Richard G. Petty, MD

Happiness and Resilience

For more than two decades, my main focus has been on ways to help people become more resilient to the slings and arrows of outrageous fortune. To enable people to withstand anything that’s thrown at them: physically, psychologically, socially and spiritually. And not just to withstand them but to use adversity as the impetus for growth.

Adversity is a fact of life: it cannot be controlled. But we can control how we react to it.

This is such an important concept.

So many people try and make themselves stronger and stronger, yet there will always be something that can overwhelm the most powerful defenses. I knew of two martial artists in Hong Kong who claimed that they could defeat anyone. They were incredibly strong and had exquisite technique.

Which did not help them one bit when some villains shot them from behind by.

I have come across others who have spent their lives eating and exercising and still dying prematurely. What was the problem? They had not learned the arts of resilience, which include adaptability, flow and seemless integration with the Universe.

Over the next few days I am going to introduce you to some of the techniques that we have developed for enhancing psychological and physical resilience, before going on to reveal some of the secrets for strengthening the subtle fields of your body, and how to maintain dynamic relationships, not just with another person, but with your Higher Self.

One of the manifestations of resilience is happiness, so before we start, I would suggest that you try this small test that was published by the BBC by arrangement with Professor Ed Diener, from the University of Illinois who designed it.

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Human Evolution

For more than a century, the received wisdom has been that humans finished their physical evolution between one hundred thousand and fifty thousand years ago, and that there have been only minor changes in cognitive abilities over most of that time.

I have always found those assertions to be fundamentally flawed. Our bodies have changed beyond all recognition in the last few hundred years, as I’ve pointed out in my last book and CD series Healing Meaning and Purpose. Even more than that we have changed and are changing mentally. If we were to go back in time ten thousand or even one thousand years, we would find that people were cognitively, emotionally and morally quite different from modern humans. Not simply because of technology and the explosion of knowledge about the external universe, but because there is a dynamic relationship between our development as a species and our creations, with each feeding off the other.

It is only recently that a number of theoreticians, philosophers and psychologists have begun to look at the ways in which we are continuing to develop and what it means for all of us.

The German psychiatrist and philosopher Karl Jaspers first pointed out the great moral leap forward in what he called the Axial Period, between about 700-200B.C.E., during which the foundations of many of the world’s great religions first appeared, probably in response to the prevailing violence and unpleasantness of the time. More recently the Polish-born Swiss philosopher Jean Gebser started developing intriguing models of the transformations of human consciousness. In the United States, the psychologist Clare Graves developed a revolutionary concept of developing levels of development of the personality, that has evolved into Spiral Dynamics. (You may be interested to look at a review that I have just written about an excellent CD program detailing the latest developments in this field.)

And then there is Ken Wilber whose work in this field is remarkable, and whose creation of the Integral Institute promises great things. To these luminaries I now add Dudley Lynch a writer whose work I have only recently discovered.

Dudley recently wrote a very sensitive blog item about the efforts of a person with a mental illness trying to keep himself integrated in a sea of psychic chaos. He was kind enough to publish my brief response, which needs a little more detail.

The reasons for raising these points about continuing human development are these:

1.The manifest physical changes in people over the last few hundred years have enormous – and largely neglected – implications for clinical medicine.

2. It is likely not just peoples’ physical bodies that have changed, but also their subtle systems. I pointed out in my last book and CD series that the chakra system has developed to its current point only within the last few thousand years. This continuing development is also one of the reasons why some therapies that once only worked occasionally are now becoming more stable and predictable, and why some new forms of therapy – like the tapping therapies – are now being discovered.

3. It is because of these profound changes that new forms of therapy are now being developed. Not just using a supplement here, or a breathing exercise there, but precise combinations that help guide the healing of every aspect of an individual and his or her relationships and spiritual connections.

4. Some people who appear to have psychotic illnesses are moving into new developmental stages without having passed through the necessary intermediate stages. I have just read a first person account of an English journalist who could easily have been diagnosed with a manic illness, but was almost certainly undergoing a spiritual emergence.

5. Major emotional, cognitive, moral, conscious and spiritual shifts can be profoundly frightening to many people, and are doubtless one of the reasons for the profound feelings of social dislocation and violent reactions that we are observing throughout the world.

6. It is no surprise that new spiritual pathways are now emerging. Many will doubtless be very helpful to many of the thirty million Americans who count themselves as spiritual seekers, but have not yet found what they are looking for.

7. Taken together, these new understanding about the longitudinal development of people, relationships and whole societies are already having extraordinary effects on our ability to guide them all in more healthy and integrated pathways.

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Categorical and Dimensional Diagnoses

I recently had the great pleasure and privilege of speaking to a group of health care providers in Monteagle Tennessee, and an interesting question came up. The sick citizens of Tennessee are having a hard time now because of the problems with TennCare. This problem is not new, and is not only happening in Tennessee. There is no malice or lack of compassion involved, it is simply a matter of $$$.

And because we need to have a diagnosis in order to apply for reimbursement, the discussion soon turned to the matter of psychiatric diagnosis. It’s pretty well known that I have lectured on the subject of psychiatric diagnosis all over the world: it was actually one of the reasons that I was first invited to come to the United States. The problem is this. When we classify an illness, we can either think of it as a “category,” like strep throat or a heart attack: an illness that has clearly defined margins. Or we can think about it as a “dimension.” So instead of seeing illness as a separate entity, we think of health and illnesses as lying on a spectrum, running all the way from being healthy and well, through mild degrees of just not feeling “right,” to being severely ill. Reimbursement requires categorical diagnoses, even if they do not reflect clinical reality.

This second – dimensional – way of thinking is particularly useful when we are thinking about psychological problems. The world is full of people who are a little bit obsessive, or who get bad mood swings. But they are not bad enough to be called an “illness.” In fact, having some of these traits can be enormously beneficial: they have continued in the population because they have a survival advantage. If I need to have surgery, I sincerely hope that my surgeon will be mildly obsessive, rather than discovering a few weeks later that he had forgotten to do something he should have!

When I am teaching about schizophrenia and bipolar disorder, I discuss how they lie on a spectrum that passes through so-called schizoaffective disorder, cluster A personality disorders – schizoid, schizotypal and paranoid – to schizophrenia. (You may be interested in looking at the blog entry for May 24th here). I also make the point that I can make just about anyone psychotic. Come and live in my research center for a week, where you will not be allowed to eat or sleep; you will have to drink 30 cups of coffee a day and take up smoking. I can guarantee that most people will develop some symptoms. If you have a family history of mental illness it would not take a week, but perhaps 3-4 days. And if you have a personal history of mental illness, it could take no more than a day or two. The key is arousal. People experiencing high levels of arousal may well start to experience manic, depressive or psychotic phenomena. The types of symptoms that are experienced are determined by background, environment and genes. This sort of “reactive” psychosis is completely different from the other end of the spectrum, where, particularly in males, there are demonstrable abnormalities in the brain – shifts in laterality and progressive loss of grey matter in specific regions, with swelling in other – many of which are present before the onset of full-blown psychosis, and before exposure to medications. Though some of the older antipsychotic medicines may make the situation much worse.

In January of 2005, some of my colleagues in Edinburgh, Scotland, published an important paper after studying people at high risk of developing schizophrenia. Many of these high-risk people did not develop the illness, although some had transient and partial symptoms. We know that some family members – the carriers of the genes – may also suffer from some symptoms of the illness. This shows us how genes do not control everything: many people suffer from mild cases because their environment or personality helped protect them from developing a full-blown illness. In other words: biology is not destiny. These findings also give us important clues as to how we may be able to reduce the risk of an illness expressing itself.

Diagnoses are not always cut and dried. Medical professionals are sometimes unable to reach a definitive diagnosis, needing to wait and see how things develop. Having specialized in the diagnosis and treatment of tough cases, family members sometimes become very upset because their loved one does not have a clear diagnosis. Psychiatric diagnosis is still primarily clinical and often needs time to clarify. Although there are many demonstrable neurological disturbances in people with schizophrenia and bipolar disorder, even the most sophisticated brain scans are still not at the stage where we can make diagnoses.

If we think in terms of dimensional diagnoses that reflect clinical reality, it helps us to understand the range of symptoms that people can experience. It also speaks to the point that I have made time and again: symptoms are signs, and they are signs that can be generated in the body, in the mind, in relationships (not just because some might be stressful), and they may have subtle system or spiritual origins. Successful treatment needs us to identify the origins in an individual and to work with all the five main dimensions of the individual.

And by the way, we have succeeded in helping virtually all of our seriously mentally ill patients back to living the kind of lives that they want: jobs, relationships and so on. So this is not an academic discusssion, but instead something supremely practical

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A New Atlas Promises a Breakthrough in some Brain Disorders

The very first attempts to take pictures of the living brain go back to the 1930s, but it is only in the last 20 years that MRI, SPECT and PET studies of the brain have really moved the field forward. After thousands upon thousands of imaging studies, we are beginning to approach the time when we can start harvesting the data collected over these years.

We are on the cusp of an extraordinary advance in our understanding of the brain and how it can go wrong in a large number of neurological and psychiatric illnesses. But that is only a side show: being able to identify the neurological correspondences of, say a psychiatric illness, does not mean that we reduce the illness to the firing of a group of neurons. But it does mean that we are gong to be much closer to providing suitable treatment for the neurological component aspect of the illness.

There has been a dramatic demonstration of this with the publication of a new brain map of people living with a rare but important illness called William’s syndrome.

One of the biggest puzzles for those of us who look at brain scans, is why there is so much variability in the structure of the brain. In the rest of the body, veins and arteries can turn up all over the place, but nerves tend to be in pretty much the same position in everybody. This is not the case in the brain. I’ve looked at many thousands of MRI scans of the brain, and I’ve never found any two alike. It’s one of the reasons that I’m a little doubtful about some of the claims of imagers who say that they can diagnose someone by looking at a brain scan. Most of the time there’s just too much normal variation.

All over the world, there have practitioners who have claimed to derive all sorts of information from brain images. Most experts remain a bit skeptical: hundreds of experts and hundreds of millions of dollars have only enabled us to speak in generalities. Some private practitioners even perform scans for diagnosis.

Some time ago I met a psychiatrist who had an unusual theory about the causes of mental illness. He wanted us to do two MRI scans on a patient to prove his theory. When I told him that we were not yet able to do that in individuals, he was indignant, “But you’ve published all those studies showing abnormal brain structure in schizophrenia.” I explained that all the brain imaging studies have told us quite a lot about groups of people with mental illness, but little about individuals. I do not know of any academic psychiatrists anywhere in the world who think that we can yet use PET, SPECT, fMRI or MRI scans for diagnosis of mental illness. Maybe we’re just being a bit slow. Or perhaps the brain scan diagnosers haven’t got all the pieces of the puzzle just yet. Research is expensive and takes a great deal of time. Busy clinicians are eager to exploit new investigative tools for the benefit of their patients, and usually do not publish their results in peer reviewed journals. With this new research we are going to be able to see if these individual practitioners are correct.

Not only are there many inter-individual differences, but also the current state of the person can have a big impact on some types of imaging. I was recently asked to review a paper for a scientific journal in which the authors had enthusiastically explained the way in which they could now diagnose a certain illness by doing a brain scan. Sad to say, they had not asked a couple of basic questions, like the person’s mood when they were scanned. Depression reduces the flow of blood in regions of the brain, the patients turned out to be depressed, and the results were invalidated. It was a real shame, but it is so important that patients don’t get misled by investigations that cannot help them.

So the moral of the story is this. If someone wants to do any kind of investigation for diagnostic purposes, ask them first whether there is any published evidence that the test actually works: what are the sensitivity and specificity of the findings generated by the test? And who else is doing it?

If the brain were so simple we could understand it, we would be so simple we couldn’t.”

–Lyall Watson (South African Biologist and Writer, 1939-)

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New Clues to Obsessive Compulsive Disorder

In this month’s edition of the Journal of Neuroscience, a team from the University of Michigan has published a very interesting report. Every one of us has made a mistake at some stage in our lives, whether it is something trivial like dropping the groceries, or something more serious, like deleting a crucial computer file. What the researchers did was use functional MRI (fMRI) to peer inside the brain at the instant of making a mistake. While in the scanner, people were forced into making an error that carries consequences – for instance, losing money. When that happened, a particular part of the brain called the rostral anterior cingulate cortex, or rACC, became much more active when the person realized that he or she had erred and there was a penalty attached to the mistake. This part of the brain is involved in deciding what kinds of emotional responses are appropriate.

What is so interesting about this work is that in a previous study on a small group of people with obsessive compulsive disorder (OCD), the same team has shown that the rACC region of the brain became much more active in response to a no-penalty error in the brains of OCD patients, compared to people without the condition. One of the characteristics of OCD is fear and anxiety about errors or failures in certain aspects of everyday life. As a result, many begin repetitive patterns of behavior to ward off or to prevent such events.

So it looks as if people struggling with OCD have a hyperactive response to making errors, after which they begin to get more and more worried that they may have made a mistake. OCD can be a terribly incapacitating condition. We think of mild cases like Melvin Udall in As Good as it Gets, or Adrian Monk, but in reality it can cause much suffering.

I was once asked to see a seventy five year old man who had suffered from a bizarre case of OCD since the age of fourteen. He had traveled the country trying to get help, and it was an extraordinary tribute to him that despite his problem he had built a successful business and family life. He came to see me for acupuncture, but left with a prescription for a medicine that was at the time relatively new. His improvement over the next few months, as we used medication, psychological and social work and then some energetic techniques was just extraordinary.

Research like that from the University of Michigan may well bear important fruit in the future.

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The Media and Mental Illness

Since time immemorial, mental illness has been used as a dramatic device, with sometimes appalling consequences. Too often people with mental illness have been depicted as dangerous villains, and for anyone working with the mentally ill, many of the portrayals of their experiences are inaccurate and inept. As a simple example, those over-wrought European movies in which one can tell that the protagonist is about to be taken away because he is seeing visions of the Virgin Mary speaking to him. Yet it is well recognized that such cross-modal hallucinations are vanishingly rare in mental illness, and are more likely to betray substance abuse, malingering or, rarely, an organic lesion of the brain.

For all the good that came of A Beautiful Mind, we are all well aware that the depictions of John Nash’s experiences made a good story, but were far from the experiences of the mentally ill. One of the first-ever sympathetic depictions of mental illness and of one person’s triumph, was the movie Out of Darkness , starring Diana Ross, on which Kimberly Littrell was the technical director.

For the last decade many of us have realized the importance of helping the media provide accurate representations of mental illness, and some of the contributors to this blog have been doing that by appearing on radio and television programs throughout the world.

A new paper discusses the research that has consistently demonstrated that news media and the entertainment industry have provided overwhelmingly dramatic and distorted images of mental illness that tend to emphasize dangerousness, criminality and unpredictability. Research also indicates that the media has in effect modeled negative reactions to the mentally ill, which have included fear, rejection and ridicule. Not so long ago, there was an infamous occasion on which Time magazine used the word “nuts” three times during their report of a tragic – and rare – case of violence perpetrated by someone struggling with mental illness. This paper makes the important point that the media can be an important ally in challenging prejudice, initiating public debate, and projecting positive, human interest stories about people who live with mental illness. It is heartening that several major syndicated television shows have recently done exactly that: presented people for whom mental illness has been a triumph over adversity.

Though not everyone will be comfortable doing this, media lobbying and press liaison can be an important role for mental health professionals. Many patients may not be able to speak out for themselves, and it provides a means of improving public education and awareness.

I would like to make a suggestion to you: one in four people live with mental disorders. Can you, personally, think of ways in which you could work with the media to improve the life chances and possibilities for recovery for them?

Resource: has compiled a list of major media contacts just for this purpose.  Click here to be taken to the page.  Some e-mail addresses are on this page (some a little dated), but this provides you a chance to make a difference right now.

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Calcium, Vitamin D, Diabetes and Schizophrenia

There are some odd puzzles in medicine. For more than 100 years it has been known that diabetes is more common in people suffering from schizophrenia, bipolar disorder and probably also depression. There has also been data indicating that some children with ADD and autism have metabolic disturbances that may underlie some of the cognitive difficulties. It has also been observed in Europe that dark skinned immigrants – whose skin coloring makes them less able to make Vitamin D – are more likely to develop diabetes. Some dark skinned immigrants are also far more likely to develop schizophrenia compared with their families that stayed in sunny tropical regions. Children – particularly boys – who are breastfed and/or have Vitamin D supplements in the first year of life are less likely to develop schizophrenia in later life. Vitamin D is not only involved in calcium absorption, but also in maintaining the integrity of cell membranes. So the link between diabetes and schizophrenia may have something to do with Vitamin D.

A new study just published in the journal Diabetes Care indicates that women with high intakes of vitamin D and calcium appear to have a lower risk of developing type 2 (maturity onset) diabetes. The study from Tufts-New England Medical Center looked at data on 83,779 women enrolled in the Nurses’ Health Study. The women had no history of diabetes, cardiovascular disease or cancer when they enrolled in the study. Vitamin D and calcium intake from foods and from supplements were evaluated every 2 to 4 years. Over the 20 years of follow-up a total of 4843 new cases of diabetes were discovered. The lowest risk of diabetes was observed among women with the highest combined intakes of calcium and vitamin D compared with those with the lowest.

These are important findings, because interventions to raise both vitamin D and calcium intake and quick, cheap and easy, and may significantly reduce the risk of developing type 2 diabetes.

So how much should we take? Although we should be able to make enough of our own Vitamin D by spending even ten minutes in the sun, not everyone can do that, the sun is not without its risks, and the mechanisms for making Vitamin D become less effective as we become older. Though a balanced diet should also help provide some vitamin D and enough calcium, the data indicates that we should take in at least 1200mg of calcium each day, and 400 International Units (10 micrograms) Vitamin D each day. It is possible, though uncommon for people to take too much Vitamin D, and that can have all manner of health consequences.

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Modafinil and ADD

The Washington Post has just reported that the FDA has turned an application from the Pharmaceutical Company Cephalon to have modafinil approved for use in children with ADD, because of worries about a potentially serious skin reaction called Stevens-Johnson syndrome .

This is a real shame: we need more options for treating children and adults with ADD, and although I am a huge proponent of non-pharmacological methods of treatment, the fact is that a lot of people simply do not respond to the methods that we currently have available, and some do not even respond to the medications that are available.

Modafinil had looked very promising: in December 1998 the FDA approved modafinil under the brand name Provigil for treating adults with sleepiness associated with narcolepsy. Its main mechanism of action is to inhibit the reuptake of dopamine in key regions of the brain, effectively increasing the amount of dopamine available. It has been used off-label for excessive daytime sleepiness and last year a study form the University of Pennsylvania indicated that it might help some cocaine addicts fight their cravings. It is an open secret that a great many students and academics have been using it for years to enable them to study and work longer. I remember an article from someone who was due to lecture in India, immediately after his arrival from the United States. He admitted to taking modafinil to help him get through the ordeal.

The application to use modafinil in ADD is not dead. The FDA has said that they want a 3000 patients study to assess the risk of Stevens-Johnson syndrome, and the company will discuss that with them. But it will inevitably mean delays.

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Neurogenesis 101

The great Spanish histologist and Nobel Prize winner in Physiology or Medicine, Santiago Ramón y Cajal, was probably the first modern scientist to say that neurons in the adult brain did not divide.  In other words, humans are born with a finite number of brain cells and an individual cannot develop/grow/replicate new cells over the course of their adult lives. This is an axiom that underlies some parts of the stem-cell debate.

There is emerging research that seems to refute this notion.  I have written a long article for my friends over at Psychiatric Resource Forum discussing the research indicating that humans may have the ability to produce new neurons in key regions of the brain throughout life, a process called neurogenesis.  I also discuss what this means for field of psychiatry.

The concept of neurogenesis also engenders hope for the fields of personal and spiritual development.  I will discuss these at a later date.  I just wanted to link to this article because it provides (along with the links) a good primer on neurogenesis that will be helpful as I write new posts.

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Attention Deficit, Money and Motivation

People often say that I’m someone who’s glass is always half full. Well, that’s not quite correct: I’m a huge realist, but I don’t like the idea of pathologizing everything that happens to us. One example of this is ADD.

Though untreated clinical ADD can lead to a great deal of distress and the ever-present risk of impulsive behaviors and substance abuse, I am also eager to examine the positive aspects of having attentional problems. Many of the young people and adults with ADD are also extremely successful in settings that don’t require the academic type of concentration. I have met entrepreneurs with ADD, as well as some highly creative people and athletes. A question has been whether ADD might confer some others gifts, benefits or advantages on people.

Although a year old, we recently came across an item that is not as well-known as it should be. Studies using fMRI have indicated that some of the regions of the brain that do not normally show much activity in young people with ADD become highly activated by monetary rewards.

This is not to say that giving young people money is the way to “conquer” ADD. Instead it suggest that rather than just thinking about people with ADD as just having an attention problem, we should also think of them as people who derive pleasure from different things than the bulk of the populations. Not having to spend all their time attending to linear learning may actually lead to greater freedom of imagination, creativity and emotional expression.

People with sever attentional problems can run into a lot of problems in relationships, even losing attention during sex. But it may be that may also be that minor degrees of loss of attentional focus may also enhance some people’s ability to feel empathy.

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