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.

Off the top, let me declare that I sometimes do marketing work in Canada for a Swedish company known as Cogmed.  They have created an on-line training program that improves working memory, a key component of ADD.  Improve working memory and you will improve focus and attention.

I first made contact with Cogmed because a friend told me he had come across their program and that, not only did it appear to work but that it was backed by solid scientific research. My friend works in the psychological services department of a large Canadian school board and spends a large portion of his work time assessing kids who have this disorder. He suggested that he and I together might try to acquire a license to use Cogmed Working Memory Training, and we set about to do that.   The discussions had just begun when I realized that we did not qualify to be a Cogmed practice a license but was asked by Cogmed’s CEO, Jonas Jendi, if I would provide support in Canada for marketing Cogmed.  At the present moment I am not engaged in doing this and have no financial relationship with Cogmed but I still view their organization and their primary service, Cogmed Working Memory Training, with a great deal of respect.

I was intrigued with how and why Cogmed worked.  I learned that Cogmed improves the brain function known as working memory but how does this happen?  I am no expert in medicine but I had thought that if a part of your brain wasn’t functioning properly, you were pretty well stuck with it.  Then I remembered a lecture I had attended at the University of Toronto Faculty of Medicine in a series known as Mini-Med School, a course designed for the public to explain various aspects of modern medical practice.  The lecture I recalled was on stoke rehabilitation and the physician who spoke began by asking the class of more than 200 people, “When was the last time you saw a stroke victim on the street?”

The class seemed a bit confused and so he curled his arm up and limped across the stage the way I had seen lots of stroke victims do in the past but for the life of me, and for that matter most of the people in the lecture hall, I couldn’t remember the last time I had seen someone who looked that way.  A few people raised their hands and then the lecturer asked, “Do you know why you don’t see people like that anymore?’  No one answered and he began his lecture.

He worked at Baycrest Geriatric Hospital in Toronto and headed up the stroke rehabilitation program there.  He said that with a stroke the last function to go is motor control.  The reason stroke victims used to end up apparently paralyzed is not because they couldn’t move their limbs but because the part of the brains that makes them aware of the arm or leg that might be affected is not working.  If you could make them aware of a limb, according to him, they will be able to move it.  This concept is what guides the most advanced stroke rehabilitation today.  This meant that stroke rehabilitation where medical practitioners are painfully moving an arm, or a leg, back and forth hoping to engender some muscle control was a total waste of time.  Instead practitioners, at least those at Baycrest, were doing things like supplying patients with special glasses that shifted a patient’s vision to one side or the other and then after the brain had adjusted, removing the glasses and behold, the patient was aware of the limb and, more importantly, could move the it.

I realized, after some more research, that the concept of neuroplasticity is quite new and absolutely groundbreaking in the world of medicine.  In his bestselling book, The Brain That Changes Itself, Norman Doidge said, “The discovery that thoughts can change the structure and function of our brains—even in old age—is the most important breakthrough in neuroscience in 400 years.”

And so began my journey…