PT: You're proposing that many of us have mild versions of
familiarconditions like obsessive-compulsive disorder. It's odd that this
idea hasn't been widely acknowledged before.
JR: For too many years we psychiatrists have been trying to put
people into boxes and label them. We've refined our understanding of
various disorders and made those boxes tighter in order to make our
efforts seem more scientific. But this approach has been to the detriment
of people who have two symptoms of a disorder instead of the five
symptoms that you might need to be diagnosed with something like
depression.
PT: Your perspective is a more compassionate one.
JR: For me it grew out of working with people with attention
deficit disorder (ADD)--realizing how many people had it and how much
they were blaming themselves for their foibles. Many creative, wonderful
adults have a really poor self image because they have this brain
difference. One of my patients had developed a company that IBM wanted to
buy. He had all these people working for him, and he was just 32 years
old. But the only thing he was focused on was going back to college to
prove to himself that he was smart--he hadn't graduated because he failed
math. Here he was blaming himself for this deficit, for not being good at
math, instead of enjoying his accomplishments.
PT: The message of your book, Shadow Syndromes, is essentially
"know thy brain."
JR: Absolutely. Get familiar with your brain and deal with it. Use
the good qualities and acknowledge your deficits. This is not playing the
excuse card at all--it's a call to responsibility. And to
awareness.
PT: The brain scares people.
JR: Because it's so damn complicated. It's the black box nobody
wants to open. The public still thinks of brain differences as
differences in brain chemistry' of having a serotonin or dopamine
imbalance. But often it's actual brain geography that's different. In
dyslexia. autism, and even some people with OCD or ADD, brain structures
are a bit altered, and that makes people see the world differently. They
perceive things differently and react differently. So helping them may
not simply be a matter of altering their brain's chemistry.
The other misconception people have is that if we focus on biology,
there's nothing left for people to do in terms of their environment. But
they can still benefit from psychotherapy Or they can let the people they
work with know that they need help in a certain area. You make trade
offs--what I call "creative engineering."
PT: Could thinking about certain behaviors as shadow syndromes
pathologize what we now think of as temperament?
JR: Calling something a shadow syndrome doesn't mean pathologizing
it. We can't really draw a line between health and illness. A brain
difference is pathological when it interferes with your life or prevents
you from doing things you want to do.
PT: So if you're comfortable with your personality, your brain
differences, there's no problem.
JR: Right. The other issue is whether it's affecting other people.
In the book we write about a mildly depressive mother who was perfectly
comfortable being who she was, but she was ruining her daughter's life
because she was the ultimate killjoy--her temperament was making others
miserable. That doesn't mean she has to run and take Prozac, but maybe
she has to acknowledge that her temperament is somewhat
depressive.
PT: What's been your most satisfying moment as a
psychiatrist?
JR: Those moments of discovery with patients--helping them
understand their biology. It's no magic bullet, but if you hit the
target--man, does it change their life!
Tags:
attention deficit disorder,
biology,
brain,
brain chemistry,
brain differences,
detriment,
disorders,
foibles,
good qualities,
John Ratey,
math,
Obsessive Compulsive Disorder,
poor self image,
shadow syndrome,
shadow syndromes
