Brookline, Massachusetts

Welcome! At this site you will find a growing collection of essays on various topics in psychology. Two themes run through these pages. First and foremost is the importance of "voice." I suggest first reading Giving Your Child "Voice" : The 3 Rules of Parenting to see what "voice" is, how we acquire it, and how it serves us. Before moving on to the essays on "voicelessness," take the time to ask yourself two questions: Did I receive "voice" as a child? And if you have children: am I giving them "voice"? Spend some time thinking about the role "voice" has played in the lives of those closest to you.

The second theme concerns the multi-layers of human communication. If we want to understand our own personal histories, we must look at both text and subtext and become expert in reading between the lines. Such knowledge gives us the opportunity to change our futures and our children's futures.

Some of these essays fall outside the "relationships" category. Still, I hope you will find them enjoyable and thought provoking.

Finally, I've enjoyed the many thoughtful comments people have sent. I look forward to hearing your "voice."

About the author: Dr. Grossman is a clinical psychologist and author of the Voicelessness and Emotional Survival web site.

next: About Me

Self-Therapy For People Who ENJOY Learning About Themselves

At least half of the letters I get are from people who want to change somebody else.

These letters usually start by listing the other person's faults. This is followed by a list of all the things the writer has done to try to make the person change. Then there are angry statements about how frustrating the whole process has been. And the letters usually close with something like this: "What else can I do, besides all I've already done, to make this person change?"

Sometimes I just want to write: "Give it up already! You can't make someone else change!"

But people who are so frustrated deserve a more complete answer.

HOW THEY GOT THE WAY THEY ARE

Let's start with an example we can use for our discussion. Let's talk about seventeen-year-old Sandra, who is extremely overweight.

How did she get to be so heavy? She ate too much.

This is about as far as most people go when they think someone should change. They look at the result and the one behavior they think caused it. And they insist that this one thing is all that needs to be changed.

NOT SO SIMPLE

In the real world there are many different causes for every effect.

What Sandra puts into her mouth is the most significant single cause. But there are many, many other causes
which, when added together, are far more important.

For example, all of the following might be reasons for Sandra being overweight:

Physical causes:
She eats too much.
Her genes.
Her health.
Her current size.

Emotional causes:
She eats to avoid anger, sadness and fear.
She eats when she's bored.
She eats when she's lonely.
She eats for the pain of feeling stuffed, to know she is "alive."

Relationship causes:
Her boyfriend also eats too much.
Her father always controlled her food.
Her mother is ashamed of her.
Siblings and friends make fun of her.

There are many causes for every effect and every cause can have many effects. Causation, especially when it comes to behavior, is always complex.

Life just isn't so simple.

Sandra's motivations are way too complicated for a few words or some clever strategy. Words and strategies won't work no matter how they are delivered.

WHY CAN'T THEY JUST SEE?

Another kind of statement I often hear is:

"But why can't she just see that if she lost the weight everything would be so much better for her?"

The answer is that she doesn't have enough reasons to believe that!

She may not even know yet what she does believe. But she knows that most of the time the pain of giving up her addiction seems to far outweigh the good results she knows she would get from the change.

She may even feel the need for it so much that if she knew it was killing her she wouldn't stop. (That's as serious as a delusion can be!)

BUT I CARE ABOUT HER

You care about her as much as you possibly can but you don't show it by trying to make her change.

If you think she isn't OK the way she is, she may not even be able to tell that you do care.

YOUR OWN SOLUTIONS

Think back to what you've done about your own biggest problems.

If you are doing well these days, you didn't get there by accepting the demands of the people closest to you
or by allowing them to manipulate you into what they thought was best.

You did it by finding a comfortable place to relax where you could have a calm conversation (maybe with yourself)
in which you unraveled the complexities of your own motivation.

And you knew, throughout the whole process, that what you did about it was entirely up to you. You knew you were in charge of your own life.

WHAT SHOULD OTHERS DO?

If they can accept the person the way they are, they should simply enjoy being with them.

If they can't accept the person, they should give them the distance they need.

SANDRA WAS ONLY AN EXAMPLE

Alcohol, approval, food, anxiety, depression, drugs, being verbally abusive... Whatever it is, we've all had our demons.

So notice how this topic applies to you. And be kind to yourself.

[Those letters I get are usually from people who are way too hard on themselves too.]

Enjoy Your Changes!

Everything here is designed to help you do just that!

next: Clear Communication

Are antipsychotics really effective in treating schizophrenia? And are the newer atypical antipsychotics better than the older ones? Here's the research.

Effectiveness of Antipsychotics in Treating Schizophrenia

A large number of studies have been done on the efficacy of typical antipsychotics and atypical antipsychotics.

The American Psychiatric Association and the UK National Institute for Health and Clinical Excellence recommend antipsychotics for managing acute psychotic episodes and for preventing relapse. They state that response to any given antipsychotic can be variable so that trials of different medications may be necessary, and that lower doses are to be preferred where possible.

The prescribing of two or more antipsychotics at the same time for an individual is reported to be a frequent practice but not necessarily evidence-based.

Some doubts have been raised about the long-term effectiveness of antipsychotics because two large international World Health Organization studies found individuals diagnosed with schizophrenia tend to have better long-term outcomes in developing countries (where there is lower availability and use of antipsychotics) than in developed countries. The reasons for the differences are not clear, however, and various explanations have been suggested.

Some argue that the evidence for antipsychotics from withdrawal-relapse studies may be flawed because they do not take into account that antipsychotics may sensitize the brain and provoke psychosis if discontinued. Evidence from comparison studies indicates that at least some individuals recover from psychosis without taking antipsychotics and may do better than those that do take antipsychotics. Some argue that, overall, the evidence suggests that antipsychotics only help if they are used selectively and are gradually withdrawn as soon as possible.

Atypical vs Typical Antipsychotic Medications for Treatment of Schizophrenia

A phase 2 part of this study roughly replicated these findings. This phase consisted of a second randomization of the patients that discontinued taking the medication in the first phase. Olanzapine was again the only medication to stand out in the outcome measures, although the results did not always reach statistical significance, due in part to the decrease of power. Perphenazine again did not create more extrapyramidal effects.

A subsequent phase was conducted. This phase allowed clinicians to offer clozapine which was more effective at reducing medication drop-outs than other neuroleptic agents. However, the potential for clozapine to cause toxic side effects, including agranulocytosis, limits its usefulness.

Sources:

• American Psychiatric Association (2004) Practice Guideline for the Treatment of Patients With Schizophrenia. Second Edition.
• The Royal College of Psychiatrists & The British Psychological Society (2003). Schizophrenia. Full national clinical guideline on core interventions in primary and secondary care (PDF). London: Gaskell and the British Psychological Society.
• Patrick V, Levin E, Schleifer S. (2005) Antipsychotic polypharmacy: is there evidence for its use? J Psychiatr Pract. 2005 Jul;11(4):248-57.
• Jablensky A, Sartorius N, Ernberg G, Anker M, Korten A, Cooper J, Day R, Bertelsen A. "Schizophrenia: manifestations, incidence and course in different cultures. A World Health Organization ten-country study". Psychol Med Monogr Suppl 20: 1-97.
• Hopper K, Wanderling J (2000). Revisiting the developed versus developing country distinction in course and outcome in schizophrenia: results from ISoS, the WHO collaborative followup project. International Study of Schizophrenia. Schizophrenia Bulletin, 26 (4), 835-46.
• Moncrieff J. (2006) Does antipsychotic withdrawal provoke psychosis? Review of the literature on rapid onset psychosis (supersensitivity psychosis) and withdrawal-related relapse. Acta Psychiatrica Scandinavica Jul;114(1):3-13.
• Harrow M, Jobe TH. (2007) Factors involved in outcome and recovery in schizophrenia patients not on antipsychotic medications: a 15-year multifollow-up study. J Nerv Ment Dis. May;195(5):406-14.
• Whitaker R. (2004) The case against antipsychotic drugs: a 50-year record of doing more harm than good. Med Hypotheses. 2004;62(1):5-13.
• Prien R, Levine J, Switalski R (1971). "Discontinuation of chemotherapy for chronic schizophrenics". Hosp Community Psychiatry 22 (1): 4-7.
• Lieberman J et al (2005). "Effectiveness of antipsychotic drugs in patients with chronic schizophrenia". N Engl J Med 353 (12): 1209-23. doi:10.1056/NEJMoa051688.
• Stroup T et al (2006). "Effectiveness of olanzapine, quetiapine, risperidone, and ziprasidone in patients with chronic schizophrenia following discontinuation of a previous atypical antipsychotic". Am J Psychiatry 163 (4): 611-22. doi:10.1176/appi.ajp.163.4.611.
• McEvoy J et al (2006). "Effectiveness of clozapine versus olanzapine, quetiapine, and risperidone in patients with chronic schizophrenia that did not respond to prior atypical antipsychotic treatment". Am J Psychiatry 163 (4): 600-10. doi:10.1176/appi.ajp.163.4.600.

MUST HAVE Books on Alternative and Complimentary Medicine for Mental Health Issues. Mental Healing without Drugs

All HealthyPlace Mental Health TV Show Videos and Upcoming Shows.

back to: Alternative Mental Health Homepage or books on other topics

Certain medical conditions can mimic ADHD symptoms. Diet, drug interactions, an accumulation of heavy metals in the body can all lead to a misdiagnosis of ADHD.

Accurate diagnosis of ADHD in adults is challenging and requires attention to early development and symptoms of inattention, distractibility, impulsivity and emotional lability. Diagnosis is further complicated by the overlap between the symptoms of adult ADHD and the symptoms of other common psychiatric conditions such as depression and substance abuse.

Diagnosis of Attention Deficit Hyperactivity Disorder is made using symptom checklist, rating scales, and mental status testing using the diagnosis criteria listed in the DSM-IV-TR.

Medical conditions that may mimic adult ADHD include hyperthyroidism, petit mal and partial complex seizures, hearing deficits, hepatic disease and lead toxicity.

Sleep apnea and drug interactions should be considered as possible causes of inattention and hyperactivity. Patients with a history of head injury may also have problems with attention, concentration and memory.

Essential fatty acids. A growing body of scientific literature is helping parents and doctors better understand the link between fatty acids and behavioral disorders such as ADHD. The ratio between omega-3 and omega-6 fatty acids (such as arachidonic acid) seems especially important. Eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) are omega-3 fatty acids found in flaxseed oil and cold water fish. In the typical Western diet, we tend to consume more omega-6 fatty acids relative to omega-3 fatty acids. The ratio of omega-3 to omega-6 fatty acids has been shown to influence the development of neurotransmitters and other chemicals that are essential for normal brain function. Increased intake of omega-3 fatty acids has been shown to reduce the tendency toward hyperactivity among children with ADHD (Haag M 2003).

Hypoglycemia is characterized by low blood sugar concentrations. Hypoglycemia can reduce the glucose supply to brain, contributing to difficulty in concentrating, irritability, mood swings and fatigue. In a subgroup of people with ADD/ADHD, hypoglycemia may be a major contributing factor.

Heavy Metals and AD/HD

An accumulation of heavy metals in the body can contribute to behavioral disorders. Hair mineral analysis is a valuable resource used for testing for toxic mineral accumulation.

Sources:

Weiss, Margaret (2001). Adhd in Adulthood: A Guide to Current Theory, Diagnosis, and Treatment . Johns Hopkins University Press.

Goldstein, Sam; Ellison, Anne (2002). Clinicians' Guide to Adult ADHD: Assessment and Intervention . Academic Press.

next: Adult ADHD: Identification and Diagnos

Covering alternative treatments for ADHD - everything from dietary supplements to dietary interventions for ADHD plus behavior management techniques for children and students with ADHD.

• What Causes ADHD?
• Misdiagnosing ADHD
• Adult ADHD: Identification and Diagnosis
• Treatment of Adult ADHD
• The ADHD Diet
• Nutritional Treatments for ADHD
• Food, Diet and ADHD
• Dietary Interventions for ADHD Rejected by CHADD
• Hormones and Herbs for Treating ADHD
• Behavior Therapy for ADHD Children
• Behavioral Management for ADHD Children in the Classroom

next: What Causes ADHD?

I had "a feeling" with James, even before he was diagnosed with ADHD, that something was wrong.

As mothers, we instinctively know when something is not right with our child. I had these instincts with James and they became increasingly stronger by the time James turned 3-years old.

James was impulsive. He was constantly on the move. He preferred noisemaking to talking. He was destructive. He was impossible to potty train and he was consistently in trouble...in trouble with the neighbors, with family members and in daycare.

While my guts were telling me that something wasn't right with my child, family members were telling me I was nuts. James' father told me I didn't know how to control the child. Family members told me I need to be more harsh with discipline. My father told me I needed to beat my child. The pediatrician said I needed parenting classes.

A year later, things had not improved. Things had gotten worse. James had made the move into preschool and was failing. His "educated" and "professional" teachers labeled him "psychotic" and told me my son needed professional help.

At home, things were not good. The relationship between the children's father and I was deteriorating fast. The relationship became abusive. We disagreed over James. I felt there was something wrong, his Dad didn't. I wanted to take the child to the doctor, his dad refused to support me in that decision. The children fought with each other, their father fought with them, I fought with their father, I stopped visiting with my family and things were going to hell in a handcart and I was beginning to smother under a mountain of guilt.

By the time James turned 5, he was taking speech therapy lessons and beginning kindergarten. I didn't know it then, but I was about to receive the lessons that would take me down the path of becoming a Warrior.

next: Coaching Your ADHD Child
~ adhd library articles
~ all add/adhd articles

by Cara at Cara's Poetry Cove

She sees in her children
what other's can't see,
when to tame the spirit
when to set it free,

she sees the character
like no one can
and sees when a boy
turns into a man,

others may judge
and tell her she's wrong
but she hears when her girl
begins a young woman's song,

nothing should rush
a mother's judgment so true,
for she knows what she has
and she knows what to do,

sometimes she'll doubt,
and sometimes she'll cry,
and think that there's
nothing left she can try,

but sure as we live
and sure as we breathe
children will grow
into more than we perceive.

next: ADHD Medication Side Effects
~ adhd library articles
~ all add/adhd articles

Find out the most common side effects of ADHD medications - Adderall, Concerta, Ritalin, Strattera.

Aderall^® Side Effects

Concerta^® Side Effects

Ritalin^® Side Effects

Strattera Side Effects

Adderall Side Effects

The most common side effects are restlessness or tremor; anxiety or nervousness; headache or dizziness; insomnia; dryness of the mouth or an unpleasant taste in the mouth; diarrhea or constipation; or impotence or changes in sex drive. (Adderall full prescribing information).

Concerta Side Effects

In the clinical studies with patients using CONCERTA®, the most common side effects were headache, stomach pain, sleeplessness, and decreased appetite. Other side effects seen with methylphenidate, the active ingredient in CONCERTA®, include nausea, vomiting, dizziness, nervousness, tics, allergic reactions, increased blood pressure and psychosis (abnormal thinking or hallucinations). (Concerta full prescribing information).

Ritalin Side Effects

Nervousness and insomnia are the most common adverse reactions but are usually controlled by reducing dosage and omitting the drug in the afternoon or evening.

Other reactions include hypersensitivity (including skin rash, urticaria, fever, arthralgia, exfoliative dermatitis, erythema multiforme with histopathological findings of necrotizing vasculitis, and thrombocytopenic purpura); anorexia; nausea; dizziness; palpitations; headache; dyskinesia; drowsiness; blood pressure and pulse changes, both up and down; tachycardia; angina; cardiac arrhythmia; abdominal pain; weight loss during prolonged therapy.

Allergic reactions: skin rash, hives, drug fever joint pains possible. Headache, dizziness rapid and forceful heart palpitation-infrequent. (Ritalin full prescribing information).

Strattera Side Effects

Upset stomach, decreased appetite, nausea or vomiting, dizziness, tiredness, decrease in appetite, some weight loss, and mood swings were the most common side effects.

In rare cases, Strattera can cause allergic reactions, such as swelling or hives, which can be serious. Your child should stop taking Strattera. Call your doctor or healthcare professional if your child develops any of these symptoms. (Strattera full prescribing information).

next: Special Education Rights and Responsibilities
~ adhd library articles
~ all add/adhd articles

When asking for help for your ADHD child at school, if you are ignorant of your rights, you may not receive appropriate assistance.

You Call This Help?

As I mentioned earlier, what some school districts, staff and teachers consider help, and what I consider help are two different things. When I asked for help, ignorant of my rights, it took me over 3 months to get a meeting with what the school called a "Child Study Team." I called it "stall tactics."

After waiting over 3 months for the Child Study Team to meet, what I got was a 15-minute "get together" where James' teacher admitted that the child had problems. The school psychologist agreed to make time over the next couple of weeks to "observe" James in his classroom and a second meeting would then be held.

After the second meeting was held, the "child study" team decided that they would observe James for 6 more months and then hold another meeting. What all this observing was going to do, I don't know, but I do know that the 6-month period they set for "observation" put us well past the end of the school year which absolved them of any further responsibilities to my son :(

Despite the fact, I managed to get James diagnosed and placed in therapy during the summer, it wasn't until school started that next year that the worst of our problems would surface. The child study team was no help. It was a new year, child was older, different teacher, etc. Their observations from the year before were no longer valid and they felt, to be fair, they should start over on their observations.

I went to the principal. James was only 6 and still in kindergarten as he had been held back, and the principal in her infinite wisdom decided that you simply do not test children under the age of seven for learning disabilities because their age and maturity level can interfere with the outcome of the tests. Special ed testing was denied and the principal shuffled me off to James' teacher to talk to her about his diagnosis of ADHD.

I foolishly accepted the principal's word, feeling that being a professional, she surely knew of what she spoke. I left her office unsatisfied, but with the feeling that I had done what I could. Ten days later, I would find myself in her office again, with my son representatives of the local police department.

Amidst the suspensions and police reports that were flying around, I was suddenly forced to learn what my child's rights were and what the school's responsibilities were. Special Education Rights and Responsibilities...Know them, Live them, Use them! And don't wait until you're forced to learn them, be prepared!

next: ADHD Special Education Legal Rights
~ adhd library articles
~ all add/adhd articles