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Monday 24 February 2014

When Prescribing Psychiatric Drugs Becomes Reckless Endangerment of Childrem - Courtesy of the CCHR website - follow link



When Prescribing Psychiatric Drugs Becomes Reckless Endangerment

When psychiatrists or doctors prescribe dangerous, potentially life-threatening psychiatric drugs to children without the parent or legal guardian’s consent, they should be charged with reckless endangerment and/or child endangerment because these drugs are documented to cause side effects including, but not limited to, suicide, mania, heart problems, stroke, diabetes, death and sudden death.

The fact that Child Protective Service (CPS) or other government funded agencies can charge parents with “Medical Neglect” for refusing to give their child a dangerous and potentially life-threatening psychiatric drug, is an oxymoron. Moreover, there is no “medical” test in existence to prove any child has a “mental disorder” or “mental illness.” However, once prescribed drugs, such as antipsychotics documented to cause brain shrinkage or antidepressants which can cause delusional thinking, mania and psychosis, this is the actual “illness,” which has been chemically induced. Diagnosis is completely and utterly subjective—based solely on a checklist of behaviors. The only medical risk to the child is when they are prescribed psychiatric drugs.

There have been more than 200 international drug regulatory agency warnings that psychiatric drugs can cause dangerous and potentially life-threatening affects. This is now common knowledge and the information is easily available to any doctor or psychiatrist. When a psychiatrist or other mental health practitioner prescribes such drugs and puts the child at risk of being prescribed drugs documented to have severe side effects, in direct opposition to the parent/legal guardian’s wishes, and in disregard of the life and safety of the child, this should be a criminal offense.

The legal definition of Reckless Endangerment is:

Reckless endangerment is a crime consisting of acts that create a substantial risk of serious physical injury to another person. The accused person isn’t required to intend the resulting or potential harm, but must have acted in a way that showed a disregard for the foreseeable consequences of the actions. The charge may occur in various contexts, such as, among others, domestic cases, car accidents, construction site accidents, testing sites, domestic/child abuse situations, and hospital abuse. State laws and penalties vary, so local laws should be consulted.

The legal definition of Child Endangerment is:

Child Endangerment refers to an act or omission that renders a child to psychological, emotional or physical abuse. Child abuse based on the offense of child endangerment is normally a misdemeanor, but endangerment that results in mental illness or serious physical illness or injury is a felony. The child who is subjected to child endangerment is called an abused child or a neglected child.

Under the Child Abuse Prevention and Treatment Act (CAPTA) child abuse and neglect means:

    Any recent act or failure to act on the part of a parent or caretaker that results in death, serious physical or emotional harm, sexual abuse, or exploitation;

    An act or failure to act that presents an imminent risk of serious harm

Saturday 22 February 2014

Rise in children treated on adult mental health wards By Michael Buchanan - Courtesy of BBC Website


Rise in children treated on adult mental health wards
By Michael Buchanan BBC Social Affairs correspondent

An increasing number of under-18s with mental health problems in England are being treated on adult psychiatric wards, it has emerged.

And many children are having to travel hundreds of miles across the country to receive hospital treatment.

Treating young people in such units should happen only in exceptional circumstances. The Department of Health had promised this would stop by 2010.

The DoH said children and young people's mental health was a priority.

Using Freedom of Information requests, the BBC and online journal Community Care found the number of under-18s being treated in adult units was in its hundreds - and rising.

Data returned by 51 of the 58 NHS mental health trusts in England showed that 350 under-18s have been admitted so far to adult mental health wards in 2013-14, compared with 242 two years earlier.

Monday 17 February 2014

HOT OFF THE PRESS = HORIZON BBC "The medicine in our minds - The Power of Placebos." By Olly Bootle - Courtesy of BBC's Horizon programme - 17-02-14

The medicine in our minds
By Olly Bootle BBC's Horizon programme

opioids, anti-depressants, pain killers, anti-inflammatories etc. from signals to 'The Natural Pharmacy' in our heads. 


They are the miracle pills that shouldn't really do anything. Placebos come in all shapes and sizes, but they contain no active ingredient. And yet, mysteriously, they often seem to work.

Over the last couple of decades, there has been a huge amount of research into what dummy pills can do and how they work.

We know that in the right situations, they can be very effective at relieving self-reported conditions like pain and depression.

But the latest research suggests they might even be able to help relieve the symptoms of a major neurological disorder, as Paul Pattison found out.
Medication need

In many ways, Paul is just like anyone else with a love of the outdoors.

He spends much of his spare time cycling in the hills on the outskirts of Vancouver, where he lives.

And every day, he walks his dog through the pine forest that starts where his garden ends.

But there's one big difference between Paul and your average outdoorsy type.
Continue reading the main story   
“Start Quote

    There are physical things that change in me when I take my meds so how could a blank thing, a nothing, create those same feelings?”

Paul Pattinson

Whether he's walking or cycling, Paul needs medication to help him do it, because he has Parkinson's Disease.

Without his drugs, even walking can be a major struggle.

Parkinson's is caused by an inability of the brain to release enough dopamine, a neurotransmitter that affects our mood, but is also essential for regulating movement.

Luckily for Paul, his medication can give him the dopamine he needs to keep his symptoms under control.

Given everything we know about the disease, it's hard to believe that a placebo - a 'dummy pill' with no active ingredients - could do anything to help someone with Parkinson's.

And that makes Prof Jon Stoessl's experiments all the more remarkable. He is the director of the Pacific Parkinson's Research Centre at the University of British Columbia, in Vancouver.

A few years ago, Paul took part in a trial that Prof Stoessl was conducting. It required him to stop taking his medication.

The next day he headed into hospital, his symptoms in full flare-up.

He explains: "That's when they gave me this capsule, and they gave you a half-hour….a normal period of time for the meds to kick in. And boom!

"I was thinking this is pretty good, my body becomes erect, my shoulders go back. There's no way that I could be like this without having had my medication."

Except that Paul hadn't been given his medication - he'd been given a placebo.
Paul Pattinson Paul Pattison found a placebo helped his Parkinson's
Placebo 'is a trigger'

"I was in a state of shock. There are physical things that change in me when I take my meds so how could a blank thing, a nothing, create those same feelings?"

Prof Stoessl has conducted numerous experiments with dozens of patients, and is in no doubt that a placebo can sometimes relieve the symptoms of Parkinson's.

"In Parkinson's, as in many other conditions, there is an important placebo response and that can be measured with clinical outcomes."
Continue reading the main story   
The placebo effect

Doctors have known for hundreds of years that when a patient expects their condition to improve, it does.

This is called the placebo, or dummy, effect.

What is new about Prof Stoessl's work though is that, by scanning the brains of people with Parkinson's disease when they experience a placebo effect, he's been able to shed light on how a dummy pill can possibly make a difference.

He has found that when someone like Paul responds well to a placebo, it isn't the case that he's simply coping better with his symptoms, or somehow battling through them. Instead, the placebo is triggering the release of dopamine in his brain.

And it isn't a small amount of dopamine that a placebo can release:

"What we found is that in somebody with Parkinson's disease, a placebo can release as much dopamine as amphetamine or speed can in somebody with a healthy dopamine system. So it's a very dramatic response."
'Brain's own morphine'

That dramatic response only appears to last for a short while - a placebo certainly isn't a miracle cure.
Continue reading the main story   
“Start Quote

    The placebo effect taps into our natural pharmacy”

Prof Tor Wager University of Colorado

And even if it was, doctors could hardly start lying to their patients and replacing real drugs with placebo pills.

It's also unclear exactly how a placebo is able to spur the brain into producing more dopamine, given that Parkinson's is caused by an apparent inability of the brain to produce enough.

But what is certainly clear is that the dopamine isn't coming from the placebo pill itself: there's nothing in it. The dopamine is coming from our brains.

And that goes to the heart of how a placebo works. There's now a strong body of evidence that a dummy pill can activate the brain's natural ability to produce the chemicals that we need.

Prof Tor Wager at the University of Colorado is a neuroscientist who studies what happens in the brain when people receive a placebo that they think is a painkiller.

"When we've given people a placebo treatment what we see is the release of endogenous opioids, which is the brain's own morphine.

"What that means is that the placebo effect is tapping into the same pain control circuitry as opiate drugs like morphine."
Research 'in infancy'

It seems that a dummy pill can do different things according to what you expect it to do.
Brain The placebo effect seems to spur the brain into action

It can potentially encourage the release of dopamine if you think it's a dopamine-boosting Parkinson's drug; or it can relieve pain if you think it's a painkiller.

In many ways of course our brains are natural pharmacies, constantly giving us chemical hits of one form or another - to stop pain, or to feel it; to energise us, or to calm us down, and it seems to be this in-built pharmacy that a placebo can trigger.

In fact, the drugs that we buy in a real pharmacy are often mimicking the chemicals that our brains produce themselves.

As Prof Wager puts it, "The placebo effect taps into our natural pharmacy.

"Drugs work because we have receptors for the drugs, and that means that there's some endogenous chemicals that our brains are producing that act on those receptors - the receptors evolved to respond to those natural chemicals."

Research into the power of the placebo is still in its infancy.

There is still an enormous amount that we don't know: what exactly are the mechanisms by which it works? Why do placebos work on some people and not others?

But research in the field of placebo studies has boomed over the last decade, and the evidence is growing that a placebo effect can be a powerful thing.

Prof Stoessl says: "The placebo effect is real, quantifiable and in fact you're doing quite well with an active therapy if you can get as good a response as the placebo response."

And the more we understand it, the better our chances of harnessing the placebo effect, and making the most of the medicine in our minds.

Horizon's The Power of the Placebo will be on BBC2 on Monday 17 February

    'Most GPs' have given placebo drugs
    21 MARCH 2013, HEALTH
    Placebo effect 'down to genes'
    24 OCTOBER 2012, HEALTH

Around the BBC

    Horizon - The Power of the Placebo

Sunday 16 February 2014

Emotions: Finding a Path through the Chaos of Current Beliefs by Thomas Scheff + INTERVIEW VIDEO February 10, 2014 - Courtesy of dxsummit.org


Emotions: Finding a Path through the Chaos of Current Beliefs
Thomas Scheff       February 10, 2014 

Understanding the realm of emotions is beset by an elemental difficulty: the meaning of words that refer to emotion are so ambiguous that we hardly know what we are talking about. Virginia Woolf stated it succinctly: “The streets of London have their map; but our passions are uncharted” (1922). Compared to maps of the material world and the social/behavioral science of behavior, thoughts, attitudes, perception, and beliefs, the realm of emotions is still terra incognita.

This state of affairs can be viewed in any standard dictionary. Here, for example, are three definitions from the current Merriam-Webster Online Dictionary:

Pride:  A feeling that you respect yourself and deserve to be respected by other people. or, A feeling that you are more important or better than other people.

Anger: A strong feeling of being upset or annoyed because of something wrong or bad: the feeling that makes someone want to hurt other people, to shout, etc.

Shame: a feeling of guilt, regret, or sadness that you have because you know you have done something wrong. Or:  dishonor or disgrace.

This definition of pride shows a crucial aspect of vernacular usage, its ambiguity. The word can mean either of two different things. Moreover, these two meanings are opposites: the first is positive, the second, quite negative. It may be so negative to even taint the positive version.

The definition of anger is not ambiguous, but it seems to imply support for a popular idea that has been proven erroneous many times (E.g. Bushman 2002), that anger is resolved by venting. According to the definition, anger “makes someone want to hurt other people. The use of the word “makes” connects with the still popular confusion between anger as an emotion and as a behavior. This confusion is an aspect of the idea that the emotion of anger compels aggressive behavior: “I couldn’t help it: my anger made me do it.”

Finally, the definition of shame, like that of pride, is ambiguous, since there are two different meanings. One of them erroneously defines shame in terms of two other emotions, grief and guilt. The first definition is about inner feeling, the second seems to include the outer world also. As will be discussed below at greater length, the English language is particularly confused and misleading with respect to shame.
Defenses against Emotion

In modern Western societies, children are routinely taught that emotions are usually unimportant or inappropriate. The ruling idea of rationality gives rise to this process; emotions are seen as irrational. One major source of this idea is confusion over the meaning of anger: many see it as meaning behavior:  the acting out of anger. But anger is only an emotion.  Acting it out is usually irrational, as is hiding it completely.

People learn how to avoid or condemn emotions in four ways.

1. Ignore: Most discussions in lay language don’t mention emotions. Objects, behavior, thoughts, beliefs, attitudes, images, and perception are speakable, but not emotions. This is by far the most prevalent defense. For many years the social/behavioral sciences had no sections devoted specifically to the study of emotions. Now that such sections had been established, they remain small enclaves relative to the more established subfields.

2. Generalize: When emotions are mentioned, as they are beginning to be, the references are often at so abstract and general a level as to amount to dismissal. The word emotion and terms like feeling, affect, and emotional arousal or upset refer to such a variety of states as to avoid most issues. Another almost as obscuring usage is to name groups of emotions instead of single specific ones. Guilt and shame are often mentioned together, as are fear, shame and anger, and many other groups. The widespread practice of classifying emotions as either positive or negative seems also to be erroneous. All emotions, when in their normal form, are life enhancing. Emotions are like breathing, they only hurt when they are curtailed

3. Disguise: There are a vast number of words that avoid the specific name, such as feeling “hot under the collar,” “awkward” or “rejected” instead of using the term angry, embarrassed or the s-word itself (Retzinger 1995).

4. Confuse: The final line of defense is that even words that refer to specific emotions are ambiguous and/or mask one emotion with another.

Experts disagree on almost everything about emotions. For example, several studies have pointed out the lack of agreement on basic emotion names. Ortony et al (1988, p. 27) reported on twelve investigators, some leading experts in the field. Even the number of such emotions, much less the specific emotions, is in contention; the fewest proposed is two, the most, eleven. There is not a single emotion term that shows up on all 12 lists. Plutchick (2003) also shows wide-ranging disagreement (see the 16 theorists on p. 73).

This disagreement involves emotion words in only one language, English. The comparison of different languages opens up a second level of chaos. Anthropological and linguistic studies suggest that just as the experts disagree on the number and names of the basic emotions, so do languages. Cultural differences in emotion words will be briefly referred to below, but it is too large an issue to be discussed at length.

The emotion taxonomy in the West, particularly in English, is relatively small. Although English has by far the largest total number of words (approaching a million), its emotion lexicon is smaller than other languages, even tiny languages like Maori. In addition to having a larger emotion lexicon than English, its emotion words are relatively unambiguous and detailed compared to English (Metge 1986).
Emotion Terms

As indicated above, in Western societies, emotions are seldom mentioned. Or if mentioned, often abstractly, avoiding specifics. The last stage of defense is that even when specific emotions are mentioned, usage of these words tends to confuse.

Grief: In this case, ambiguity might seem to amount only to the choice of words. Most authors use the term grief to refer to the emotion of loss. But there was a very large literature on attachment in which the authors used the term distress instead. Distress is broader than grief and implies consciousness more than grief.

For reasons that he didn’t make clear, Silvan Tomkins (1962) seems to have started the use of the word distress. In the first three volumes of his influential study (1962; 1963; 1965; 1992) distress is used frequently, with grief occurring only once. However, in V. 4, there is a sharp change; distress disappears, its place taken by grief.

Usage in the first three volumes it is fairly clear, because he connects distress to loss and crying. In IV, he makes this connection using only the word grief. What happened? As far as I know, there has been no published response to this dramatic change in nomenclature.

The original studies of facial expression of emotion followed Tompkins first usage: neither Ekman & Friesen (1978) nor Izard (1977) referred to grief. However, later works, such as Harre’ and Parrott (1996), refer only to grief, never to distress. Plutchik (2003) also refers only to grief. Others use the word sadness, rather than distress or grief. Like distress, sadness implies conscious feeling, which seems to be a sizable error. Counselors who deal with delays in mourning often report the absence of sadness as a particularly difficult obstruction to completing mourning. This issue was considered by Volkan (1993), but he elided around both grief and distress by referring only to failure to mourn. It would seem that anarchy rules in the naming of the emotion associated with loss and crying.

Pride: As already indicated, the confusion is flagrant, since pride has two distinct and opposing meanings in current usage, one positive, the other negative. The dominant one is negative, as in the Biblical “Pride goeth before the fall.” This usage confounds the positive meaning, authentic or justified pride, with arrogance, egotism or self-centeredness. (This duality has been noted many times in my work on shame, and recently by Tracy et al 2009).

Fear/anxiety: Before Freud, fear meant the emotional signal of physical danger to life or limb, and anxiety was just a more diffuse kind of fear. But after Freud, the meaning of these words began to expand. Anxiety became broader, enough to include many kinds of diffuse emotion, but not as broad as “emotional arousal.” Current vernacular usage is so enlarged that fear can be used to mask other emotions, especially shame and humiliation. “I fear rejection” has nothing to do with danger of bodily harm, nor does “social fear” or “social anxiety.” These terms refer rather to the anticipation of shame or humiliation.

Anger: the confusion in the vernacular over the meaning of this word seems to be different than any of the above. It involves confounding the feeling of anger with acting out anger. We don’t confuse the feeling of fear with running away, the feeling of shame with hiding one’s face, or the feeling of grief with crying. But anger is thought to be destructive, even though it is only an emotion.

Anger is an internal event, like any other emotion. It is one of the many pain signals that alert us to the state of the world inside and around us. In itself, if not acted out, it is instructive, not destructive. The condemnation of emotions as negative in Western societies is another aspect of the chaos of emotion words. Normal emotions, at least, are not negative, since they are brief, instructive and vitally necessary for survival.

When anger is expressed verbally and respectfully, rather than acted out as yelling or aggression, it is usually constructive. It explains to self and other how one is frustrated, and why. Both self and other need to know this information. The confounding of anger expression with acting out can be a seen as a way of justifying aggression, as in spousal abuse and road rage. “I couldn’t help myself.”

Shame: Current usage of shame in English aims toward an extremely narrow meaning: a crisis feeling of intense disgrace. In this usage, a clear distinction is made between embarrassment and shame. Embarrassment can happen to anyone, but shame is conceived as horrible. Embarrassment is speakable, shame is unspeakable. This usage avoids everyday shame such as embarrassment and modesty, and in this way sweeps most shame episodes under the rug.

Other languages, even those of modern societies, treat embarrassment as a milder version of shame. In Spanish, for example, the same word (verguenza) means both. Most languages also have an everyday shame that is considered to belong to the shame/embarrassment family. For example, the French pudeur, which is translated as modesty, or better yet, a sense of shame, is differentiated from honte, disgrace shame. If you ask an English speaker is shame distinct from embarrassment, they might answer with an impassioned yes. But a French speaker might ask “Which kind of shame?”

Suppose that just as fear signals danger of bodily harm, and grief signals loss, shame signals disconnection. In modern societies, since actually connecting with others, even briefly, is infrequent, we can hide that fact. Instead of saying that we were embarrassed, we can use an elaborate alternative: “It was an awkward moment for me.” It was the moment that was awkward (projection), not me that was embarrassed (denial).

In English especially, there is a vast supply of code words that can be used as alternatives to the s-word (Retzinger 1995). She lists more than a hundred vernacular words that may stand for shame, under six headings:

Alienated: rejected, dumped, deserted, etc.

Confused: blank, empty, hollow, etc.

Ridiculous: foolish, silly, funny, etc.

Inadequate: powerless, weak, insecure, etc.

Uncomfortable: restless, tense, anxious, etc.

Hurt: offended, upset, wounded, etc.

The broadening use of fear and anxiety is another way of disguising shame. To say that one fears rejection, or to use a term like social anxiety, is to mask the common occurrence of shame and embarrassment. We can also disguise the shameful pain of rejection by masking it with anger or withdrawal and silence. Studies of stigma, even though this word literally means shame, seldom take note of the underlying emotion, concentrating instead on thoughts and behavior. Apologies suggest another instance of masking shame with another emotion. The ritual formula for an apology in English is to say that you are sorry. But the word sorry (grief) serves to mask the more crucial emotion of shame. ”I’m ashamed of what I did” is a more potent apology.
Masked Shame

To make the point of the hiding of emotions more strongly, this section will suggest that there are a vast number of studies of shame that are not known as such. Unlike many researchers, the psychiatrist James Gilligan (1997) wrote a book that openly focused on shame. He proposed that hidden shame is a cause of violence, based on his experience as a prison psychiatrist. When he asked prisoners why they killed, the answers were virtually all the same: being dissed (disrespected). Gilligan didn’t write a book about dissing or even disrespect as a cause of violence. Instead, he related it to what might turn out to be a universal human emotion, shame.

Although there is a personal and cultural part of shame, it also seems to be universal as a mammalian signal of threat to the social bond, the feeling, however slight or intense, of rejection. The difficulty in studying shame in modern societies is that even more than the the f-word, the s-word is usually taboo. For that reason, there are many studies of the shame system, but hidden under other terms: fear of rejection, disrespect, stigma, social anxiety, honor cultures, revenge, etc.

Gilligan’s book was not a huge success, either commercially or academically. It was never on the bestseller lists; it stands currently at below the 30 thousandth mark. According to Google Scholar, it has been cited 400 times, which is 24 times a year since its publication. It seems that it has been little noticed by the public or by scholars.

Perhaps it might have been more popular with a different title and approach. The actual title, Violence: reflections on a national epidemic, is neither attractive nor informative. Perhaps a title like Dissing as a Cause of Violence would have had more appeal. But if Gilligan had wanted to have the word dissing in the title, he might have had to stick with the dissing-disrespect thesis, not even mentioning his notion of secret shame. The s-word might not only be not appealing, but even repulsive. Publishers notoriously find it so, especially if the author wants to put it in the title.

What could be repulsive about the s-word, since it’s only a word? One could ask the same question about the f-word, since it also is only a word. It is clear that the f-word was completely repulsive for the sixty years before 1961, at least in print. According to the Google Ngram, there was not a single occurrence in books in the English language between 1900 and 1960. It appears that printed books were fussy about this matter, since when I was in basic training in the Army in 1953, it seemed to be almost every other word out of the mouths of trainers and trainees alike.

Oddly, with the f-word becoming more visible in print beginning in 1961, the s-word has been getting less. The N-gram shows that the frequency of use in English language books has been decreasing steadily for two hundred years (1800-2000). To see if this decline was in English only, I checked the Ngrams for French, German and Spanish equivalents. The decrease has been occurring in these languages also over the two hundred years. What is going on?
The Taboo on Shame

From his study of European history, the sociologist Norbert Elias (1939; 1978) proposed that shame and its close kin (embarrassment and humiliation) are the dominant emotions in modern societies, even though they are taboo. As already indicated, these three emotions have also been frequently studied in social/behavioral, political and medical science (particularly psychiatry), and history, but under different names.

There are many studies in anthropology of “cultures of honor”: how insults to honor lead to humiliation and revenge. Most of these studies however, assume that this sequence causes violence in traditional societies, where shame is out in the open. It is usually not considered to occur in modern societies. Although the word honor has gone out of style, the emotion of shame has not. If it is biologically based, it is also a human universal and ahistorical.

The taboo on shame has many weakening effects on knowledge, because it cordons off into separate groups what ought to be a single field, reinforcing the existing taboo. For example, it hides other studies that support Gilligan’s conjecture on hidden shame as a cause of violence, such as status attainment, loss of social status, search for recognition, honor/dishonor, vengeance or revenge, and so on. It also slows down the process of replicating studies that support the hypothesis (Lacey 2009; Websdale 2010), and testing a broader hypothesis extending to both violence and silence (Scheff 2011). If the shame-violence/silence hypothesis is even partly true, it carries a crucial message for our civilization.

Norbert Elias also provided another thesis: there is a difference between shame that is felt, the basis of morality, and shame that is hidden not only from others but even from self.  In his study (1939; 1978) of five hundred years of European history, he analyzed etiquette manuals in three languages. Two key findings:  1. As physical punishment decreased, shame became dominant as the main agent of morality. 2. As shame became more prevalent, it also went underground, becoming virtually invisible.
Hiding Shame

How can shame become invisible? Modern audiences cannot accept this idea, since they equate emotion and feeling. However, most people will agree that at times a person’s anger can be obvious to others, yet the angry person seems unaware of it. A similar argument can be made about fear: since boys, especially, are taught to equate fear with cowardice, they learn to automatically suppress fear to the point that they don’t feel it. It may be that recklessness, particularly, arises from this process. Similarly, perhaps a person can be in a bodily state of shame without feeling ashamed.

Elias interpreted invisibility in terms of taboo: in modernization shame becomes a topic that is not to be talked about, just as sex was such a topic in the 19th century. As sex and especially the f-word were taboo then, so the s-word has become taboo now. The psychologist Gershen Kaufman is one of several writers who have argued that shame is taboo in our society:

    American society is a shame-based culture, but …shame remains hidden. Since there is shame about shame, it remains under taboo. ….The taboo on shame is so strict …that we behave as if shame does not exist (1989).

The taboo is not on all uses of the word shame, since there are speakable usages, such as “What a shame” or the jokey “Shame on you.” What is taboo is the central meaning of shame, the emotion of being excluded and perhaps worthless for that reason. The phrase “What a shame” does not refer to a specific feeling, since “What a pity” means exactly the same thing. Just as the f-word was once completely taboo before the 1960’s, the s-word, when used to mean the emotion of shame, is still taboo.
Reclaiming Shame Studies

Shame and its siblings are much less discussed than other emotions, not only by the public, but also researchers. How could that be? There have been many studies of shame, but most of them use what Elias called circumlocutions. An illustrative example is found in a recent study of doctor-patient relationships by Leape, et al (2012). Instead of referring to how the doctor may shame a patient, the title uses the phrase “disrespectful behavior toward patients.”  The article makes no reference to shame. Although the reader will understand what is meant, the phrase cuts the authors off from an understanding of shame dynamics that are openly available in the literature on shame and its siblings.

Another example is stigma. There are thousands of studies in the social, behavioral and medical sciences of this topic. The idea is that police arrest or illness diagnosis may carry with it an unintended consequence: shaming the recipient to self and/or his/her social network. These studies virtually never use the term shame in the title, and in most cases, even in the body of the study. In this case taboo causes the shame connection to be hidden even though shame is the literal meaning of stigma. Self-esteem is a vast domain that has gone utterly awry because it ignores the pride/shame dimension (Scheff and Fearon 2004).

The idea that shame is taboo in modern societies points to the necessity of bringing it and all emotions out in the open. Perhaps it can be done first in scholarship, then with the public. It appears that many of the worse features of modern societies, such as war, are caused, in part, by the hiding of shame. Other areas that might be better understood: the punitive element in legal systems, especially in imprisonment, stuck negotiations and mediations, and individual and mass prejudice in social class, ethnic/racial and gender relationships. Perhaps it may be possible to bring shame out of the closet at least as far as been done with sex.

Bushman, Brad J. 2002. Does venting anger feed or extinguish the flame? Catharsis, rumination, distraction, anger and aggressive responding. Personality and Social Psychology Bulletin. Vol 28(6). 724-731.

Ekman, Paul, and Friesen, Wallace. 1978. Facial Action Coding System. Palo Alto: Consulting Psychologists Press

Elias, Norbert. 1939. Über den Prozess der Zivilisation). Reprinted in 1978 as The Civilizing Process. London: Blackwell.

Gilligan, James. 1997. Violence – reflections on a national epidemic. New York: Vintage Books.

Harre, R. and G. Parrott. 1996. The emotions: social, cultural and biological dimensions. London: Sage

Izard, Carroll. 1977. Human Emotions. New York: Plenum

Kaufman, Gershon. 1989. The Psychology of Shame. New York: Springer.

Lacey, David. 2009. The Role of Humiliation in Collective Political Violence. Sydney: U. of Sydney Press.

Leape, Lucian L. MD; Shore, Miles F. MD; Dienstag, Jules L. MD; Mayer, Robert J. MD; Edgman-Levitan, Susan PA; Meyer, Gregg S. MD, MSc; Healy, Gerald B. V. 2012.  The Nature and Causes of Disrespectful Behavior by Physicians. Academic Medicine:87, 7, 845–852

Metge, Joan. 1986. In and Out of Touch. Wellington, NZ: Victoria University Press.

Ortony, Andrew, Gerald Clore, and Allan Collins. 1988. The Cognitive Structure of Emotions. New York: Cambridge University Press.

Plutchick, Robert. 2003. Emotions and Life. Washington, D.C.: American Psychological Association.

Retzinger, Suzanne. 1995. Identifying Shame and Anger in Discourse. American Behavioral Science. 38: 104-113.

Scheff, Thomas. 2011. A Theory of Multiple Killing.  Aggression and Violent Behavior, 16, 6, 453-460.

Scheff, Thomas and David Fearon, Jr. 2004. Social and Emotional Components in Self-Esteem. Journal of the Theory of Social Behavior. 34: 73-90

Tomkins, Silvan. 1962. Affect/Imagery/Consciousness V. I. New York: Springer.

Tracy, Jessica; Joey Cheng; Richard Robins; Kali Trzesniewski. 2009. Authentic and Hubristic Pride: The Affective Core of Self-esteem and Narcissism. Self and Identity, 8, 2 & 3, 196 – 213.

Volkan, Vamik D. and Zintl, Elizabeth (1993). Life after Loss: Lessons of Grief. New York, NY: Charles Scribner.

Websdale, Neil. 2010. Familicidal Hearts: The Emotional Style of 211 Killers. Oxford: Oxford University Press.
An interview with Thomas Scheff on Emotions

Friday 14 February 2014

Medication: The smart-pill oversell - Ritalin used to boost learning evidence is questioned - Courtesy of Nature Magazine - February 2014


Medication: The smart-pill oversell

Evidence is mounting that medication for ADHD doesn't make a lasting difference to schoolwork or achievement.

12 February 2014

Ben Harkless could not sit still. At home, the athletic ten-year-old preferred doing three activities at once: playing with his iPad, say, while watching television and rolling on an exercise ball. Sometimes he kicked the walls; other times, he literally bounced off them.

School was another story, however. Ben sat in class most days with his head down on his desk, “a defeated heap”, remembers his mother, Suzanne Harkless, a social worker in Berkeley, California. His grades were poor, and his teacher was at a loss for what to do.

Harkless took Ben to a therapist who diagnosed him with attention deficit hyperactivity disorder (ADHD). He was prescribed methylphenidate, a stimulant used to improve focus in people with the condition.

Harkless was reluctant to medicate her child, so she gave him a dose on a morning when she could visit the school to observe. “He didn't whip through his work, but he finished his work,” she says. “And then he went on and helped his classmate next to him. My jaw dropped.”

ADHD diagnoses are rising rapidly around the world and especially in the United States, where 11% of children aged between 4 and 17 years old have been diagnosed with the disorder. Between half and two-thirds of those are put on medication, a decision often influenced by a child's difficulties at school. And there are numerous reports of adolescents and young adults without ADHD using the drugs as study aids.

As the drugs have become more widespread, so has their cultural cachet. Stimulant medications have gained a reputation for turbo-charging the intellect. Even news stories critical of their use refer to them as “good-grade pills”, “cognitive enhancers” and “mental steroids”.

For most people with ADHD, these medications — typically formulations of methylphenidate or amphetamine — quickly calm them down and increase their ability to concentrate. Although these behavioural changes make the drugs useful, a growing body of evidence suggests that the benefits mainly stop there. Studies indicate that the improvements seen with medication do not translate into better academic achievement or even social adjustment in the long term: people who were medicated as children show no improvements in antisocial behaviour, substance abuse or arrest rates later in life, for example. And one recent study suggested that the medications could even harm some children1.

After decades of study, it has become clear that the drugs are not as transformative as their marketers would have parents believe. “I don't know of any evidence that's consistent that shows that there's any long-term benefit of taking the medication,” says James Swanson, a psychologist at the University of California, Irvine.

Now researchers are trying to understand why. The answer could lie in sub-optimal use of the drugs, or failure to address other factors that affect performance, such as learning disabilities. Or it could be that people place too much hope on a simple fix for a complex problem. “What we expect medication to do may be unrealistic,” says Lily Hechtman, a psychiatrist at McGill University in Montreal.

Unrealistic expectations?

In 1937, psychiatrist Charles Bradley noticed that problem children treated with a stimulant, benzedrine sulphate, became quieter, better behaved and more studious. Since then, studies have repeatedly demonstrated that stimulant medications reduce the core symptoms of ADHD, which include incessant, disruptive activity coupled with a lack of reflectiveness and inhibition. Stimulants work by increasing levels of the neurotransmitter dopamine in the brain, affecting regions involved in focus, self-control and the sense that an activity is rewarding. They take effect immediately, and they help as many as 80% of those with ADHD — one of the best response rates for a psychiatric drug.

Years of lab and classroom studies attest that the medications help affected children to perform in school. Treated children fidget less. They do better on laboratory tests requiring concentration and short-term memory. And they take better notes and hand in more homework, making fewer careless mistakes. Nora Volkow, director of the National Institute on Drug Abuse in Bethesda, Maryland, says that these benefits carry over into the real world, at least in the short term. “They help you pay attention,” she says. “The grades do improve.”


But the few studies that have examined the effects of ADHD medication much beyond a year have found that the benefits either vanish or shrink to clinically meaningless proportions.

In the early 1990s, as rates of stimulant prescriptions were beginning to climb, the National Institute of Mental Health in Bethesda, Maryland, funded a study to compare different treatments for the disorder. Known as the Multimodal Treatment Study of Children with ADHD, or MTA, the study randomized 579 children aged between seven and ten with ADHD to receive one of four treatments: stimulant medication, behaviour therapy, medication and behaviour therapy combined or whatever care they had already been receiving.

After 14 months, the groups treated with medication alone and medication plus behaviour therapy showed greater improvements in core ADHD symptoms than the other two groups. For academic achievement, only the group receiving medication and behaviour therapy combined outperformed the group receiving regular care2. By three years in, the four groups had become indistinguishable on every measure3. Treatment conferred no lasting benefit in terms of grades, test scores or social adjustment. Eight years later, it was the same story4. “Nothing we did could tease out and say there's a long-term effect,” says Swanson, who was one of the lead investigators on the MTA.

The MTA's findings are borne out in most of the studies that followed students for long periods of time. A literature review in 2012, which included studies that tracked children with ADHD for three years or more, found little evidence for a significant effect on standardised-test scores, grades or on the likelihood that a student would be held back a year5. A 2013 review of randomized controlled trials longer than 12 months similarly concluded that there is scant evidence for improvements in ADHD symptoms or academic performance lasting much beyond a year6.

There is even some evidence that ADHD medication could worsen outcomes. In 2013, a team of economists published a study1 examining the effects of a policy change in Quebec that resulted in thousands of children being given prescriptions for methylphenidate. The authors found that children who began taking it actually did worse at school and were more likely to drop out than those with similar levels of symptoms who did not receive drugs. Girls taking the drug had more emotional problems, and both sexes reported worse relationships with their parents.

There are a few studies that do show long-term gains in academic performance, but the boost is not large. A study that tracked 594 students aged 5–11 with ADHD found that those using medication for at least a year scored 3 points out of 100 higher on standardized maths tests and 5 points higher on reading tests than those not taking medication7. But this was not enough to close the test-score gap between those with ADHD and those without. And the gains faded over time even if the children stayed on the drugs, according to study co-author Stephen Hinshaw, a psychologist at the University of California, Berkeley.

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In 2012, a study in Iceland — the only country where rates of stimulant medication use are comparable to those of the United States — found that although the scores of all children with ADHD declined, on average, on standardized maths tests between the ages of 9 and 12, those of students who started medication earlier during that period declined less than those who waited longer to start8.

It is possible that there are long-term benefits that studies so far have not captured. But given the abundance and consistency of the data, the drugs cannot be doing much for most of the millions of children who take them, says Alan Sroufe, a psychologist emeritus at the University of Minnesota in Minneapolis. “If they were, it wouldn't be hard to detect.”

Puzzling paradox

Researchers are beginning to address this paradox. How can medication that makes children sit still and pay attention not lead to better grades?

One possibility is that children develop tolerance to the drug. Dosage could also play a part: as children grow and put on weight, medication has to be adjusted to keep up, which does not always happen. And many children simply stop taking the drugs, especially in adolescence, when they may begin to feel that it affects their personalities. Children may also stop treatment because of side effects, which can include difficulty sleeping, loss of appetite and mood swings, as well as elevated heart rate.

Or it could be that stimulant medications mainly improve behaviour, not intellectual functioning. In the 1970s, two researchers, Russell Barkley and Charles Cunningham, noted that when children with ADHD took stimulants, parents and teachers rated their academic performance as vastly improved9. But objective measurements showed that the quality of their work hadn't changed. What looked like achievement was actually manageability in the classroom. If medication made struggling children appear to be doing fine, they might be passed over for needed help, the authors suggested. Janet Currie, an economist at Princeton University in New Jersey, says that she might have been observing just such a phenomenon in the Quebec study that found lower achievement among medicated students1.

And it may simply be that drugs are not enough. Stimulant medications have two core effects: they help people to sustain mental effort, and they make boring, repetitive tasks seem more interesting. Those properties help with many school assignments, but not all of them. Children treated with stimulants would be able to complete a worksheet of simple maths problems faster and more accurately than usual, explains Nora Volkow. But where flexibility of thought is required — for example, if each problem on a worksheet demands a different kind of solution — stimulants do not help.

Beyond belief

In people without ADHD, such as students who take the drugs without a prescription to help with school work, the intellectual impact of stimulants also remains unimpressive. In a 2012 study of the effects of the amphetamine Adderall on people without ADHD, psychologists at the University of Pennsylvania in Philadelphia found no consistent improvement on numerous measures of cognition, even though people taking the medication believed that their performance had been enhanced10.

Increased focus has benefits, say some experts, but many children with ADHD need help in more areas if they are to succeed at school. “Many things go into grades,” says Joshua Langberg, a psychologist at Virginia Commonwealth University in Richmond. “One of those is certainly a child's behaviour and ability to focus, which medication does a nice job of improving. But they also include a child's basic abilities in math and reading, their IQ and their ability to manage time and plan. It's not clear why we would expect medication to impact those things.”

“Only one in four kids are getting anything close to what we would say is good treatment.”

Some researchers think that the lack of evidence for long-term academic benefits is a result of flawed study design. Peter Jensen, a leader on the MTA study, says he believes that if the children had been maintained on the study's protocol, the initial gains they made would have lasted. Longer randomly controlled trials would be challenging both from a technical and ethical standpoint, but the suggestion highlights another problem, namely the discrepancy between the optimal care given during a trial and that which most children receive.

After the 14-month, randomized trial period, participants in the MTA study began to receive what Jensen calls treatment 'in the community'. He says it is typically of low quality. Few doctors monitor children closely enough to arrive at optimal dosage or identify and treat co-occurring conditions — such as depression and anxiety — that affect up to 70% of children with ADHD. “Only one in four kids are getting anything close to what we would say is good treatment,” Jensen says.

When the MTA team examined the follow-up data, it found that many non-medical factors play a big part in whether improvements last. The best predictor of a child's response to treatment wasn't which treatment they were assigned, but a cluster of factors that were present at the start. Children with more advantages — higher intelligence, better social skills, intact families, higher parental education, fewer conduct problems or higher socioeconomic status — were likely to make big strides and hold onto them no matter what the treatment was, whereas children without these advantages typically progressed more slowly and regressed after treatment stopped2, 3, 4.

But disadvantaged children benefited when they received both medication and behaviour therapy. “The kids with the most problems needed the combination,” says Jensen, who adds that parents should have easier access to proven behaviour therapies. The effects of behavioural treatment don't seem to be longer-lasting than those of medication, however: once active treatment stops, they dissipate.

Future studies might explore whether medication offers subtle benefits that are not reflected in test scores or grades. Many researchers think that a stint on medication, when it is needed, can create an upward spiral of self-esteem that may make a crucial difference to a child's life — but there are no hard data to support this. “It may be that treatment doesn't translate into better grades” in the long term, Volkow says. “But what I'd like to see is, are those kids overall better integrated?”

Some experts think that the focus on academic achievement is misguided — that the point of the drugs has never been to improve children's grades, or increase their chances of admission to the best universities. “Medications are given for their short-term effects,” says Swanson. “Don't expect medication to get rid of every problem a child has. But if the problem right now is not passing the second grade, or not having any friends in the third grade, we can do something about that now.”

Some parents seem to understand that. Suzanne Harkless says that her hopes for medication are modest. She wants to keep Ben engaged in the fifth grade while she looks for a middle school that might provide him with the structure he needs. “My goal right now is not to get him into a good college,” she says. “My goal is to keep him in school.”

Other parents may pin unrealistic hopes on these drugs as their use goes up around the world (see 'Popular prescriptions'). “Competition in today's global economy is fuelling the dramatic increase in the use of ADHD medications, especially in the United States,” says Richard Scheffler, a health economist at the University of California, Berkeley, and co-author of a forthcoming book with Hinshaw on the growing popularity of ADHD drugs.

For Currie, the question comes down to transparency. “Parents do care about how their children are doing in school,” she says. “It's misleading to tell parents that this will help their children succeed, when there's no evidence that it's the case.”

  1. Currie, J., Stabile, M. & Jones, L. E. National Bureau of Economic Research Working Paper 19105 (NBER, 2013); available at http://www.nber.org/papers/w19105

  1. MTA Cooperative Group Arch. Gen. Psychiatry 56, 1073–1086 (1999).
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  1. Molina, B. S. G. et al. J. Am. Acad. Child Adolesc. Psychiatry 48, 484–500 (2009).
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  1. Zoëga, H. et al. Pediatrics 130, e53–e62 (2012).
  1. Barkley, R. A. & Cunningham, C. E. Clin. Pediatr. 17, 85–92 (1978).
  1. Ilieva, I., Boland, J. & Farah, M. J. Neuropharmacology 64, 496–505 (2013).