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A Conversation With John Ratey

Presents an interview with John Ratey regarding various mental disorders such as obsessive-compulsive disorders. Symptoms of the disorders; Message of Ratey's book 'Shadow Syndromes'; Ratey's views regarding some of his patients; Views regarding Ratey's book; Ratey's most satisfying moment as a psychiatrist.

PT: You're proposing that many of us have mild versions of familiar conditions 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!