Monday, September 26, 2016


Recently a study appeared showing that a common drug used in treatment of diabetes was a risk factor for ADHD in pregnant mothers taking the drug compared to mothers with diabetes but not taking the drug.

In mothers treated with antidiabetic medication (n = 7479), there was a small but significant increased risk of ADHD (HR, 1.20, adjusted to 1.16; P = .03), compared with children from mothers with diabetes [gestational or type 2 diabetes] who did not take the drug.

A journalist dismissed the importance of this effect on the overall prevalence of ADHD: "the increased risk for this (presumably) very small group of women can't have that much effect on the ultimate numerator of ADHD."

I believe this response may reflect the common assertion that most of the elevated prevalence is due to non medical factors such as pressure from pharmaceutical companies.

While partially true, the assertion incorrectly dismisses the relevance of multiple medical causes of ADHD. As I responded, "The numerator for prevalence of ADHD may be small but it shows how a particular causative effect is in play, along with numerous other pre and perinatal causes. I would count it in toto to be highly significant. We don't know the impact of numerous other pills being ingested by pregnant women. Samples of numerous pills are found in large swaths of waste water in the country."

To this must be added known risks of ADHD from organophosphate pesticides, lead in house paint & drinking water; low birth weight; brain trauma from a variety of sources, including infectious, radiologic, or immunologic factors in prenatal or perinatal environments.

In other words, ADHD has many causes related to early neurodevelopment, as well as the well-established hereditary or temperament causes. It is important to beware of "simple & sovereign theories," as Gordon Allport  warned long ago.

Sunday, September 25, 2016



Andras Angyal was an American-Hungarian psychiatrist who died in 1960, the same year I started my career as a psychologist at Johns Hopkins  hospital. Now At 83 my mind returns to this forgotten genius who I only knew through his writing as a student while a graduate student at Harvard.
Late at night, awake in my "segmented sleep" cycle, my thoughts about the events of my past life somehow bring him to mind. Before I tell you of those thoughts I want to quote a succinct summary of his ideas from Wikipedia.
"Angyal ... coined the word biosphere. The word refers to both the individual and the environment, 'not as interacting parts, not as constituents which have independent existence, but as aspects of a single reality which can be separated only by abstraction.'[...]
The biosphere is seen as a system of interlocking systems so arranged that any given sub-system of the biosphere is both the container of lesser systems and the contained of a greater system or systems. The interplay of the interlocking systems creates a tension which gives rise to the energy, which is available to the personality. Moreover, the biosphere as a whole is characterized by a fundamental polarity which gives rise to its most fundamental energy. This polarity arises from the fact that the environment pulls in one direction and the organism in the other.
To these fundamental yet opposed pulls of the biosphere, Angyal has given the names of autonomy and homonomy, respectively. Autonomy is the relatively egoistic pole of the biosphere: it represents the tendency to advance one's interests by mastering the environment, by asserting oneself, so to speak, as a separate being. Homonomy is the relatively 'selfless' pole of the biosphpere: it is the tendency to fit oneself to the environment by willingly subordinating oneself to something that one perceives as larger than the individual self. In place of the words autonomy and homonomy, Angyal has also used the terms self-determination and self-surrender to describe these opposing yet co-operating directional trends of the biosphere, and he has felicitously summed up the individual's relationship to them with the remark that, 'the human being comports himself as if he were a whole of an intermediate order'"
As I review my own life, I now clearly see that there are ego-driven periods as well as those self-surrender or homonomy periods. Moreover, as Angyal described, these very distinct functions are like those Gestalt illusions which can 'flip' back and forth, where you experience one side of your personality without conscious awareness of the other.
These are not necessarily 'good vs bad' experiences as commonly judged by others.For some of the ego moments are positive and others negative; and some of the selfless periods display either good or bad behaviors. But I see my most secret and undeniably bad actions as a part of my self which can succumb to that conscious state in which I am a selfless and admiral part of the larger society.
When it is possible, as you scan over your past thoughts and actions, especially those you keep most secret from view, you may discover a more unified, larger picture of yourself. There is then a relief of the tension between opposite views, and according to that wise psychiatrist I never met, there remains a holistic unified vision of a peaceful self.

Thursday, September 15, 2016

Association of book Reading With Longevity

A chapter a day: Association of book reading with longevity

 Strange as it may seem, there is good empirical evidence that reading novels prolongs life. Consider this study by epidemiologists at Yale University, published in Social Science & Medicine.

Book reading provides a survival advantage among the elderly (HR = 0.80, p < 0.0001).

Books are more advantageous for survival than newspapers/magazines.

The survival advantage of reading books works through a cognitive mediator.

Books are protective regardless of gender, wealth, education, or health.
Although books can expose people to new people and places, whether books also have health benefits beyond other types of reading materials is not known. This study examined whether those who read books have a survival advantage over those who do not read books and over those who read other types of materials, and if so, whether cognition mediates this book reading effect.

The cohort consisted of 3635 participants in the nationally representative Health and Retirement Study who provided information about their reading patterns at baseline.

Cox proportional hazards models were based on survival information up to 12 years after baseline. A dose-response survival advantage was found for book reading by tertile (HRT2 = 0.83, p < 0.001, HRT3 = 0.77, p < 0.001), after adjusting for relevant covariates including age, sex, race, education, comorbidities, self-rated health, wealth, marital status, and depression.

Book reading contributed to a survival advantage that was significantly greater than that observed for reading newspapers or magazines (tT2 = 90.6, p < 0.001; tT3 = 67.9, p < 0.001). Compared to non-book readers, book readers had a 23-month survival advantage at the point of 80% survival in the unadjusted model. A survival advantage persisted after adjustment for all covariates (HR = .80, p < .01), indicating book readers experienced a 20% reduction in risk of mortality over the 12 years of follow up compared to non-book readers.

Cognition mediated the book reading-survival advantage (p = 0.04). These findings suggest that the benefits of reading books include a longer life in which to read them.
Why Reading Literature Matters for Psychologists.

An article in the Washington Post today by Christopher Ingraham makes the point that there is a long slow decline of novel reading in this country. It argues that novel reading is important because it increases the empathy in its readers.  This is a belief I have shared with my psychology students for many years.

Gustavo Flaubert's novel about a doctor's wife who commits adulterous affairs then commits suicide to avoid the banalities of rural life is a story that teaches much about the way an individual life transpires in an environment that is both loveless and boring. I often suggested this and other writers as important for psychologists trying to learn how to piece together the life story of their patients. Getting a person's real life story is the essence of "diagnosis" which is an art best taught by artists.

Qualities of compassion and empathy are shaped in ways not easily taught better than under the microscope of the novelist. Whether Tolstoy, Turgenev, Dostoyevsky or Sylvia Plath, the complex nature of the human story is absorbed by the reader and built into their cognitive and emotional understanding.

The same argument applies to poetry which can teach skills and emotions valuable to a psychotherapist, physician, nurse or anyone whose life enriches others. But this form of teaching has to do with emotional growth at a subtle level, which is why many programs for physicians--not just psychiatrists--recommend a background in humanistic and artistic studies.

As a patient there is an immediate connection with a primary care doctor who projects empathy at an automatic and unconscious level. Humans are remarkably astute at recognizing genuine empathy vs machine-like behavior.

It seems plausible that increasing levels of strife and conflict at the national and world level may also reflect the decline of empathy.