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.

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.

A new study from Dr Tracy Alloway, from the University of Stirling in Scotland, suggests that using Facebook has beneficial effects on working memory while Twitter can be detrimental. She describes working memory as “the structures and processes used for temporarily storing and manipulating information in short-term memory.”

Dr. Alloway, one of the leading researchers in the working memory, said that Twitter provides an endless stream of information but that it is also quite succinct so you don’t have to process the information. “Therefore,” Dr. Alloway said, “Your attention span is being reduced and you are not engaging your brain and improving neural connections”

Dr. Alloway has conducted many studies about working memory and believes that it is far more important than IQ when it comes to living in the world and that it is the real foundation for learning.

She said, “It doesn’t matter if your mother left school at 15 or got a PhD, it’s a level playing field. Not only does working memory have a profound impact on every aspect of our working lives but now there is exciting evidence that we can train it and improve it.”

I did a full psycho-neurological assessment about five years ago courtesy of a not-for-profit organization dedicated to assisting adults with learning disorders in their careers. The testing indicated I had real problems with “immediate and long term visual and non-verbal memory.” Not long after I had an appointment with Dr. Atilla Turguay (one of the top experts on ADHD in Canada) who does a quick three-part test of working memory and did okay on verbal and numerical but miserably on the visual part. When I told him the results on the psychological testing he just nodded. I have been taking karate now for about seven years. I started because it was recommended by the psychiatrist who diagnosed me with ADHD. I now have a first degree black belt and am preparing for a grading for a second degree this fall. I get by. I have to make some minor adjustments in my learning style to accommodate problems with focus and attention but I do have a black belt so I must be doing something right. Knowing that I had this visual working memory problem I also started classes in Kobujutsu a few months ago thinking it would help with the visual working memory problems. It’s been tough going. Time after time I have find myself standing on the dojo floor, just after the sensei has demonstrated something and is waiting for me to duplicate what he has just shown me. I am searching my mind for a mental picture of what he has just done and there is nothing. He’s waiting. I’m waiting. Nothing is happening. Eventually I do something and get corrected again (my sensai has the patience of Job) and wait for the mental picture…and wait. This Sunday I am being graded for a yellow belt, the first belt after white which is what you start with. The symbolic meaning of the white belt is that it is a clean slate…nothing on it. You know nothing and you don’t know you know nothing. A yellow essentially means you now know enough to know you don’t know anything. The point of all this is how much harder it has been for me to learn weapons than just straight karate. There is something about extending my control beyond my physical self that stops me dead. In Kobujutsu you usually start training with the bo (a six-foot wooden staff). I have to imagine that I am striking some target that is at least three or four feet from where I am gripping the bo. And that’s where my brain gets into trouble. What keeps me going, class after class, is the knowledge, no really the hope, that this training is making a difference in my visual working memory. I wish I could say that I know it is making a difference but I don’t. I just hope.

A new study, that will be published in the August edition of Applied Cognitive Psychology, conducted at the University of York in the U.K. shows that stimulant medication significantly increases visuo-spatial working memory but that Cogmed Working Memory Training leads to significant improvements in all four critical measures of working memory: verbal and visuo-spatial short-term and visuo-spatial working memory. In addition the training effects were still in place when the subjects were retested six months later.

The subjects were 25 children with ADHD. The study is the latest from the team of Joni Holmes Ph.D and Susan Gathercole Ph.D who have been performing independent research examining the impact of Cogmed training on subjects with ADHD and working memory problems.