohol. We now know what was happening to those rats. Drugs of abuse stimulate dopamine in the survival center of the brain and make continued use so reinforcing that other human “goods” lose their appeal.

Fewer people know of the “Rat Park” study of drug self-administration. In that and related studies, researchers hypothesized that the social environment plays a big role in the rats’ willingness to self-administer addictive drugs. Rat Park was Disneyland for rats—lots of food, lots of tunnels and things to do and play with, as well as other rats to play and mate with. The rats were given a choice of two fluid dispensers: one contained a morphine solution and the other plain tap water.   The rats in Rat Park repeatedly selected the plain tap water by substantial margins. Even rats that were made dependent on morphine and then detoxified chose to avoid morphine self-administration when they were in Rat Park and had opportunities for social interaction. The isolated rats, on the other hand, continued to use morphine when given the opportunity.

So what does Rat Park tell us about human addiction? We know that addictive substances and behaviors are extremely rewarding. But people who achieve recovery don’t just stop using drugs; they find security and connection in healthy, supportive social relationships. Successful treatment must accommodate this social need. When we help patients overcome social anxiety, depression, trauma, grief, family dysfunction and other obstacles to develop and maintain human connection, we help them achieve health and recovery. Addiction is a disease of isolation as well as a disorder of brain function. Recovery necessarily involves social support and connection.


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