Archive for the ‘neurotransmitters’ Category
adult ADHD – what’s the buzz?
Jacinta: So this is a commissioned piece, sort of, by someone who wants us to look into this disorder (attention deficit hyperactivity disorder, in full), for our sakes and of course for the sake of humanity.
Canto: Sounds like a first world issue to me.
Jacinta: Okay consider yourself lucky you don’t have to scrounge around rubbish heaps for a living, or travel miles on a half-dead donkey to see a medico, or dodge government bullets because you’re an outspoken female…
Canto: Okay okay. So we know that diagnoses of adult ADHD have risen substantially in recent years, in the WEIRD* world, along with autism spectrum disorder (ASD), bipolar disorder, major depressive disorder, PTSD, chronic fatigue syndrome, and others. A lot of work is being created for clinical psychologists, and the waiting lists are getting longer.
Jacinta: So we’ve started by watching a couple of videos, one from CNBC in the US, another from the ABC in Australia. And a few points here about research and reliable info. Avoid social media! And for the most part avoid commercial news and info networks, which are privately owned and often have a commercial-financial agenda. The most reliable sources in the WEIRD world are generally government subsidised and mandated sites (the ABC in Australia, the BBC in Britain, PBS and NPR in the USA, DW (Deutsche Welle) in Germany, France TV and Radio France, for example).
Canto: Well, we’ve broken that rule by starting with this video from CNBC, but it does give a good overview of the symptoms, via field professionals such as Dr Leonard Adler, director of an adult ADHD programme at NYU. The symptoms are divided into two types, those associated with inattentiveness and with hyperactivity, though there are obvious crossovers. Under each type heading, nine more or less connected symptoms are described. For example, symptoms of inattentiveness include ‘forgetfulness in daily activities’, ‘failure to finish tasks’ and ‘losing important things’, and under hyperactivity comes ‘interrupting others’ or ‘trouble with turn-taking’, and ‘being always ‘on the go”. Apparently you need at least five of the nine symptoms in either category to be diagnosed with ADHD, at least in the USA. Personally, I can relate to all of the symptoms some of the time. All of this, by the way, comes from the famous, or infamous, DSM-5, the 5th edition of the diagnostic and statistical manual of mental disorders.
Jacinta: So you may be skeptical, but on the question posed throughout this video: ‘Is ADHD on the rise or is there simply a rise in diagnoses?’, my answer would be ‘yes there is a rise in diagnoses’, but not for the cynical reason you seem to favour – that it’s all about lining the pockets of psychiatrists. Remember we’ve been studying Freud and the post-Freudians, who pioneered the uncovering of disorders due to childhood trauma, sexual repression, unconscious guilt and the like, all in a groping, hit-and-miss sort of way, before anything much was known of neurology, endocrinology or genetics. Now in the 21st century, we can make connections between genetics, family and personal histories and brain processes in a more scientific way – at least slightly. There’s a long way to go. And this has led us to the reality of ongoing behavioural disorders, where previously people were just considered in vague terms as oddballs, eccentrics, psychos, losers or pains in the arse.
Canto: Steady on. I understand that it’s not about having some symptoms sometimes, which we all do, it’s about having a number of them to a degree that it becomes debilitating. And, as more than one expert has said, what’s frustrating to these sufferers is that sometimes, with certain specific tasks, or aspects of their professional lives, they perform perfectly well on a regular basis, while the rest of their lives are a mess of procrastination, disorganisation, impulsivity and the like. But the more I learn about the disorder, the more I wonder about treatment. These symptoms seem so multi-faceted, I can’t imagine how they can be dealt with though drugs. I can’t even begin to imagine the brain chemistry behind such varied behaviour. Surely there’s no medication that’s going to make you more organised or a better listener – never mind both at the same time.
Jacinta: Well, and yet it all has to be about brain chemistry and signalling. What else can it be? And patterns of behaviour – that’s to say, patterns of brain signalling, that have become habitual since childhood. In response to family dynamics and such. No free will, remember. Much that I’ve heard so far indicates that it runs in families. And of course there are prescription medications for the disorder. So we have to look at effectiveness (method of action), cost, availability and any side-effects or downsides. And then there are other treatments such as cognitive behavioural therapy.
Canto: Yeah I’ve heard that medications are expensive, and I doubt that therapy comes cheaply either. But let’s look at the brain of ADHD sufferers and what can be done medically, if anything, to alter it.
Jacinta: Well Britain’s National Health Service has this to say:
Research has identified a number of possible differences in the brains of people with ADHD from those without the condition, although the exact significance of these is not clear. For example, studies involving brain scans have suggested that certain areas of the brain may be smaller in people with ADHD, whereas other areas may be larger. Other studies have suggested that people with ADHD may have an imbalance in the level of neurotransmitters in the brain, or that these chemicals may not work properly.
Canto: Wow, that’s really informative. I like the bit about smaller or larger. Are they talking about brains or dicks? I mean, really…
Jacinta: Hmm. We need to look at research papers. And one thing I note is that researchers don’t readily distinguish ‘Adult ADHD’ because it’s understood to have emerged in childhood, though symptoms might have changed over time. In fact many children may ‘get over it’. Dr Judy Ho, in an interview on ADHD in the USA, quoted that childhood ADHD affects some 5% of the population but the adult version affects some 2.5%, which seems to make sense.
Canto: Well, having checked Google Scholar, I don’t see much in the way of recent research that jumps out. Sheeting home the various symptoms of the disorder to brain chemistry is really difficult…
Jacinta: Well since they do have medications on the market – the NHS describes 5 types- methylphenidate, lisdexamfetamine, dexamfetamine, atomoxetine and guanfacine – and these presumably work on brain chemistry, they must have some idea. ..
Canto: Well these are generally amfetamines, which act as stimulants, speeding up brain functions through the release of hormones and monoamine neurotransmitters such as dopamine and norepinephrine, and this kind of ‘upper’ activity would help with the disorder most associated with ADHD, which is depression, though there are definite downsides related to prolonged use or overuse. Combining, and possibly replacing, such medications with more behavioural-analytical treatments such as Cognitive Behavioural Therapy might be an idea, if there were enough decent therapists around, and if it was affordable, but it’s all a bit hit and miss.
Jacinta: You have to distinguish between proximal causes and ultimate causes. The proximal causes of most of these conditions is hormone levels and neurotransmitter activity, but that says nothing about why those levels are higher in some people than in others. If you don’t know the underlying causes, you’re just treating symptoms – drugging people to behave ‘normally’. But those underlying causes are generally fiendishly difficult to deal with – for example how can you cure an abused childhood, or damage done in the womb?
Canto: But many people with ADHD may just want to be ‘normalised’, to a degree. They know that what’s been done to them can’t be undone, but they just might want those symptoms reduced, to concentrate better, to be more organised, to calm down, whatever.
Jacinta: And given that we’re not that good at tolerating differences, why not give people drugs so they can all be the same, at least tolerably so….
*western ,educated,industrial,rich,democratic
References
ADD/ADHD – What is Attention Deficit Hyperactivity Disorder? (video)
https://www.nhs.uk/conditions/attention-deficit-hyperactivity-disorder-adhd/treatment/
https://www.cdc.gov/ncbddd/adhd/index.html
leadership, thugs, hormones, bonobos, oxytocin and the future: an interminable conversation 2
just a bunch of female leaders, circa 2018
Jacinta: So, in pointing out that, according to the democracy index, female leadership and some of the best democracies go together, I didn’t mention the fairly obvious chicken-and-egg issue. Does quality governance lead to more female leadership, or does female leadership lead to better quality governance?
Canto: Isn’t this called a synergistic effect? So it’s not quite chicken-and-egg. Or is it?
Jacinta: No matter, you’re right. The term’s generally used in science – here’s an overly-complicating definition from one scientific paper:
Synergistic effects are nonlinear cumulative effects of two active ingredients with similar or related outcomes of their different activities, or active ingredients with sequential or supplemental activities.
You need to learn that – it’ll be in the test.
Canto: The idea being that female leadership and good governance result in more than the sum of the two parts.
Jacinta: Well, when I wrote about the democracy index, I found that the countries near the top of that index, the best democracies, were top-heavy with female leadership, by which I meant Prime Ministers and Presidents, but I didn’t look more closely at the social make-up of those countries – the predominance of female business leaders, scientific team leaders, the percentage of women in other political or governmental posts and so forth. I made the perhaps reasonable assumption that those countries are also leading the world in every kind of leadership position for women.
Canto: To be fair, researching all those things for each country would be quite a job. We don’t get paid for this shit. I think we can at least assume that those Nordic gals are pretty formidable. Northern European countries feature heavily in the top twenty. Even the UK gets in there.
Jacinta: Australia squeezes into the top ten. And will only improve with the new diversity in government after the recent election. And the most women in our parliamentary history.
Canto: So, as this female empowerment continues apace, at least in the WEIRD world, what will this human world look like, in the 22nd century?
Jacinta: Well, it could be – and this wouldn’t surprise me – that the macho world, run by Mr Pudding, Mr Pingpong and their enablers, and possibly their successors, will do catastrophic things before the turn for the better, because out of catastrophes – the two world wars of the twentieth century, the holocausts in Europe and Africa, Hiroshima and Nagasaki – come rude awakenings and changes for the better – the United Nations and a whole host of NGOs such as Amnesty International (1961), Médecins Sans Frontières (1971) and Human Rights Watch (1978), as well as various international defence and common interest groupings.
Canto: Yes, China and Russia – that’s to say their governments – are the scary ones, simply because they can do the most damage globally, though dog knows many African, Middle Eastern and Asian thugocracies are doing terrible things today.
Jacinta: Getting more female leadership into those countries that everybody pays most attention to – such as those with the greatest destructive ability (the USA, Russia and China) – that would be absolutely key.
Canto: The three countries most fond of interfering with other countries. Funny that.
Jacinta: What’s the point of having all that power if you can’t use it to push others around? Old Drivelmouth in the USA is a perfect example. Not to mention the Taliban, etc etc etc.
Canto: So you want female empowerment so you can push blokes around?
Jacinta: Ah, touché. Yes, there’s some truth to that – after all, we’ve had millennia of being pushed around by blokes. But I don’t want to resurrect the Society for Cutting Up Men, though I must say I’m glad that manifesto was written.
Canto: We need extremists so we can feel superior to them?
Jacinta: Haha well we can just about get rid of men, once we’ve drained them of sperm. Think of black widow spiders and such. There’s a strong argument that the basis of all life is female – turning Aristotle’s views upside-down. Anyway, we’re a long way from taking over the world, unfortunately.
Canto: And such a possible world makes me think of bonobos again, where the male life isn’t too bad at all. If you accept your place.
Jacinta: Would you be happy with that?
Canto: Well, no I wouldn’t be happy to be a bonobo after my life as a human, I’d want to do all the human things – sex of course, but also exploring where we came from, what makes us tick, how the self-animating came from inanimate matter, how the universe came to be, how we can solve all the problems we create for ourselves, and enjoying all the beautiful and amazing things, like birds and bushes, music, the sea breeze, the tastes of various cheeses, a good whisky, laughs with friends and so on. As long as my female overlords allow me these joys – and I know they would – I’d be happy as a bonobo with a perpetual hard-on.
Jacinta: Haha, I’m not sure if that’s the best definition of happiness. The spicy variety is more like it. And of course you’re right, human life is potentially much more varied and complex than bonobo life. The real point is that the potential is more likely to be realised, for more people, with less macho thuggery and more female-led community. And here’s another point: hierarchy isn’t a bad thing, or rather, it’s an unavoidable thing, because we’ll never be equal in skills and knowledge, due to age, experience and upbringing. And there will always be challenges to existing hierarchies, and changes to them. It’s a matter of how we manage those changes, and females are generally better at that. As to why, that’s a good question. Maybe it’s hormonal. In any case, that’s a generalisation, which admits of exceptions.
Canto: But those hierarchies are much harder to shift in those complex communities called nations, where there are entrenched classes, such as the Party in China, or the Military in Burma, or the Theocracy in Iran, or the Billionaire CEOs in the USA. These people tend to live as far from the great unwashed as possible, often in gated communities or their equivalents, even on physically Higher Ground, as Robert Sapolsky and others have noted.
Jacinta: Yes, that’s a good point. I was thinking recently of Nixon and his crimes, and of the USA’s ludicrous and shocking Presidential pardoning system, exposed even more in recent times. Nixon was merely ‘persuaded’ to resign, and would have spent his retirement in one of those gated communities, full of backslapping commiserators, and I have few expectations of Trump experiencing anything worse. Anyway, what we need is a society, and a political system, in which this kind of scum doesn’t rise to the top in the first place. I wonder if there have ever been any brutish alpha females in the bonobo world. It’s unlikely, but there may have been the odd one-off.
Canto: You mentioned hormones. You know, I’ve never really understood what they are. I recall Sapolsky warning us against over-simplifying – assuming that testosterone is the male hormone or the aggression hormone, and that serotonin is the relaxing hormone, mostly associated with females…
Jacinta: Serotonin’s a neurotransmitter. You might be thinking of oxytocin, which is both a neurotransmitter and a hormone, apparently. Or, more likely, oestrogen?
Canto: Yes, I’ve heard of them all, but I don’t know what basket to put them in. Is a neurotransmitter a wave or a particle? Are hormones like cells, or molecules of some kind? Amino acid chains, like so much else in the body? We should do a whole self-educating conversation on that topic.
Jacinta; Absolutely. Anyway, we need more of an oxytocin-soaked society – without the downsides of drug induction, and as long as it doesn’t interfere with our sciencey rationality too much. Here’s something from a typical popular medical website about oxytocin:
Oxytocin is a hormone and a neurotransmitter that is involved in childbirth and breast-feeding. It is also associated with empathy, trust, sexual activity, and relationship-building. It is sometimes referred to as the “love hormone,” because levels of oxytocin increase during hugging and orgasm. It may also have benefits as a treatment for a number of conditions, including depression, anxiety, and intestinal problems.
Canto: Hmmm, doesn’t it just immediately make you think of bonobos? I bet they have no problems with their intestines.
Jacinta: Well it does make me fantasise about a touch of biochemical engineering, just to help the feminising process along. Whadya reckon?
Canto: Interesting. That’s for a future conversation.
References
https://www.sciencedirect.com/topics/engineering/synergistic-effect
Melvin Konner, Women after all: sex, evolution and the end of male supremacy, 2015
Robert Sapolsky, Behave: the biology of humans at our best and worst, 2018
https://my.clevelandclinic.org/health/articles/22513-neurotransmitters