One Brain's journey

I was looking at the Arrowsmith website yesterday and came across a note on a decision from the Tax Court of Canada in 2005 declared that fees for the Arrowsmith program would be considered a medical expense and should be tax deductible. I can only assume that this would apply to many of the other programs available now that exploit the concept of neuroplasticity to improve cognitive functioning. Presumably this would apply to those programs that are administered by trained practitioners or, as is the case with Cogmed Working Memory Training, supervised by a professional such as a licensed physician or a registered psychologist. When I am asked about the cost of the program I am most familiar with, Cogmed Working Memory Training, the $1,500 does seem to cause some concern even though the cost of medication for just one year could amount to more than this. The cost of medication in Canada is, of course, not taxable and in many cases would be covered, all or in part, by group health insurance.

Somewhere on my bookshelf, the one with all the ADHD books, there is one book with an interesting suggestion for doing chores. The technique was called “body double”. This is how it works: you ask a friend to join you in getting some task done. It doesn’t matter what it is but most likely it is something you have been putting off and maybe even made a few false starts at. The friend joins you but they don’t have to do anything. It is probably best if they have a conversation with you and that they are at least in the same room but they don’t assist you or join in on the work. I tried it. It works. I have no idea why. Nor did the author of the book but I do have a theory.

I was reminded of it yesterday when I was watching a rerun of Awakenings on television…you know the movie in which Robin Williams plays a physician called Dr. Sayer but the movie is based on the book by the same name written by Dr. Oliver Sacks.  In the movie (and I presume the book) Robin Williams’ character is working in a mental hospital (in the language of the time) and he is in charge of a section with patients who were all catatonic states as a result of an influenza epidemic in the 1920’s.  They are totally none reactive but at one point he discovers they can catch tennis balls if they are thrown in their direction.  They can also dance.  Williams’ character guesses when asked how they can do this and he responds that it is if they can borrow another person’s will.  When I read the suggestion for getting difficult chores done, I wondered if that was what the mechanism was that made this work, if it wa not possible to borrow the body double’s will. If you have ADHD, or even if you just have trouble doing chores, try it and let me know what happens.

Also interesting, in the movie, the patients gain a temporary reprieve when the doctor administers L-Dopa to them.  He describes L-Dopa as synthetic dopamine, which at the time was used with patients with Parkinson’s Disease.  Drugs that increase amounts of dopamine or prevent it’s reuptake are common medications for ADHD

Back in the days when psychoanalysis ruled, when patients had Oedipus Complexes and Penis Envy, the major difference between treatment then and treatment now was the cure rate. There weren’t very many then and treatment could go on for decades and cost thousands of dollars. One hundred years of psychoanalysis has produced a dismal record of cures.

What has changed? It was a little book known as the Diagnostic and Statistical Manual of Mental Disorders, now in its fourth version. This DSM-IV, used by most physicians and health care workers in North America, categorizes disorders by symptomology and with it comes a rather novel idea in the world of mental health and this is the concept that if you don’t have symptoms–you don’t have the disorder. This means, for example, if you have been diagnosed with ADHD and you work in a high stimulation environment, say as a firefighter, and don’t exhibit symptoms, technically you don’t have ADHD. You can, of course, at some point have symptoms and then you once again have ADHD. But the diagnosis is not something that is going to be with you for the rest of your life nor is it your defining characteristic. The label is separate from the individual.

A few months ago I interviewed the Director of the Learning Center at one of Canada’s most prestigious independent schools and she told me she tells students with a diagnosis that they own the label and are free to use it as they will. At the time, I remember appreciating the simplicity and innate compassion in what she said.

But what am I getting at here? It is this–the DSM-IV has taken the witch doctoring out of psychiatric treatment by removing all the psycho-analytic terms from common practice, and it has made the labelling process, and the shame that can go with it, temporary and practical. The primary purpose of the DSM in the first place was not to create labels for patients but to create a common language amongst mental health practitioners.

The manual is not new.  It has been around in some form or other since 1950 but now it is employed by almost everyone in the field, at least in North America.  And in Europe, there is a similar tool known as the International Statistical Classification of Diseases and Related Health Problems.

New ideas about neuroplasticity mean that there are now effective and permanent treatments from many disorders, acquired and innate.  Finally, we have been freed from this notion that if you have a mental disorder, the best you can hope for is symptom alleviation.  Now you can be made well and whole again.  A diagnosis is no longer a label for life but the beginning of a treatment program leading to a cure.

The summer of my 21st year when I was in university, I was training to be an officer in the Canadian Armed Forces at Base Borden near Toronto. There were a lot of fearful things in that place and I often wondered why my fellow officer cadets didn’t seem as alarmed by them as I was. For one thing, the obsactle course was truly terrifying. It seemed to me that there were at least four of five obstacles that were capable, if you made a mistake, of causing you serious injury like a fractured spine and deep lacerations. We ran the course in pairs because many of the obstacles were impossible for one person to overcome. At one point on the course, there was an assault net, 15 feet in height with two ropes running off at the top. Those in charge decided on our second run through that we should fix bayonets on our FN-C1 assault rifles. My partner went over the top of the net and, as he did, his rifle came off his shoulder and the bayonet cut a huge gash right across his face, running right between his eyes.

My memories of the time were of being frightened all the time but that is somewhat untrue. When I was actually running the course I was fine. It was only after, or before, when I thought about it that I was fearful. What I neglected to remember was that when on the course I probably did better than the rest of my troop.

Quite a few years late I was still convinced that I was a coward, and I had lots of help from the military in coming to that conclusion. One day on a driving vacation I, left the car and was walking down a path at an Amythist mine in Northern Ontario along with an animal control officer that I had run into in the parking lot. As we walked, he allowed that he was there to check out a potentially rabid dog owned by the people who looked after the property. There was no-one else there as the mine was closed and, although it was normally open to tourists, it was end of season and it was closed As he was telling me about the dog on the property that had attacked a tourist, suddenly the dog, a huge German Shepherd, appeared and came running down the path towards us. The animal control officer stepped in front of me raising his metal clipboard, and shouted at me to get behind him. I didn’t need to be asked twice.

What unfolded in the next few minutes turned out to be an important insight into how my brain worked in an emergency leading to the subsequent conclusion that I was anything but a coward. Or perhaps more accurately I was only a coward when I was thinking about something scary. When it actually happened I was fine–more than fine. The dog charged us and the officer hit it on the snout with the metal clipboard and then hit it again before the dog backed off. We continued on down the road because the officer wanted to check with the dog’s owners but it was soon apparent they were not home and the dog was now getting louder and more threatening. The officer told me to pick up a handful of gravel and if the dog got around him, to throw them in the dog’s face. I did as I was told and then once again the dog charged. This time there was no barking and growling. The dog ran straight at us and the officer threw the gravel into its face. It whimpered and ran back to the house. We then walked backwards, as per the officer’s instructions back down the road all the way to the parking lot and then went our separate ways. It wasn’t until half an hour later when I had driven to a tourist information office and stopped to make a phone call at the pay phone and reached out to dial that I realized I was shaking. During the whole time in the confrontation with the dog my mind seemed to be running in slow motion assessing the situation, going over my option. I seemed perfectly calm. That’s what happens to my mind in an emergency.

I have heard people say that ADHD brains run faster. They seem to but I have also heard from more reputable sources that they actually run slower and it seems faster as a result. It’s a bit like film or video. If you want to the image to move slower, in slow motion if you will, you don’t lower the number of frames per second, you actually increase it.

At first I thought that because of the way my brain behaved, I was brave and sometimes when I watch movies on television and the protagonists get into trouble and fall apart in the situation, I feel angry and critical. But I am not really brave and I have no right to judge how others react to danger because, in my case I know that it’s all about brain chemistry and how my brain reacts to emergencies. It is not a conscious decision. I know that heroes will say that it’s not about whether they were afraid or not. They were afraid and they took the appropriate action anyway.

The controversy over the Arrowsmith Program in the Toronto Catholic District School Board is pretty well over. Richard Allway, the newly appointed supervisor of the board is overturning the decision to cut the Arrowsmith program from schools ending a lawsuit brought by parents against the board and Ontario’s Education Minister.

In a letter to parents Mr.Allway stated that after careful review and in consultation with the board’s director of education, the program would be continued for students already enrolled until 2012. He also stated that he was sure that the rationale to cut it in the first place was at the time in keeping with the best of human and fiscal resources.

Arrowsmith was one of the first programs designed to improve performance in children with learning disorders that exploited the concept of neuroplasticity. The program arose from techniques developed by Barbara Arrowsmith Young to address her own learning problems. Her aim was not to compensate for her weaknesses but to strengthen the cognitive capacities underlying them.