Comfortably Numb p.95

The brain is the most complicated object in the universe. Nobel Prize – winning psychiatrist Eric Kandel has written, “In fact, we are only beginning to understand the simplest mental functions in biological terms; we are far from having a realist neurobiology of clinical syndromes.” Neuroscientist Torsten Wiesel, another Nobelist, scoffed at the hubris involved in naming the 1990’s “The Decade of the Brain,” by presidential proclamation. “Foolish,” he called it. “We need at least a century, maybe even a millennium” to comprehend the brain… In my travels in the neuro world, I have consistently found that the elite scientists are surprisingly modest about how little we know about the brain, despite spectacular progress in recent decades. It is the midlevel scientists who are prone to making exalted claims about the certainty and sophistication of our present knowledge.

To this day, no one knows exactly how the drugs work. The etiology of depression remains an enduring scientific mystery, with entirely new ways of understanding the disease – or diseases, as what we think of as “depression” now is probably dozens of discrete disease entities – emerging constantly. While serotonin has something to do with depression, the relationship is not a simple nor a well-understood one. No deficiencies in the serotonin system have consistently been reported among depressed people; in fact, no simple one-to-one relationship between any psychiatric disorder and a single neurotransmitter has ever been proven. While the SSRIs do indeed act on serotonin regulation in the brain, allowing the neurotransmitter to linger a little longer in the synapses, the changes that the drug ultimately exerts on the brain are entirely unclear. As an indicator of how little we know, it is striking that one of the more popular antidepressants in Europe, tianeptine, is a serotonin reuptake enhancer – it has the opposite effect of the SSRIs, allowing less serotonin to flow between the synapses. And yet it, too, can be an effective antidepressant!

The flimsiness of the entire enterprise was brought home to me in devastating fashion in a conversation with Elliot Valenstein, a leading neuroscientist at the University of Michigan and author of three highly regarded and influential books on psychopharmacology and the history of psychiatry. I was talking to Dr. Valenstein about why all psychiatric drugs address only a very small proportion of the neurotransmitters that are thought to exist. Virtually all psychiatric drugs deal with only 4 neurotransmitters: dopamine and serotonin, most commonly, and also norepinephrine, and GABA (gamma-aminobutyric acid). While no one knows exactly how many neurotransmitters there are in the human brain – indeed, even how a neurotransmitter is define exactly can be a matter of debate – there are at least 100, perhaps 125.

So I asked Dr. Valenstein, “Why do all the drugs all deal with the same brain chemicals? Is it because those four neurotransmitters are the ones understood to be most implicated with mood and thought regulation – i.e., the stuff of psychiatric disorders?”

“It’s entirely a historical accident, “ he said. “The first psychiatric drugs were stumbled upon in the dark, completely serendipitously. No one, least of all the people who discovered them, had any idea how they worked. It was only later that the science caught up and provided evidence that those drugs influence those particular neurotransmitters. After that, all subsequent drugs were ‘copycat’ of the originals – and all of them regulating only those same four neurotransmitters. There have not been any new radically different paradigms of drug action that have been developed.” Indeed, while by 1997 one hundred drugs had been designed to treat schizophrenia, all of them resembled the original, Thorazine, in their mechanism, of action.

“So,” I asked Dr. Valenstein, “if the first drugs that were discovered dealt with a different group of neurotransmitters, then all the drugs in use today would involve an entirely different set of neurotransmitters?”

“Yes”, he said.

“In other words, there are more than a hundred neurotransmitters, some of which could have vital impact on psychiatric syndromes. Yet to be explored?” I asked.

“Absolutely,” Dr. Valenstein said. “It’s all completely arbitrary.”

Indeed one of the basic tenets of biological psychiatry, that depression is a result of a deficit in serotonin (or the “monoamine theory of depression,” as it is known in the scientific literature), has proven prematurely seductive to psychiatric practitioners and patients alike. When the monoamine theory emerged in the 1960s, it gave the biologically minded practitioners of psychiatry what they had long been craving – a clean, decisive, scientific theory to help bring the field in line with the rest of medicine. For patients, too, the serotonin hypothesis was enormously appealing. It not only provided the soothing clarity of a physical explanation of their maladies, it absolves them of responsibility for their illness, and to some degree, their behavior. Because, after all, who’s responsible for a chemical imbalance?

Unfortunately, from the very start, there was a massive contradiction at the heart of the monoamine theory, whatever it is that SSRIs do to change brain chemistry, it happens almost immediately after they are ingested. The neurochemical changes are quick. However, SSRIs typically take weeks, even months, to have any therapeutic influence. Why the delay? No one had any explanation, until the late 1990s, when Ronald Duman, a researcher at Yale, showed that antidepressants actually grow brain cells in the hippocampus, a part of the brain associated with memory and mood regulation. Such a development would have been viewed as preposterous even a decade earlier; one of the central dogmas of brain science for more than a century has been that the adult brain is incapable of producing new neurons, a belief that has been disproved by Duman and a host of other well-regarded scientists. Duman believes that it takes weeks or months to build up a critical mass of the new brain cells in order to exert a healing process in the brain.

While Duman’s explanation for the mechanism of action of the SSRIs remains controversial, a consensus is building that most likely SSRIs initiate a series of complex changes, involving many neurotransmitters, that alter the functioning of the brain at the cellular and molecular levels. The emerging truth appears to be that the SSRIs may be only the necessary first step of a “cascade” of brain changes that occur long after, and well “downstream,” of serotonin alterations. The frustrating truth is that depression, and all mental illnesses, are incredible complicated and poorly understood diseases, involving many neurotransmitters, many genes, and an intricate, infinite, dialectical dance between experience and biology. One of the leading serotonin researchers, Jeffrey Meyer, of the University of Toronto, summed up the misplaced logic of the monoamine hypothesis: “There is a common misunderstanding that serotonin is low during clinical depression. It mostly comes from the fact that many antidepressants raise serotonin. This is a bit like saying pneumonia is an illness of low antibiotics because we treat pneumonia with antibiotics.” Correlation with serotonin is not necessarily causation by serotonin.

Furthermore, the monoamine system comprises only a small percent of the neurons in the brain. The largest regulatory systems in the brain are the glutamate and GABA (gamma-aminobutyric acid) systems. Glutamate excites neurons and induces activity, whereas GABA inhibits neurons.

 

Comfortably Numb: How Psychiatry Is Medicating a Nation p.95

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Comfortably Numb p.66

Steven Rose, a British neurobiologist, says, “The power of molecular talk [in biology, neuroscience, and psychiatry] is very seductive because it seems somehow much closer to the hard sciences.” Rose goes on to point that physics is always the measuring stick. In the development of western science, physics, and chemistry came first, and thereby framed what we believe a science should be. Biology came late and aspired to fit these earlier paradigms. This is all well and good, but the difficulty lies in the fact that biology is inherently messy-and neurobiology messier still. The completion of the Human Genome Project in 2001, also, by association, has served to bolster psychiatry’s newfound scientific image. That a rough draft of the human genetic makeup has been developed contributes to a popular belief that psychiatric disorders proceed in neat Mendelian inheritable patterns. But if anything has been gleaned from the last two decades of work in the genetics of psychiatric disorders, it is that it is a terribly complex business. No single gene for psychiatric disorders have been found and likely will never be found. Psychiatric disorders are almost certainly the dialectical product of an infinitely complex dialogue between genes and the environment.

 

Charles Barber – Comfortably Numb: How Psychiatry Is Medicating a Nation p.66

The Challenging Child p.177

An interesting point worth remembering is that our schools, in the early years, tend to be biased towards children who are strong auditory-verbal learners. Verbal systems are highly valued as children learn to talk, read, and write. Even if they have trouble picturing math concepts, they can master them in these early years because the simple concepts can easily be memorized. Because the verbal systems is so overvalued in those early years, visual-spatial learners, who can understand math concepts but may not be able to memorize multiplication tables and have more difficulty with reading and writing, are thought to be slower in learning. Verbal children are more apt to be labeled “gifted” in those early years. Later, in high school and beyond, when science and math become more challenging and when even subjects like English and history are more analytical than factual and descriptive, visual-spatial learners (who are very analytical) may begin doing better. Some of the gifted auditory-verbal learners who depended too much on their outstanding memories and never grasped the concepts or principles behind what they were learning may begin to struggle…

Ideally, we should value different types of skills even in the early school years so that children would get a sense of their relative strengths no matter what they were. The child who can find his way to grandma’s house, even after going there only once, should feel just as smart as the child who can read directions about how to go to grandmother’s house.

 

Stanley I. Greenspan – The Challenging Child: Understanding, Raising, and Enjoying the Five “Difficult” Types of Children p.177

How to Talk to Your Kids about Your Divorce p.213

In instances of parental alienation, one parent sometimes purposely invents incidents of abuse or neglect at the hands of the other parent, and, tragically, the child begins to believe that these events took place. The child will swear up and down that a parent abused him even if prior to the other parent discussing it, he had no such memory.

A significant body of research demonstrates that children are extremely suggestible. The way that they view situations, and even the memories that they have, can be influenced by a variety of factors. The children themselves can believe wholeheartedly that situations happen, even if there is no evidence for this. The work of Elizabeth Loftus shows that false memories can be implanted in children just by having them hear an adult describe a situation that never took place. Later, the children are convinced that this event actually transpired.

There was a huge controversy in the world of psychology in the 1990s when some therapists stated that they could help clients recover repressed memories of abuse. While there is certainly evidence for repression, there is also evidence that false memories can be planted with enough suggestion, so many of these clients were being led to believe that abuse occurred when it did not. The therapists were not malicious; they genuinely felt they were helping clients realize what had happened to them.

 

Samantha Rodman – How to Talk to Your Kids about Your Divorce p.213

How to Talk to Your Kids about Your Divorce p.200

It is also natural for a child, particularly an older child, to feel sexually excited by watching displays of sexual affection (even more subtle ones like open-mouthed kissing or caressing). Children, as small humans, are sexual beings – which is why they have crushes on other kids or adults, play doctor or express curiosity about other children’s bodies, and touch their genitals when young or mastubate when older. It is normal and healthy for children to express curiosity and interest in sex, but being exposed to contact that is too stimulating or intense can be difficult for them. For example, when seeing a parent naked, some toddlers, preschool-age children, or school-age children will become overly focused on a parent’s genitals or breasts, which is a sign that the child is old enough to be stimulated and fascinated by sex and bodies. This is why many parents, particularly opposite sex parents, decide to stop bathing with their children when children grow out of toddlerhood.

If your child (of any age) makes comments about you touching or engaging in expressions of physical affection with a new partner, or if your child has accidentally walked in on you having sexual contact with a new partner, it’s a good time to initiate a conversation about sex. You can tell your child that one way to express love is through touching, which is why you and your new partner touch each other. If your young child asks what sex is or how babies are made, you can give a straightforward response, such as:

“A man has sperm, and a woman has small eggs in her body, and when the sperm and the egg meet, a baby is made. The sperm come out through the man’s penis, and if the man puts his penis in the woman’s vagina, the sperm can reach the eggs in her body. People only have sex when they are older and many people choose to wait until they are in love with someone. Sex is normal and healthy, but parents like to tell their own kids about sex. So, don’t tell any kids at school about sex in case their parents haven’t told them yet.”

This is a good explanation for a school-age child. If a child asks about sex or babies before that, often you can discuss the sperm and eggs without elaborating on how they meet. Note that I am not against telling even a young child about how sex occurs, but if your child repeats what you’ve told him at school, many parents are less liberal and may be upset if your child tell their child about sex. Therefore, I include the clause about not telling the other children, just as you would if your child learned that Santa or the tooth fairy aren’t real before other children his age.

If your child expresses disgust or discomfort around the topic of sex, or when seeing physical affection between you and your new partner, use mirroring, empathy, and validation to ensure that your child feels heard and respected. Then consider whether you are being respectful of your child’s boundaries. Apologize if you realize you have been excessive.

In general, only engage in forms of physical affections in front of your child that would be acceptable in public. A child does not need to hear any sounds of sex or be explicitly or implicity told that you’re going to have sex or that you have an enjoyable sex life. Often children in environments where sex is on display become promiscuous before they are ready, because their curiosity is piqued and they are fitting in with this new household norm. This can lead to a child getting into relationships that he is not emotionally ready for. Therefore, it is best to keep your expressions of physical intimacy moderate and discreet.

 

Samantha Rodman – How to Talk to Your Kids about Your Divorce p.200

How to Talk to Your Kids about Your Divorce p.137

A typical question about regression sounds something like this: “My daughter is four and we just told her last week that Daddy will be moving out. He has been gone for two days now. Since then, she has started to say she is the baby and use a baby voice. She even had her first potty accident in over a year. What is going on and how can I help her?”

When children are under stress or feel anxious, their behavior often regresses. You might have heard or experienced this happening when a new baby sibling arrives. During a divorce, small children become anxious about all the unexpected change in their families, and are not sure who will take care of them. Children unconsciously think that if they act like babies, they will be more likely to get cared for. Additionally, babies are not expected to make any choices or act in ways that are too difficult for them, like choosing one parent’s side over the other’s. Any potty accidents or disrupted sleep could be related to a child’s desire to be a cherished baby again, or it could be related to her increased level of anxiety immediately following the news of the divorce.

It’s important to reassure your child that your love is as strong as ever, and hopefully your child’s other parent will do the same. The news of your divorce undoubtedly came as a huge shock to your small child; there is no toddler or preschooler who can conceive of divorce as the result of even tremendous amounts of conflict. Therefore, a small child who is regressing may be feeling extremely confused and frightened.

Here are some things to tell your child, again and again:

  • When, exactly, your child will next see each co-parent (if you don’t know, try for when she will be able to talk to her other parent on the phone)
  • That your child will have a home with each parent
  • Whether her school and activities will remain the same
  • That you and her co-parent will always love her, and will always be her mommy and daddy
  • That you love your older child now as much as you did when she was a baby

Emphasize that divorce is nobody’s fault, and explain, even if you already have, that Mommy and Daddy decided they don’t want to live together anymore because they don’t get along, but that parents and children never get divorced. You can also explain that your child is a big kid now, but you still love to cuddle and hug her just like you did when she was a baby.

Reassure your child that anything she is feeling now is fine, including sad or mad, and that you are her whenever she wants to tell you about what she feels. This would also be a good time to read a picture book about divorce with your child, which can help open up a discussion about divorce and your child’s feelings.

If your child is exhibiting regression, allow her to continue in this “baby” phase for a while. Avoid showing annoyance or irritation and try to accept that this is the way your child is dealing with her sadness and worry. Giving your child extra love, reassurance, cuddles, and one-on-one playtime at this time will make a world of difference in showing that your divorce will not change your loving relationship.

 

Samantha Rodman – How to Talk to Your Kids about Your Divorce p.137

How to Talk to Your Kids about Your Divorce p.80

Let’s look at an example of two ways to handle a common parenting scenario:

Your five-year-old is playing with a toy, and his one-year-old brother takes it. Your five-year-old begins to shriek. You say, “Don’t be angry; he’s a baby. Take this other toy.” Your  child quiets down. You have inadvertently taught him:

  1. Emotions are not okay.
  2. Try to avoid feeling them by busying yourself with something else.
  3. Don’t come to me with your negative emotions, because I don’t really want to hear about them.

Now let’s look at this same scenario from a different perspective. Your five-year-old is playing with a toy, and his one-year-old brother takes it. Your five-year-old begins to shriek. You say, “Wow, you seem really angry.” Your five-year-old says, “Yeah! He took it!” You say, “I know!” Your five-year-old says something like, “He’s a baby, I guess,” or goes to take another toy. He may keep talking about how angry he is for a little while or he may not. However, in this second scenario, you have taught your child:

  1. Emotions are okay.
  2. Emotions are understandable.
  3. Emotions don’t actually last very long, and they are nothing to be scared of.
  4. You can express yourself in this house.
  5. You have the ability to problem solve for yourself.

In the first scenario, your child did not get to see that his anger would have peaked and decreased over time without “fixing” it by trying to suppress it and distracting himself from it. As an older child or teen, this child may try to suppress emotions or distract himself from emotions with food, alcohol, or risky behaviors. In the second scenario, your child got to see that he can just accept his emotions, as they are not anything to be scared or ashamed about, and they will go away fairly quickly. This is the child who will also come to you with his issues later in life, because he sees that you accept his emotions without judging them, or him.

 

Samantha Rodman – How to Talk to Your Kids about Your Divorce p.80