The Diagnostic Statistical Manual (DSM) is considered the bible of American psychiatry. It provides diagnostic criteria to assist qualified clinicians in making mental disorder diagnoses in order to treat clients whose symptoms and behaviors meet the criteria for those disorders.

The American Psychiatric Association (APA) published its first diagnostic manuals in 1952 and 1968 which were spiral bound booklets comprised of 130 pages.  In 1980 the DSM-III was a 494 page hardbound book and reflected an emerging revolution in the field of American psychiatry.

The DSM-III discarded the psychoanalytical approach of the DSM-I and DSM-II which relied primarily on theories of unconscious conflict being the cause of most expressions of psychopathology. The DSM-III wanted to achieve greater diagnostic reliability by creating a new approach to identifying mental disorders based solely on observable signs and symptoms. Prior to the DSM-III, disorders ranged along a spectrum from ‘normal’ to ‘severe’. The DSM-III organized ‘observable’ signs and symptoms into discrete categories outlining the criteria for a particular disorder. By 2000, the DSM-IV had expanded to almost 1,000 pages and in 2013 the DSM-V was published after 6 years in the making amid much criticism and controversy.

Among those who challenged the DSM-V were Robert Spitzer, the editor of the DSM-III and Allen Frances, the editor of the DSM-IV. Their two primary complaints were the secrecy surrounding the process that determined what would be included in the new edition and the belief that by lowering thresholds for particular disorders, the APA was pathologizing behaviors that were previously considered appropriate or normal in response to the circumstances. They referred to this paradigm shift as the ‘medicalization of normal human emotions’. In other words, in the absence of using a spectrum to assess symptoms and behaviors on a scale from ‘normal’ to ‘severe’, we now run the risk of pathologizing and subsequently medicating what might not have previously met the criteria for ‘severe’ but is, instead, developmentally or situationally appropriate.

Having worked for several years with at-risk, under-served populations in my community, I have witnessed first-hand their extreme vulnerability and the significant impact that the DSM and the field of psychiatry can have on their lives. In order for insurance companies, including Medicaid, to be willing to pay mental health professionals so that individuals can receive treatment and services there must be a documented diagnosis with a corresponding numerical code for billing purposes. Unfortunately, these diagnoses can negatively impact the lives of millions of people in the United States every day by influencing where they can live, what jobs they can hold, and how their children will be educated. Because the DSM is also utilized by public housing authorities, school officials, lawyers, judges, and prison officials, a mental disorder diagnosis could end up causing more harm than good.

While helping at-risk youth transition back into the community from correctional facilities, I was deeply disturbed to discover that all juveniles in the state of Virginia who are incarcerated are initially processed at the “Reception and Diagnostic Center” for psychiatric evaluation. Every kid I worked with, without exception, had been given a diagnosis for a mental disorder and medicated before being assigned to a correctional facility.  One can only conclude that containing a large population of adolescents within an over-crowded prison setting must be much more manageable if that population has been heavily medicated.

Since the first DSM was published in 1952, psychiatric diagnoses have increased significantly leading to speculation by many experts in the field of psychology and psychiatry that many diseases are now being promoted by large pharmaceutical companies in their marketing campaigns in an attempt to increase sales. 

Shyness made its debut in 1980 in the DSM-III as a psychiatric disorder now referred to as ‘Social Phobia’. By 1994, the DSM-IV was referring to it as ‘Social Anxiety Disorder’. Five years later the FDA approved Paxil for said disorder and sales soared into the billions of dollars for GlaxoSmithKline. On July 2, 2012 Glaxo pled guilty to criminal charges and was fined 3 billion dollars for marketing Paxil for unapproved uses and failing to report drug safety information to the U.S. Food and Drug Administration (FDA). The settlement covers improper Glaxo practices from the late 1990s to the mid-2000s in which Glaxo offered kickbacks to doctors and sales reps to push the drug and helped publish a paper on Paxil in a medical journal that misrepresented clinical trial data.

As reported by Time Magazine on July 5, 2012:

• Although the antidepressant Paxil is not approved for patients under 18, Glaxo illegally marketed the drug for use in children and teens, offering kickbacks to doctors and sales representatives to push the drug.
   
• A government probe was launched in 2002, and it was discovered that Paxil, as well as several other antidepressants, were no more effective than placebo in treating depression in kids. Indeed, between 1994 and 2001, Glaxo conducted three clinical trials of Paxil’s safety and efficacy in treating depression in patients under 18, and all three studies failed to pass muster.
   
• One clinical trial, known as Study 329, found that teens who took the drug for depression were more likely to attempt suicide than those receiving placebo pills. Glaxo hired a company to prepare a medical journal article that downplayed Paxil’s safety risks, including increased risk of suicide, and misrepresented data to trump up the positive results of the study. The article was published in 2001, falsely reporting that Paxil was an effective treatment for child depression.
   
• Prosecutors accused Glaxo sales representatives of then using the article to promote the use of the drug for depressed youth. Sales reps invited prescribing psychiatrists to luxury resorts for “Paxil forum meetings” where they were treated to fancy dinners and free entertainment like sailing trips, spa treatments, and balloon rides.
   
• Reports of teens committing suicide while taking Paxil began surfacing in 2003, and the FDA discovered that 10 of the 93 Paxil patients in Study 329 had attempted suicide or thought about it, versus one out of the 87 patients on placebo. In 2004, the FDA added a black-box warning on the drug’s label about the increased risk of suicidal thoughts in teens who take it.
  
  

This now brings us to an even greater concern which makes the waters of the American Psychiatric Association (APA), Big Pharma, and the DSM so murky that any attempt to navigate it may cause us to completely and collectively lose our minds. However, let’s do our best to push ahead in the hope that we may find some pharmaceutical intervention to ease the ever increasing cognitive dissonance around what it is we’re about to discover.

In 2006, a research paper out of the University of Massachusetts was published in the journal “Psychotherapy and Psychosom” entitled “Financial Ties between DSM-IV Panel Members and the Pharmaceutical Industry.”

The following is the Abstract:

Background: Increasing attention has been given to the transparency of potential conflicts of interest in clinical medicine and biomedical sciences, particularly in journal publishing and science advisory panels. The authors examined the degree and type of financial ties to the pharmaceutical industry of panel members responsible for revisions of the Diagnostic and Statistical Manual of Mental Disorders (DSM).

Methods: By using multimodal screening techniques the authors investigated the financial ties to the pharmaceutical industry of 170 panel members who contributed to the diagnostic criteria produced for the DSM-IV and the DSM-IV-TR.

Results: Of the 170 DSM panel members 95 (56%) had one or more financial associations with companies in the pharmaceutical industry. One hundred percent of the members of the panels on ‘Mood Disorders’ and ‘Schizophrenia and Other Psychotic Disorders’ had financial ties to drug companies. The leading categories of financial interest held by panel members were research funding (42%), consultancies (22%) and speakers’ bureau (16%).

Conclusions: Our inquiry into the relationships between DSM panel members and the pharmaceutical industry demonstrates that there are strong financial ties between the industry and those who are responsible for developing and modifying the diagnostic criteria for mental illness. The connections are especially strong in those diagnostic areas where drugs are the first line of treatment for mental disorders. Full disclosure by DSM panel members of their financial relationships with for-profit entities that manufacture drugs used in the treatment of mental illness is recommended.
 
The following paragraphs are transcribed from “Shrinks for Sale: Psychiatry’s Conflicted Alliance”, an article published by the Citizens Commission on Human Rights (CCHR), an international mental health industry watchdog:

• In July 2008, the U.S. Senate Finance Committee requested that the APA provide accounts for all of its pharmaceutical funding. In March 2009, the American Psychiatric Association announced that it would phase out pharmaceutical funding of continuing medical education seminars and meals at its conventions. Despite its announcement, within two months, the APA accepted more than $1.7 million in pharmaceutical company funds for its annual conference, held in San Francisco.Within a month of the APA’s announcement, its conflicts came under criticism again with the release of a study that found that 18 of the 20 members overseeing the revision of clinical guidelines for treating just three “mental disorders” had financial ties to drug companies. The three diagnoses generated some $25 billion a year in pharmaceutical sales.
   
• In June 2007, The New York Times reported that psychiatrists in Vermont and Minnesota topped the list of doctors receiving pharmaceutical company gifts and that this financial relationship corresponds to the “growing use of atypicals [new antipsychotics] in children.” From 2000 to 2005, drug maker payments to Minnesota psychiatrists rose more than six-fold to $1.6 million.During those same years, prescriptions of antipsychotics for children under the state’s insurance program rose more than nine-fold.
   
• With the U.S. prescribing antipsychotics to children and adolescents at a rate six times greater than the U.K., and with 30 million Americans having taken antidepressants for what psychiatrists admit is a pharmaceutical marketing campaign, it is no wonder that the conflict of interest between psychiatry and Big Pharma is under congressional investigation.
  
  

The APA is heavily steeped in a conflict of interest with the pharmaceutical industry since making at least $40 million in sales of the DSM. The financial conflicts between psychiatrists involved with the DSM-IV and DSM-V Task Forces are under scrutiny along with Big Pharma’s influence on what disorders are included in the DSM since these disorders contribute to the current $25 billion in annual antipsychotic and antidepressant drug sales in the U.S.  The following is a summary from the Citizen's Commission on Human Rights (CCHR) listing a handful of individuals who were under Senate Finance Committee investigation for the roles they played in furthering sales for Big Pharma in exchange for large monetary donations:

Nada Stotland: The 2008 APA President, Stotland serves on the Board of the National Mental Health Association (now called Mental Health America), a group that received over $3 million in pharmaceutical company funding in one year alone. In 2008, Pfizer donated at least $500,000 to Mental Health America while Eli Lilly donated $600,000. Stotland is on the speakers’ bureau for Pfizer and GlaxoSmithKline (GSK).

David Kupfer:  A member of the DSM-IV Task Force and Chair of the DSM-V Task Force.  He has been a consultant to Eli Lilly & Co., Johnson and Johnson, Solvay/Wyeth, Servier and also sat on the advisory boards of Forest Labs and Pfizer.  In 2008, Kupfer also disclosed that he had been a consultant for Forest Pharmaceuticals, Pfizer Inc., Hoffman La Roche, Lundbeck and Novartis.

Dilip V. Jeste: APA Trustee and Member of the DSM-V Task Force is a consultant to Bristol-Myers Squibb, Lilly, Janssen, Solvay/Wyeth and Otsuka; honoraria from Bristol-Myers Squibb, Janssen and Otsuka; received “supplemental support to NIMH-funded grants” from Astra Zeneca, Bristol-Myers Squibb, Eli Lilly, and Janssen in the form of donated medication for the study, “Metabolic Effects of Newer Antipsychotics in Older Patients.”  Jeste’s 2008 APA disclosure for the DSM-V Task Force stated he received honorarium from Abbott, AstraZeneca, Bristol-Myers Squibb, Eli Lilly Janssen, Pfizer-Eisai, Solvay-Wyeth and Otsuka. He also received consulting fees from nine pharmaceutical companies.

Steven Sharfstein: Former APA president who sat on the Board of Directors of the American Psychiatric Foundation (APF), an organization formed by the APA that lists 17 major pharmaceutical companies as its corporate adviser.  Since 1992, he has been President and CEO of Sheppard Pratt Health System and in 2002, he signed on 6 pharmaceutical companies to test their products at Sheppard Pratt. He signed contracts with Eli Lilly & Co., Merck and Janssen Research Foundation.

Joseph Biederman:  Chief of the Program in Pediatric Psychopharmacology, Massachusetts General Hospital, Biederman has received research funds from 15 pharmaceutical companies. The New York Times exposed how Joseph Biederman earned $1.6 million in consulting fees from drug makers between 2000 and 2007 but did not report all of this income to Harvard University officials. His marketing of the theory that children have “bipolar” was attributed to the increase in antipsychotic drug sales for pediatric use in the United States—today 2.5 million children. Following exposure of his conflicts, he stepped down from a number of industry-funded clinical trials. In March 2009, in newly released court documents, Biederman was reported to have promised drug maker Johnson & Johnson in advance that his studies on the antipsychotic drug Risperidone would prove the drug to be effective when used on preschool age children.

Melissa DelBello:  Research psychiatrist, University of Cincinnati was cited for her failure to disclose to the university much of what she had earned from pharmaceutical companies. In 2002, she was the lead author of a study that reported some patients benefited from the antipsychotic drug Seroquel, which is manufactured by AstraZeneca, which paid her $100,000 in 2003 and $80,000 in 2004. DelBello disclosed that she’d received $100,000 from the company between 2005 and 2007, but federal investigators discovered it was more than double that—$238,000.

Frederick Goodwin:  Former National Institute of Mental Health (NIMH) director, Goodwin earned at least $1.3 million between 2000 and 2007 for giving marketing lectures to physicians on behalf of drug makers—a fact he did not reveal to the audience, broadcaster or producers of “The Infinite Mind,” that he hosted on the National Public Radio during its 10-year run.

Charles Nemeroff:  Professor and Chairman of Psychiatry and Behavioral Sciences, Emory University School of Medicine in Atlanta. From 2000 through 2006, Nemeroff received just over $960,000 from GlaxoSmithKline (GSK), but only disclosed no more than $35,000 to Emory. Between 2000 and 2007, Charles Nemeroff earned more than $2.8 million from various drug makers but failed to report at least $1.2 million. He signed a letter in 2004 promising Emory administrators that he would earn less than $10,000 a year from GSK but on the same day he was at a hotel earning $3,000 of what would become $170,000 in income from the company—17 times greater than the figure he agreed upon. He was the principal investigator for a five-year $3.9 billion grant financed by the NIMH for which GSK provided the drugs, during which he received more than the annual $10,000 threshold allowed from the company. In 2003, he coauthored a favorable review of three therapies in Nature Neuroscience failing to mention his significant financial interests in these, including owning the patent for one of the treatments—a lithium patch.  Nemeroff has consulted for 21 drug and device companies simultaneously.  In 1991 Nemeroff testified before the FDA on behalf of Eli Lilly in hearings into Prozac, saying that the drug did not cause suicidal acts of ideation—yet 13 years later, the FDA concluded the opposite and issued a black box warning about suicide risks.

Martin Keller: Professor of Psychiatry and Human Behavior at Brown University, chairman of the psychiatry department at the Alpert Medical School, Keller’s study (329) on GSK’s Paxil use in children and adolescents and its authors have been fiercely criticized in medical journals for allegedly misrepresenting data, suppressing information linking the drug to suicidal tendencies and reaching a conclusion unsupported by the relevant data. There are also claims that a GSK-affiliated employee ghostwrote Study 329, while Keller et al. made huge sums of money from the antidepressant manufacturer.  In 1999, it was disclosed that while serving as chief of the psychiatry department at Brown University, Keller earned more than $842,000 from Pfizer, Bristol-Myers Squibb, Wyeth-Ayerst and Eli Lilly, makers of antidepressants he “lauded in a series of medical research reports.” After a three-year criminal investigation by the Attorney General’s Office, Brown University “agreed to return $300,170” of taxpayer money to the state of Massachusetts for psychiatric research Keller’s psychiatry department never performed. Additionally, Keller did not disclose the extent of his financial ties with companies to the medical journals that published his research—this included $93,199 in 1998.  In the same year that Keller authored a review article in Biological Psychiatry, and concluded that the newer antidepressants were more effective, he received $77,400 in personal income and $1.2 million in research funding from the makers of two of these drugs.

Alan Schatzberg was appointed APA President in May 2009, despite the exposure of his conflict of interest. As exposed in The New York Times and other media, Schatzberg owned $6 million equity in drug developer Corcept Therapeutics at the same time that he was principle investigator in an NIH-funded, Stanford-based study of Corcept’s drug mifepristone. Schatzberg had initiated the patent application on mifepristone to “treat psychotic depression” in 1997. He co-founded Corcept in 1998, and in 1999, extended the NIH grant for the study of psychotic depression to include mifepristone.

Thomas Spencer: Assistant Director of the Pediatric Psychopharmacology Unit at Massachusetts General Hospital and Associate Professor of Psychiatry, Harvard Medical School, he is under Senate investigation for reportedly failing to disclose at least $1 million in earnings from drug companies between 2000 and 2007.

Karen Wagner: Professor, University of Texas Medical Branch at Galveston reportedly failed to disclose more than $150,000 in payments from GSK. Between 2000 and 2008, Wagner had worked on NIH-funded studies on the use of Paxil to treat teenage depression and was a co-researcher on Study 329 (See Keller). In 2001, when study 329 was published, the company reportedly paid her $18,255. Between 1998 and 2001, she was one of several researchers participating in more than a dozen industry-funded pediatric trials of antidepressants and other drugs.  In her Zoloft study, Wagner said she had received “research support” from several drug makers, including Pfizer, but did not disclose she had received “sizeable payments” from Pfizer for work related to the study. Between 2000 and 2005 GSK paid her $160,404, but only $600 was disclosed to the university. In 2002, Eli Lily also paid her over $11,000, which was not disclosed.

Timothy Wilens:  Associate Professor of Psychiatry at Harvard Medical School in Boston allegedly failed to report that between 2000 and 2007 he had earned at least $1.6 million from drug makers. Federal grants received Dr. Joseph Biederman (above) and Wilens were administered by Massachusetts General Hospital, which in 2005 won $287 million in such grants.  He is under Congressional investigation.

The Citizens Committee on Human Rights further reported that:

The Senate Finance Committee also requested the financial records of NAMI, a group long accused of being a covert marketing arm of the pharmaceutical industry.  The mental health alliance, which is hugely influential in many state capitols, has refused for years to disclose specifics of its fund-raising, saying the details were private. But according to documents obtained by The New York Times, drug makers from 2006 to 2008 contributed nearly $23 million to the alliance, about three-quarters of its donations.”

While the National Alliance on Mental Illness (NAMI), claims to be an advocacy organization for people with “mental illness,” its actions indicate otherwise. The group opposed the black box warnings on antidepressants causing suicide for under 18 year olds in 2004, and black box warnings on ADHD drugs causing heart attack, stroke and sudden death in children in 2006, when you look at their biggest source of funding: Pharma.

From the previous article “What is Normal”:

As a mental health professional advocating for children, adolescents and their families within the legal, academic, and social institutions for a number of years, I have observed a growing intolerance within our society to behavioral presentations and patterns that do not conform to an increasingly narrow perception of what is 'normal'. Simultaneous to this increasing intolerance is a continuous breakdown within the institutions themselves which limits their ability to respond effectively to the needs of the individual. Unprecedented cutbacks in education, arts, and social programs which assist our most vulnerable citizens; the young, the elderly, the impoverished and the disabled, is creating a new culture of 'normal'; one in which our ability to respond to the 'troubled' or 'maladapted' individual is becoming more and more limited to chemical restraints. In our public schools physical exercise, creative expression, and critical thinking skills have been replaced with educational strategies such as "No Child Left Behind" and Standards of Learning requirements that entrain our children to focus primarily on test-taking and grade percentages. The results of which appear to directly correlate to their developing sense of self-worth or lack thereof. Policies such as "Zero Tolerance" has created a fear-based culture of reactivity within our academic institutions, resulting in extreme, irrational consequences for what was previously recognized as falling within the realm of developmentally appropriate behaviors.

For the first time in history we are engaged in the largest social experiment in which we have agreed on a scale never before seen that it makes perfect sense to chemically restrain our children when their behaviors and achievements do not conform to our expectations. Consequently, one in four children in this country between the ages of 13 and 18 has now been identified as suffering from an anxiety disorder.  In 1985, half a million children in the United States met the diagnostic criteria for ADHD. Today it is estimated that 5 to 7 million children in this country now have this diagnosis. Three and a half million children have met the criteria for a diagnosis of depression and a recent study showed a 600 percent increase in the diagnosis of pediatric bipolar disorder in children under the age of 13 in the last 10 years.  Most of these children are receiving pharmacological interventions despite the absence of longitudinal studies that have not been funded by pharmaceutical companies excluding long-term, negative consequences on a developing brain still in its most critical stages of development.

One of the most concerning expressions of this particular social experiment that I’ve witnessed during the past eleven years is the increasing vulnerability of children to be diagnosed with Attention Deficit Disorder(ADD) and prescribed amphetamines because of their inability to conform to rigid and unrealistic expectations within the classroom.  

In my opinion, this phenomenon has been perpetuated by a fear-based culture that took root in response to the Columbine school shootings that occurred in 1999. Prior to this unprecedented and unimaginable event, there was a greater willingness to assess child and adolescent behaviors on a scale that provided a context for what would be considered developmentally and situationally appropriate.

It is also my opinion that the pharmaceutical companies have knowingly taken advantage of this and contributed to this culture of fear by manipulating parents, teachers, administrators, and pediatricians into believing that medicating a brain with stimulants during its most critical stages of development is the wisest course of action when academic excellence becomes difficult for the child to achieve.

The following are excerpts from the New York Times published on December 14, 2013 on “The Selling of Attention Deficit Disorder” by Alan Schwarz:

• Recent data from the Centers for Disease Control and Prevention show that the diagnosis had been made in 15 percent of high school-age children, and that the number of children on medication for the disorder had soared to 3.5 million from 600,000 in 1990.
   
• Profits for the A.D.H.D. drug industry have soared. Sales of stimulant medication in 2012 were nearly $9 billion, more than five times the $1.7 billion a decade before, according to the data company IMS Health.
   
• Dr. Conners, a psychologist and professor emeritus at Duke University, said in a subsequent interview. “This is a concoction to justify the giving out of medication at unprecedented and unjustifiable levels.”
   
• The rise of A.D.H.D. diagnoses and prescriptions for stimulants over the years coincided with a remarkably successful two-decade campaign by pharmaceutical companies to publicize the syndrome and promote the pills to doctors, educators and parents. With the children’s market booming, the industry is now employing similar marketing techniques as it focuses on adult A.D.H.D., which could become even more profitable.
   
• Even some of the field’s longtime advocates say the zeal to find and treat every A.D.H.D. child has led to too many people with scant symptoms receiving the diagnosis and medication. The disorder is now the second most frequent long-term diagnosis made in children, narrowly trailing asthma, according to a New York Times analysis of C.D.C. data.
   
• Behind that growth has been drug company marketing that has stretched the image of classic A.D.H.D. to include relatively normal behavior like carelessness and impatience, and has often overstated the pills’ benefits. Advertising on television and in popular magazines like People and Good Housekeeping has cast common childhood forgetfulness and poor grades as grounds for medication that, among other benefits, can result in “schoolwork that matches his intelligence” and ease family tension.
   
• The Food and Drug Administration has cited every major A.D.H.D. drug — stimulants like Adderall, Concerta, Focalin and Vyvanse, and non-stimulants like Intuniv and Strattera — for false and misleading advertising since 2000, some multiple times.
   
• Insurance plans, increasingly reluctant to pay for specialists like psychiatrists, are leaving many A.D.H.D. evaluations to primary-care physicians with little to no training in the disorder. If those doctors choose to learn about the diagnostic process, they can turn to web-based continuing-education courses, programs often subsidized by drug companies.
   
• Many doctors have portrayed the medications as benign — “safer than aspirin,” some say — even though they can have significant side effects and are regulated in the same class as morphine and oxycodone because of their potential for abuse and addiction.
   
• Companies even try to speak to youngsters directly. Shire — the longtime market leader, with several A.D.H.D. medications including Adderall — recently subsidized 50,000 copies of a comic book that tries to demystify the disorder and uses superheroes to tell children, “Medicines may make it easier to pay attention and control your behavior!”
   
• Even Roger Griggs, the pharmaceutical executive who introduced Adderall in 1994, said he strongly opposes marketing stimulants to the general public because of their dangers. He calls them “nuclear bombs,” warranted only under extreme circumstances and when carefully overseen by a physician.
   
• Adderall quickly established itself as a competitor of the field’s most popular drug, Ritalin. Shire, realizing the drug’s potential, bought Mr. Griggs’s company for $186 million and spent millions more to market the pill to doctors. After all, patients can buy only what their physicians buy into.
   
• As is typical among pharmaceutical companies, Shire gathered hundreds of doctors at meetings at which a physician paid by the company explained a new drug’s value.
   
• Such a meeting was held for Shire’s long-acting version of Adderall, Adderall XR, in April 2002, and included a presentation that to many critics, exemplifies how questionable A.D.H.D. messages are delivered.
   
• Dr. William W. Dodson, a psychiatrist from Denver, stood before 70 doctors at the Ritz-Carlton Hotel and Spa in Pasadena, Calif., and clicked through slides that encouraged them to “educate the patient on the lifelong nature of the disorder and the benefits of lifelong treatment.” But that assertion was not supported by science, as studies then and now have shown that perhaps half of A.D.H.D. children are not impaired as adults, and that little is known about the risks or efficacy of long-term medication use.
   
• The PowerPoint document, obtained by The Times, asserted that stimulants were not “drugs of abuse” because people who overdose “feel nothing” or “feel bad.” Yet these drugs are classified by the government among the most abusable substances in medicine, largely because of their effects on concentration and mood. Overdosing can cause severe heart problems and psychotic behavior.
   
• Slides described side effects of Adderall XR as “generally mild,” despite clinical trials showing notable rates of insomnia, significant appetite suppression and mood swings, as well as rare instances of hallucinations. Those side effects increase significantly among patients who take more pills than prescribed.
   
• Another slide warned that later in life, children with A.D.H.D. faced “job failure or underemployment,” “fatal car wrecks,” “criminal involvement,” “unwanted pregnancy” and “venereal diseases”, but did not mention that studies had not assessed whether stimulants decreased those risks.
   
• Dr. Conners of Duke, in the audience that day, said the message was typical for such gatherings sponsored by pharmaceutical companies: Their drugs were harmless, and any traces of A.D.H.D. symptoms (which can be caused by a number of issues, including lack of sleep and family discord) should be treated with stimulant medication. 
   
• Like most psychiatric conditions, A.D.H.D. has no definitive test, and most experts in the field agree that its symptoms are open to interpretation by patients, parents and doctors. The American Psychiatric Association, which receives significant financing from drug companies, has gradually loosened the official criteria for the disorder to include common childhood behavior like “makes careless mistakes” or “often has difficulty waiting his or her turn.”
   
• Drug company advertising also meant good business for medical journals – the same journals that published papers supporting the use of the drugs. The most prominent publication in the field, The Journal of the American Academy of Child & Adolescent Psychiatry, went from no ads for A.D.H.D. medications from 1990 to 1993 to about 100 pages per year a decade later. Almost every full-page color ad was for an A.D.H.D. drug.
   
• When federal guidelines were loosened in the late 1990s to allow the marketing of controlled substances like stimulants directly to the public, pharmaceutical companies began targeting perhaps the most impressionable consumers of all: parents, specifically mothers.
   
• A magazine ad for Concerta had a grateful mother saying, “Better test scores at school, more chores done at home, an independence I try to encourage, a smile I can always count on.” A 2009 ad for Intuniv, Shire’s nonstimulant treatment for A.D.H.D., showed a child in a monster suit taking off his hairy mask to reveal his adorable smiling self. “There’s a great kid in there,” the text read.
   
• “There’s no way in God’s green earth we would ever promote” a controlled substance like Adderall directly to consumers, Mr. Griggs said as he was shown several advertisements. “You’re talking about a product that’s having a major impact on brain chemistry. Parents are very susceptible to this type of stuff.”
   
• The Food and Drug Administration has repeatedly instructed drug companies to withdraw such ads for being false and misleading, or exaggerating the effects of the medication. Many studies, often sponsored by pharmaceutical companies, have determined that untreated A.D.H.D. was associated with later-life problems. But no science determined that stimulant treatment has the overarching benefits suggested in those ads, the F.D.A. has pointed out in numerous warning letters to manufacturers since 2000.
   
• Shire agreed last February to pay $57.5 million in fines to resolve allegations of improper sales and advertising of several drugs, including Vyvanse, Adderall XR and Daytrana, a patch that delivers stimulant medication through the skin.
   
• However, many critics said that the most questionable advertising helped build a market that is now virtually self-sustaining. Drug companies also communicated with parents through sources who appeared independent, from support groups to teachers.
   
• The idea of unleashing children’s potential is attractive to teachers and school administrators, who can be lured by A.D.H.D. drugs’ ability to subdue some of their most rambunctious and underachieving students. Some have provided parents with pamphlets to explain the disorder and the promise of stimulants.
   
• Today, 1 in 7 children receives a diagnosis of the disorder by the age of 18. As these teenagers graduate into adulthood, drug companies are looking to keep their business.
  
  

While being interviewed by Time Magazine in 2012 Dr. Irwin Savodnik, an assistant clinical professor of psychiatry at the University of California, Los Angeles, summed it up best:

                    “The very vocabulary of psychiatry is now defined at all levels by the pharmaceutical industry.”


 
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Heart frequency is the highest frequency that can be expressed in this dimension while in a physical body.  Gratitude is an aspect of the heart and its profound expression. All of my spiritual teachers, without exception, have acknowledged that without Gratitude, healing does not occur. My own experiences have taught me that this is, in fact, quite true.

Our religious conditioning has largely taught us to use prayer as a petition to God by focusing on what it is we don’t have and asking for it. The problem with this approach is that Quantum Physics has already taught us that we will continue to manifest what it is we focus on. So if we focus on ‘lack’ then that is what we will continue to manifest.

Gratitude is, instead, the experience of acknowledging everything we do have that we are incredibly grateful for beginning with the fact that we are still here on the planet, in a body, and breathing. For a lot of us that is a miraculous feat of accomplishment and something to be incredibly grateful for.

Gratitude is a posture of acceptance having arrived at a place in our lives in which the primary focus is on abundance rather than lack. To focus on lack is a posture of non-acceptance because the focus is always on what isn’t okay; what we’re essentially in opposition to. Being able to maintain a posture of acceptance in response to whatever is unfolding even when it is extremely difficult, is the key for healing from our trauma/wound imprinting.

To assist in the process of healing within the frequency of Gratitude I am sharing a prayer I came across a number of years ago which I use often to align with all of the profound blessings I continue to experience in my life. In fact, this is the only prayer I recite because it says everything I could possibly imagine there is to say on the subject of being infinitely grateful for the profound healing that comes from being deeply interconnected with the natural world and the awareness that there is no separation between any living thing despite our conditioning that tells us otherwise.

Surprisingly, this prayer was not written by a theologian, a guru or a saint but rather a political cartoonist from Australia:

I believe that a large part of my effectiveness as an ‘agent-of-change’ when working with my clients directly relates to whether or not I’ve actually experienced and navigated the same challenges they are attempting to recover from and move beyond.  As it relates to substance abuse, this correlation is especially true.

I began drinking alcohol at the age of eight. By the time I was twelve I was frequently impaired. The first time I drove a car at the age of fifteen was the first time I ‘dropped’ acid. For a period of ten years between the ages of fifteen and twenty-five, I was stoned on something every single day. Alcohol, marijuana, hashish, and magic mushrooms were the most common substances of choice on a daily basis. Cocaine and LSD were usually reserved for special occasions such as birthdays, graduations, and weddings.

Despite my extended proclivity for not being fully present in my mind, body, or this dimension; I somehow managed to complete five years of high school in three years and graduate from a reputable University with a four-year undergraduate degree.  (In Toronto, where I grew up, grade 13 was a requirement for admissions into University)

The good news is that I survived these years of extended impairment despite there being no rational explanation as to why I’m still alive. The sad news is that my brain and body were significantly compromised due to engaging in extreme, high-risk behaviors while under the influence of one or more mind-altering substances. Lots of broken bones, severe concussions, and a small neurological event referred to as a mild stroke at the age of eighteen ensured that I will never truly know the full capacity of the mental or physical acuities I came into this world with.

However, an important part of my recovery was to discover what all of the emotional, psychological, and physiological  factors were that put me at incredible risk for such an extended period of time during my most formative years of development. Many of these insights are now embodied within my clinical practice as well as the modality that this book is based on. Two of those insights are as follows:

1. I inherited a strong, genetic pre-disposition to addiction through the DNA of my maternal and paternal lineages; the O’Connell’s and the McGowan’s.
   
   
2. I was extremely vulnerable to manifest addiction as a dis-ease expression and a coping mechanism in response to significant chronic stress and trauma I experienced throughout childhood and adolescence.
   
   

At the end of my first year of graduate school in the summer of 2004 I was provided the opportunity to return to the substance abuse recovery center that I had attended as an outpatient in 1995 in order to complete my graduate internship requirement. This proved to be and incredibly surreal and satisfying experience for having come full-circle in the space of nine years.

Having sat on both sides of the room as client and clinician, I bring a much wider perspective to the issue of recovery from substance abuse and life in general; one that is far more holistic and non-judgmental.  And because the recovery framework I participated in was scientifically and biochemically based, lasting change actually occurred beyond the endless cycles of relapse that more than often characterize this complex and challenging issue.
 
                                           Understanding Addiction through the Biochemical Paradigm
 
The Baldwin Research Institute is a not-for-profit corporation approved by the New York State Department of Education as an institute conducting alcohol and drug research. Baldwin Research began its efforts in 1989 when it conducted studies of modern Alcoholics Anonymous and Narcotics Anonymous and their claims of success rates as high as 93 percent.  Baldwin Research was unable to validate a single treatment program with a success rate greater than 3 percent. Despite there being no research to date to support the efficacy of the 12-step model of recovery, 90% of addiction treatment facilities in the United States employ this approach. (BRI, 2003) 

This is one reason why adequate treatment continues to elude the current medical model. Many people still believe that 12-step interactive group psychotherapy can help individuals abusing drugs and alcohol achieve sobriety through self-understanding.  This perception diverts attention from the physical causes of alcohol and drug abuse and can compound the individual’s guilt and shame by encouraging them to surrender to a “higher power,” pray to have their “defects of character” lifted, and to accept their “powerlessness.”

The concept of addiction being a moral failure is still evidenced by our country’s investment in criminal justice rather than treatment. It is estimated that as many as 165,000 people are court-mandated to attend AA and NA meetings annually in the United States. Consequently, the need for community education is as strong as ever.   

Within the past 30 years, biochemical research has created a new paradigm of understanding that invites us to treat substance abuse problems more effectively at the cellular and molecular level.  This has allowed the field of psychiatry to change its thinking about addiction disorders, moving them from categories of moral failures to brain diseases.  

Millions of chemical reactions occur every second in the trillions of cells that make up our bodies.  Biochemical imbalance can result from inadequate nutrients being supplied to these cells.  These nutrients are the raw materials that allow our cells to carry out these complex chemical reactions.  If left uncorrected, biochemical imbalance can result in physical and mental deterioration.

Imbalances in the biochemistry of brain cells, known as neurons, can affect our moods and our behavior dramatically. Biochemical explanations focus on neurotransmitters as playing a key role in the cycle of dependency as manifested in the brain disease of addiction.  Neurotransmitters are chemicals in the brain, which act as messengers between the neurons and essentially control every aspect of our behavior. 

Feelings of optimal well-being are radically compromised when the brain’s ability to produce adequate supplies of these neurotransmitters is suppressed through the chronic use of alcohol and other potentially addictive substances.  When neurotransmitter availability is reduced, too few receptor sites are filled, resulting in symptoms that include craving, depression, and anxiety.  To ease these symptoms, the use of alcohol or drugs is repeated.  The cycle continues, resulting in increased tolerance and a need for more frequent use.  Chronic intoxication can cause behavioral changes and irreversible brain damage, disabling the person for a lifetime. 
 
Treatment is often difficult because of such poor recovery rates and the social stigma attached to the condition.  However, it is important for the alcoholic or addict to understand that the symptoms of their disease, such as cravings and withdrawal are not character flaws and they should expect the same level of care, concern and compassion that anyone diagnosed with a chronic and potentially fatal disease would expect to receive.

Since neurotransmitters are made up of amino acids, the nutritional components of a treatment program take on tremendous significance for long-term, successful recovery. The brain cannot synthesize all of the amino acids involved in the formation of neurotransmitters.  Some are derived from food and metabolism.  As a result, certain vitamins and minerals influence the conversion of amino acids into neurotransmitters. For example, vitamin C is involved in the conversion of dopamine to norepinephrine; vitamin B6 is involved in the conversion of phenylalanine to dopamine and tryptophan to serotonin, and zinc influences the metabolism of neurotransmitters in general.

The following chart outlines the amino acid deficiency symptoms and the corresponding amino acids necessary to supplement the brain depending on the individual’s drug(s) of choice. It is important to take these with a high grade multivitamin in order for the brain and body to be able to fully synthesize the amino acids and nutrients necessary for a sustained recovery process:

Amino acids are critical for stopping cravings because they are the essential building blocks of the neurotransmitters that tell the brain whether or not we are satisfied.  As a result, nutrition plays a critical role in healing addiction because key nutrients can help restore pre-existing neurotransmitter deficiencies and help heal the body of the destructive physiological effects caused by this disease.

The frontal lobe region in our brains is the primary location of the neurotransmitter activity associated with alcohol and drug abuse. This area, located behind the forehead, is thought by neurobiologists to be one of the last areas of the brain to develop. It also accounts for characteristics considered uniquely human such as artistic expression, subtle humor, creative thinking, and the ability to project what the probable consequences of our actions might be.  It is not until we reach our mid-20’s that our frontal lobes are completely developed.

For this reason, it is imperative that we develop educational tools and information for young people based on the biochemical understanding of alcohol and drug addiction.  Alcohol and drug use disrupts the development and growth of the very parts of our brain that separate us from other mammals.  

Historically, relapse prevention has focused on cognitive and behavioral modification techniques to counteract biological cravings and the conditioning process associated with chronic addiction.  However, Abraham Maslow aptly demonstrated that an individual’s foundation for building towards self-actualization must be physical stabilization.  This stabilization process in substance abuse and addiction must involve the improvement of brain chemistry capabilities.  Today, nutritional supplement combinations are available that dramatically enhance neurotransmitter availability and hasten the individual’s recovery towards long-term, higher level functioning manifesting in increased stability and confidence as well as positive feelings and thoughts.
 

Adolescence is the most complex and challenging stage of development an individual will ever have to navigate. Rapid physical, hormonal, and neuronal changes are occurring every day resulting in increased vulnerability to environmental stressors which can often result in emotional and behavioral issues manifesting as a defense mechanism to those perceived stressors. Depression, substance abuse, anxiety, suicidal ideation, truancy, cutting, and increased oppositional defiance are just some of the issues that can manifest as coping mechanisms in response to this increased psychological and physiological vulnerability.

An additional reinforcement to the potential instability of adolescence is the emergence of newly sophisticated metacognitive abilities which lead to increased egocentrism, self-absorption and the development of ‘The Personal Fable’. ‘The Personal Fable’ is the view of the adolescent that what happens to them is unique, exceptional, and shared by no one else. They may feel that no one has ever experienced the pain they feel; that no one has ever been treated so badly; or that no one can understand what they are going through. This perceptual framework can lead to feelings of isolation, despair, and disconnect, further increasing the adolescent’s vulnerability to manifest maladaptive behaviors.

During the time my son was navigating the challenges of this complex developmental stage, I was compelled to make myself a t-shirt with the following inscription on it:

                                              Mothers of teenagers understand why wolves eat their young

What made this sentiment even more apropos was that, at the time, we were living in the Adirondacks with two wolves. So we were both able to enjoy the sentiment with the provision that I not wear it out in public while in his company.

All of my experiences, both personal and professional, have helped me discern over the years that the most balanced and effective approach to parenting the adolescent is achieved by focusing primarily on what it means to be an adolescent from the perspective of the adolescent.

Just as with the child, joining the adolescent where they happen to be in the moment in their experience is the most important thing we can do. This requires that we, as parents, teachers, mentors, and coaches, suspend our own personal agendas in favor of establishing a truly empathic connection with the teenager.  What makes this difficult to do is that the adolescent’s experience is often infused with a lot of instability, drama and crisis which serves as a reflection and painful reminder for all of us of a time in which we experienced the same deep existential angst and suffering that often defines this stage of development.

In addition to not wanting to revisit our own imprinting from adolescence, parents will become extremely uncomfortable with the recognition that they have less influence on their child than in previous years despite using the same external control mechanisms which had always proven successful. So what’s changed?

Around the age of twelve rapid neuronal changes in the brain result in newly emerging metacognitive abilities. Metacognition is essentially ‘thinking about thinking’ and once the adolescent has reached this cognitive benchmark; from their perspective, everything is up for review; including whether or not they will continue to conform to the conditioning and control mechanisms that have been in place since they were born .

Around the age of two when language is acquired, one of the first and frequent utterances that comes from the toddler's mouth is the word "No". Unfortunately, the widely accepted interpretation of this new verbal expression is often referred to as the beginning of the "Terrible Two's ". However, I could not disagree more. It is my personal belief that this new verbal expression is related to 'Object Relations Theory' in which prior to 18-24 months of age, the child's experience is that they are literally attached to their primary care giver. At the age of two they begin to differentiate from their primary caregiver by seeing themselves as separate and apart from them and the word "No" is their attempt to do so by identifying that it is so. It is also my belief that the adolescent's version of the need to further differentiate from their primary caregiver is often expressed with some variation of the verbal expression "Fuck You". Both examples are drawn from the two most critical stages of development as it relates to rapid and accelerated physical and cognitive development which absolutely requires that the child further differentiate from their primary caregivers. In both examples it is developmentally appropriate and biologically driven. Unfortunately, in both examples the parents will often attempt to defend themselves by engaging in a power struggle with either the child or adolescent.

From the previous article, “Parenting the Child”:

“Increased differentiation from our parents is a requirement for transitioning successfully into adulthood. However, in order for this to happen the parents or primary caregivers need to be fairly healthy, balanced, conscious and aware. If they are not then they will take the child’s attempts to differentiate from them very personally. They experience it as extremely threatening since their influence and control over their child appears to be diminishing. This is evidenced by the fact that the negative consequences and positive reinforcements that they have come to rely on to ensure acceptable behaviors in their child are no longer effective. In response to this unwelcome development, the parent usually ratchets up the control mechanisms and engages in increased power struggles with their child which always fails to satisfy either party’s needs.”

One of my mantras to the parents I work with is “Don’t get involved in a power struggle with your child.” It is my experience that if you do, you will almost always lose because the child is willing to lay prone on the floor of the grocery aisle and the adolescent is often willing to take them self off the planet rather than conform to control mechanisms which, for them, represent the equivalent of self-annihilation.
 
“Without realizing it, they are defending their right to exist beyond the boundaries and confinement of this conditioning that projects onto them that their inability to conform is evidence of some inherent flaw that will limit their ability to be successful in getting their physical and emotional needs met throughout the course of their lifetime.”      - Beyond the Imprint -
 
What is most important for the parent to understand is that their control/defense mechanisms are more of an attempt to get their own physical and emotional needs met by alleviating the anxiety associated with the dawning awareness that, over time, they have increasingly less control over their child and fundamentally little, if any, control over their teenager. It is never helpful to parent by establishing a power dynamic with the child or adolescent because you are essentially imprinting them with the understanding that whoever is bigger, stronger, louder, and more threatening is the one who gets their needs met. And without a doubt, the child/adolescent will bring this unconscious imprinting into their adult relationships by replicating a co-dependent, power dynamic with their significant other by playing the role of either 'victim' or 'perpetrator'.
 
“If we, as adults, were able to recognize the degree to which we are influenced by our own imprinting and subsequent conditioning we would be much better equipped to parent, teach, and mentor this most critical and dynamic stage of developmental.  Our teenagers are our ‘truth tellers’ and we have much to learn from them if we could only allow ourselves to listen and accept them without feeling the need to defend our position.”       - Beyond the Imprint -
 
 

Despite this being an extremely large and comprehensive topic in the field of human development, all of the work that I have
facilitated for children and their families during the past eleven years as well as my own experience as a parent, has helped 
me distill my primary focus down to one specific tenet regarding child development.  Joseph Chilton Pearce described it best 
in 1977 in his groundbreaking book “Magical Child”:

“Learning to take our cues from the child and make a corresponding response means learning to heed and respond to the 
primary process in ourselves as well.  A child can teach us an incredible amount if we are willing to learn, and because s/he 
is biologically geared to take his/her cues from us, s/he learns as we do.”                
             
I believe that it is the most important dynamic to embrace and embody for parents who seek to model and demonstrate 
positive, loving, and healthy relationship patterns for their children. In doing so, the greatest opportunity for the child to know 
themselves and actualize their fullest potential is achieved.

Unfortunately, cultural conditioning over countless generations has created very different relationship dynamics within the 
familial, academic, and community environments. Conformity to whatever agenda the prevailing authority figure has
determined is appropriate for the child and society as a whole is achieved and reinforced through a system of punishment 
and rewards.

The problem with this approach is that all that has been accomplished is to ‘bend’ the child to the will, boundaries and false 
limitations of whoever is ‘in charge’.  Not only is the wound/trauma imprinting reinforced in the adult who takes this approach 
but it subsequently creates similar wound/trauma imprinting in the child. Consequently, the child and the adult become
imprisoned together within these limiting, shaming, and fear-based patterns and beliefs because the parents are only at ease when the child is able and willing to conform to whatever conditions and limitations are being placed on them. 

"No matter how we camouflage our intent, to ourselves and to our child, all parenting and education is based on: “Do this 
or you will suffer the consequences.”  This threat underlies every facet of our life from our first potty training through university 
exams, doctoral candidate’s orals, employment papers, income tax, on and on ad infinitum down to official death. Culture is 
a massive exercise in restraint, inhibiting, and curtailment of joy on behalf of pseudo and grim necessities.” 
                                                          – Joseph Chilton Pearce, “The Biology of Transcendence” -

Children enter the world with the capacity for optimal growth and development. However, well-meaning parents begin to limit 
and distort this capacity from the moment they become aware that another life has been conceived and they begin to project 
identifications onto the child that have nothing to do with the unique being who is taking shape and form in the mother’s womb. 
After the child is born these projections continue well into adulthood since most parents believe that they have a responsibility 
as ‘guide’ and ‘teacher’ to bestow onto their child all of what they believe to be ‘true’ about them, the external world, and
‘reality’ in general. 

What they fail to recognize, however, is that their well-meaning attempts to be responsible and effective parents has more to 
do with their own agendas than it does the child’s best interests. This is because their ideas about parenting are always being 
informed by their own unconscious and unresolved wound imprinting and subsequent fear-based beliefs from childhood.

“Since we must pattern ourselves and our worldview after our culture and parents, when that is a disordered system for 
modeling, we are ourselves disordered in precisely the same way.”        - Joseph Chilton Pearce, “Bond of Power” -

I have never met a parent, including myself, who, in determining their specific style of parenting, was not somehow trying to 
compensate for how they were parented during their own childhood. Unfortunately, it turns out, that when we parent from our 
unresolved wounding in an attempt to ensure that our children are not wounded in the manner or to the degree that we were; 
we end up just shifting to the opposite end of the dualistic spectrum and are as equally out of balance as we judged our parents to be.
 
Shifting this parenting paradigm requires that we be open to learning new patterns and possibilities; the absence of which 
has us responding and reacting from unconscious defense mechanisms stemming from whatever wounding we, as parents,
experienced throughout our own childhoods and still carry with us in the form of cellular imprinting and limiting beliefs. This 
shift requires a tremendous amount of trust which is counter-intuitive to the control dynamics that we were raised with and have 
relied on to ensure our own survival at the deepest levels.

It is extremely challenging for a parent to trust that their child carries an inherent, intuitive understanding of who they are and 
what they came here to do and that their role, as a parent, has less to do with being a mechanism for control and instruction 
and more to do with being a loving reflection of acceptance, acknowledgment, and reassurance. It is this dynamic, and only 
this dynamic, that creates the safest and most secure environment for the child to explore their world, develop their identity, 
and actualize their potential. What makes it so difficult to model is that the parent is encoded with cellular memory that continuously identifies that the world is not safe and in response to their own anxiety around this distorted belief, utilizes external control mechanisms in order to ensure that their child is safe. Unfortunately, these fear-based, control dynamics accomplish very little other than to infuse the child with the same level of anxiety that the parent is vibrating around.

Since a large part of human development is about ongoing identity formation; it’s important to bring awareness and 
understanding to the fact that a child growing up in a controlled, anxious, and fearful environment will have an extremely 
limited opportunity to explore and identify their true sense of self. Taking cues from this type of environment leaves the child 
no other option other than to learn, from a very early age, the importance of being able to defend themselves. This posture is 
then reinforced throughout lifetime and reflected in all of their relationship dynamics. Therefore, a very different parenting
paradigm is required in order to have the desired impact on human development; a paradigm that is no longer being 
determined by the parent’s fear-based agendas or self-interests but is reciprocal in meeting the true needs of both the child
and adult.

Decision-making and behavioral expressions are primarily shaped and determined by the anticipated response the child has
learned to expect from those individuals who have the greatest control and influence over them. Therefore, I am always 
reminding the parents I work with to stop telling their children who they are and what they need to do and to just join them in the moment in their experience. 

However, children whose parents continue to have the perception that their child is out of control, are just reflections of how 
much the parent needs to be in control in order to feel safe and secure. This has nothing to do with the child but is rather a 
reflection of the parents own conditioning and unresolved imprinting from childhood. It is for this reason, that I always, without exception, choose to work as much with the parents as I do the child much to the parent's unexpected surprise.

“Once shame is imprinted there will never again be “unquestioned acceptance of the given” but a faltering hesitancy as doubt 
intrudes and clouds the child’s knowledge of self and world”           - Joseph Chilton Pearce, “The Biology of Transcendence”-

Letting go of the unconscious agendas that infuse the child’s environment and shape their limiting beliefs about themselves 
and their world is paramount in ensuring that they have the potential to realize themselves without shame, doubt, or self-recrimination.  

Once again:

“Learning to take our cues from the child and make a corresponding response means learning to heed and respond to the 
primary process in ourselves as well. A child can teach us an incredible amount if we are willing to learn, and because s/he 
is biologically geared to take his/her cues from us, s/he learns as we do.”       
                      
A paradigm such as this takes us all beyond the duality of our cultural conditioning and childhood imprinting by providing new
patterns and  possibilities for anyone who mentors, teaches, parents or works with children; thereby changing the course of
human development.

Julian B. Rotter was an American psychologist who developed the Social Learning Theory in 1954 which identified that an individual’s behavior was largely influenced by environmental factors within a social context. This was a departure from earlier theories based on psychoanalysis which identified behaviors as being driven primarily by psychological factors.

Rotter theorized that negative and positive outcomes were largely responsible for determining if an individual was likely to repeat a behavior. As the framework for his Social Learning Theory, he further developed the understanding of Locus of Control which attempted to differentiate between two concepts which he referred to as “achievement motivation” (Internal Locus of Control) and “outer-directedness” (External Locus of Control). He attributed these two different concepts as aspects of the individual’s personality in determining the extent to which people believe they can control events affecting them.  This was measured on a scale which he referred to as a continuum in which individuals either believed outcomes in their lives were attributed to their own abilities (Internal Locus of Control) or to chance, luck, or destiny (External Locus of Control). Rotter’s theories were grounded in the fields of Social and Personality Psychology.

My interpretation and application of Locus of Control is slightly different than I believe Rotter had intended.  How I interpret it applies primarily to the field of Developmental Psychology.

Throughout the stages of childhood development; our behaviors are largely being shaped and determined by outside influences which include our primary caregivers, siblings, teachers, coaches, grandparents, and babysitters. Negative consequences and positive reinforcements are designed to reinforce the behaviors which are considered most acceptable and discourage those that are not. Over time we learn that the most effective way to get our physical and emotional needs met is to behave in ways that elicit the greatest amount of acknowledgement, acceptance, positive regard, and love from others.  The developmental stages of childhood and early adolescence are largely influenced by what Rotter would refer to as “outer-directedness” or External Locus of Control.  Decision-making and behavioral expressions are primarily shaped and determined by the anticipated response the child has learned to expect from those individuals in their environment who have the greatest control and influence on them.

As the child grows into adolescence; a hallmark of this developmental stage is increased differentiation from the very people in their environment who have had the greatest influence in shaping their schemas and subsequent beliefs and behaviors. It is my contention that the adolescent’s ability to successfully navigate from this developmental stage into adulthood is largely determined by their ability to shift from “outer-directedness” or External Locus of Control to “achievement motivation” or Internal Locus of Control.  However, despite this shift being optimal in determining a healthy transition into adulthood; it often puts the adolescent on a collision course with the individuals in their environment which have had the greatest influence on them since they were born.

Increased differentiation from our parents is a requirement for transitioning successfully into adulthood. However, in order for this to happen the parents or primary caregivers need to be fairly healthy, balanced, conscious and aware. If they are not then they will take the child’s attempts to differentiate from them very personally. They experience it as extremely threatening since their influence and control over their child appears to be diminishing. This is evidenced by the fact that the negative consequences and positive reinforcements that they have come to rely on to ensure acceptable behaviors in their child are no longer effective. In response to this unwelcome development, the parent usually ratchets up the control mechanisms and engages in increased power struggles with their child which always fail to satisfy either party’s needs.

Whenever I get the opportunity to work with parents before their child reaches adolescence I make sure I spend a significant amount of time on the subject of “External Locus of Control vs. Internal Locus of Control”.  Locus of Control is as an unconscious mechanism that continues to influence how we attempt to get our physical and emotional needs met throughout our entire lifespan. It is my assertion that being able to shift that mechanism from an external orientation to an internal one during adolescence is critical in ensuring that we mature into healthy, self-reliant, and successful adults.

I do not believe, as Rotter theorized, that the tendency to operate from either Internal or External Locus of Control is a personality trait that is crystallized throughout the individual’s lifespan. Instead, I believe that the pattern of relying on the self or the environment to determine our behaviors is a byproduct of our imprinting and conditioning within our childhood environments as we continued to develop around the need to have our emotional and physical needs met. Once we accept that premise then we can accept that the tendency to be over-reliant on others to reassure us that we are performing and behaving appropriately can shift even in adulthood once we bring conscious awareness to the pattern.

Being in alignment and integrity with the self requires that we mature beyond the External Locus of Control orientation in which the need to conform to others as well as the social conditioning within our environments is the primary motivation for getting our physical and emotional needs met. An overreliance on others to influence our perceptions, beliefs and behaviors well into adulthood suggests chronic imprinting from a controlling and dysfunctional childhood environment largely influenced by fear. In the absence of those controls; we, as adults, are unable to mature into the Internal Locus of Control orientation because we were never able to develop that mechanism before launching ourselves into the world.

So rather than think of Internal and External Locus of Control as the difference between believing whether or not you have control over events in your life; I encourage you to think of it more as the difference between whether or not you rely primarily on yourself or others to determine the choices you make in life including how you attempt to get your physical and emotional needs met.

More on this subject will be explored in the upcoming articles “Parenting the Child” and “Parenting the Adolescence.”
 

Three of the most important things to understand about all behaviors whether they are personal or professional, someone else's or our own, or being demonstrated by a child or adult is that:

1. All behaviors make perfect sense when you understand the underlying schemas and imprints that inform them.
   
   
2. All behaviors are expressions of the individual unconsciously attempting to get their needs met.

     3.   Everyone, at any given moment, is showing up doing their best.

Understanding these three tenets allows us to move beyond the duality of our personal and professional relationships including our own conditioning and subsequent imprinting.

So let’s take a closer look to get a better understanding of what it is I’m referring to:
 
“All behaviors make perfect sense when you understand the underlying schemas and imprints that inform them.”
 
When reviewing the role of schemas from the previous article on this subject, we are reminded that they act as our mental GPS which we unconsciously use to navigate our external world. Schemas develop throughout our most critical stages of development in response to our experiences and act as the interface between our cellular imprints and our perceptions of self, others and our external reality.  We unconsciously rely on our schemas to infer future probabilities both concrete and abstract. In turn, these inferences become the motivation for all of our behaviors.
 
“All behaviors are expressions of the individual unconsciously attempting to get their emotional needs met.”
 
In addition to relying on our schemas to help us successfully navigate our external world at the concrete, rational level; we also rely on them to infer more abstract, future outcomes regarding how we can be reassured that our emotional needs will be met. These inferences are based on our previous relationships and experiences which began at the moment of conception when we were implanted in our first environment and influenced by how securely we were attached to this environment and our primary caregivers.  If our experiences throughout childhood were primarily safe and secure and our primary caregivers were attentive to our needs; then our schemas would have developed in such a way that our behaviors would consistently reflect that level of stability. Dysfunctional, reactive and manipulative behaviors suggest significant trauma imprinting from chronic stressful, chaotic, and unsafe, childhood environments that end up being replicated in our adult relationships and environments. Regardless of whether the behaviors are considered stable or maladaptive, they always reflect our best attempt(s), in the moment, to get our emotional needs met.

“Everyone, at any given moment, is showing up doing their best.”

I have found that this tenet is the hardest one for folks to accept because our schemas formed around extremely different conditioning and subsequent beliefs within the dualistic paradigm.  We grew up with infinite projections that had us believe that we needed to keep trying harder in order to excel beyond our capacity in order to meet the expectations of others. Standardized learning became a big part of this conditioning which often taught us that our best was never good enough as we were being measured against a standard that had very little to do with our own abilities and individual needs. Our best was often, if not always, being measured in relation to a larger collective and always by someone other than ourselves. This conditioning not only occurred within our personal relationships but also from the larger collective of our cultural conditioning which reinforces our belief that in order to be loved and accepted we need to consistently achieve some level of excellence.  This, in turn, guarantees that our emotional needs will be met through projections of positive regard and acceptance by others. In the absence of being able to achieve these external standards of perfection, we learn and embody at the cellular level that we are not enough.

Within the dualistic paradigm, our inability to meet the expectation of others is always evidence of us not doing our best because this is the paradigm in which we are always being reflected back to ourselves by others. However, these projections are also unconscious attempts by others to minimize their own anxiety relative to whatever imprinting and subsequent beliefs they are unconsciously holding onto which constantly identifies that they are not enough; and so on and so on and so on….

Whatever we choose to do at any given moment is what we think is best until we have a different understanding of what that is. Once we have a different understanding of what that is; we choose that instead.  Our degree of mental and emotional stability combined with our level of awareness, at any given moment, will always determine what that looks like.

If we are able to accept the tenet that everyone, at any given moment, is showing up doing their best, then we have allowed ourselves to step beyond the duality of our own conditioning.  The ability to do so dissolves our own imprinting and subsequent self-judgements that has us believing that we are not enough because we are finally able to accept that we have always shown up and done our best, without exception. For those of us who engage in 'life reviews' from time to time and continue to cringe at whatever our version of 'best' was ten years ago, three years ago, or even 6 months ago; it is important to remember that the tendency to cringe is evidence that we continue to grow and develop and increase our awareness which is always a cause for celebration rather than self-recrimination.

Many factors influence what that might look like such as our age/schematic development, our environment, our history of abuse/neglect/trauma and whatever we may have inherited through our respective DNA lineages that makes us vulnerable to manifest some emotional, mental, or physical imbalance or dis-ease expression in response to whatever stressors we’ve experienced throughout the course of our lifetime.

When sitting with clients, I often refer to the extreme as an example to illustrate new concepts within this new paradigm of thinking; beyond the duality of our conditioning:

On July 20, 2012 , James Holmes walked into an Aurora, Colorado movie theatre and using two tear gas grenades, a Smith & Wesson M&P15 rifle, a Remington 870 Express Tactical shotgun, and a Glock 22 handgun, he shot and killed 12 people while injuring 70 others.  In that moment, James Holmes was doing his best. In that moment, his mind was falling apart. His mental constructs had broken down to the extent that this unimaginable, premeditated act of violence made complete sense to him. It had to, otherwise he wouldn’t have done it. Had his mind not been falling apart, his best would have looked remarkably different and there would not have been such unimaginable and unexpected loss of life and trauma in an environment that his victims had every reason to believe was safe.

Having worked with individuals whose mental constructs have broken down, it’s probably much easier for me to accept this tenet. However if you just allow yourself to sit with it for longer than a minute or two, the simple logic of such a concept is self-evident and will begin to make sense. What makes it difficult to accept ‘at first glance’ is our collective conditioning that keeps reinforcing the duality and subsequent belief that we should have the ability to control ‘bad’ things from happening to ‘good’ people in an attempt to reassure ourselves that we and our loved ones will not become victims to such horrific acts of violence or that someone we know and love could actually become the perpetrators of such unimaginable carnage.

Unfortunately there are far too many examples showing up in this country and around the world every day that makes it impossible to guarantee our safety and security from individuals whose ‘best’ can change the course of many lives in a few minutes resulting in unimaginable suffering no matter how hard we try to anticipate and control their behaviors.

All behaviors, including maladaptive behaviors, are outward expressions of our cellular imprinting and subsequent schemas. Therefore, it is ineffective to focus exclusively on the behavior as an intervention in an attempt to influence a different outcome. When we do so, as expressed through the current models of the mental health, academic, political and legal systems, we limit the potential for any significant change to occur. Chemically restraining, physically incarcerating, or putting to death individuals as a means of controlling and containing what it is that makes us feel uncomfortable and unsafe will always ensure that in the absence of the external locus of control; the behaviors will persist. Significant, long-term change for individuals and society as a whole requires a much deeper inquiry at the cellular level. In the absence of such an inquiry we are reminded that, once again, we are taking the batteries out of the smoke alarm in an attempt to extinguish the fire.
 

Schemas are mental constructs that organize our experiences beginning at birth. They initially develop around concrete principles as we begin to interact with our external world and those individuals who inhabit it. In response to stimulus in our environment, schemas shape our perceptions and beliefs about reality by unconsciously using those principles to infer future probabilities. These future probabilities occur on many levels stemming from the concrete, action-oriented experiences of grouping related objects during early childhood and moving towards more abstract properties, inferences, events, and ideas in adolescence.

                                                “The foot feels the foot when it feels the ground.”  - Buddha -

I refer to schemas as our mental map or cognitive GPS which we unconsciously use at all times to successfully navigate our external world. Without this map, we would be unable to get out of bed let alone walk out the front door. Getting out of bed and walking out the front door becomes possible from the first time we crawled off the couch and felt our feet touch the ground. At that moment our schemas began to develop around the understanding that we can count on having solid ground under our feet and the memory of that experience becomes recorded.  As a result of that memory, we are able to successfully navigate our external world by unconsciously inferring that our feet will also touch solid ground when we crawl out of our strollers, step off the curb, or walk down the stairs.

All of our unconscious assumptions, perceptions, and beliefs about ourselves, our external world and those who inhabit it are informed by our schemas. They are the interface between the cellular memories of our experiences and the beliefs and subsequent behaviors that stem from those experiences because our schemas organize those experiences in such a way that allow us to take ‘short-cuts’ as we move through the world based on what we’ve come to understand we can count on; what we have inferred about our future experiences without even thinking about it.

During infancy and early childhood our schemas are constantly changing through an ongoing process of new experiences being successfully ‘assimilated’ into our pre-existing schemas. Those experiences are then ‘accommodated’ when the schemas are re-organized and modified to include those experiences.

This process of ‘accommodation’ has the individual continuously creating and recreating new theories that he or she relies on unconsciously to successfully navigate his or her external world. It can be as simple as coming to the understanding at the age of 2 that when Dad goes to work every morning Mom feeds me breakfast. As we get older our schemas become more advanced and can also include more sophisticated theories such as it’s not safe to interact with Dad when he comes home from work because he’s been drinking.

Cognitive dissonance is the experience we have when interacting or engaging with stimulus or information from our environment that is incongruent with our pre-existing schemas. I casually reference this experience as being consistent with the oft-used expression ‘mind-blowing’.  ‘Mind-blowing’ experiences initiate a mental and emotional process in which we are attempting to create mental congruency and emotional equilibrium in response to something that is occurring in our external world that we have never personally experienced before and is outside the parameter of what we would have unconsciously inferred was possible.

This is what happened for all of us in 2001 as the horror of 9/11 unfolded before our very eyes as we sat in our respective living rooms or offices fixated on our computers and TV’s. We struggled in disbelief to assimilate what was happening into our pre-existing schemas. The disequilibrium was so great in response to the unimaginable series of events that we were witnessing in real time that we went through a cascading series of disorienting and debilitating responses cognitively, physically, and emotionally. In order to return to some state of equilibrium, we needed to re-organize our personal and collective schemas to include this experience, inferring that similar experiences could and would be possible in the future. While this process of assimilation and accommodation was happening, I remember feeling extremely dissociative and unable to process much at all other than to connect to a very deep awareness that everything that I knew to be true and counted on as evidence that I was safe and secure was up for review somewhere in the very depths of my being.

This is why historical events such as Pearl Harbor, the assassinations of JFK, the massacre at Columbine, and the attacks of 9/11 are seared not only in our collective, conscious memories but also at a much deeper, more archetypal level of personal, social, and cultural identity because in those moments, the world as we knew it ceased to exist when everything that we thought we knew and could count on became far less predictable.

Our ability to re-organize and modify our schemas around stimulus that is beyond our ability to process or comprehend is vital in determining our capacity to function moving forward. In the absence of being able to accommodate challenging new stimulus, the potential for having your ‘mind blown’ increases. If this were a movie, it would be the scene in which the light bulbs start to pop and the floor beneath your feet begins to buckle. In the real world it would be the moment in which a psychotic break or dissociation from reality occurs both of which are common in response to unimaginable and unexpected trauma.

When we grow up in safe and secure environments, we are able to maintain a sense of equilibrium when assimilating new experiences into our pre-existing, mental map because these experiences are not overwhelming or threatening but rather gentle enough that they ensure our sense of safety and security while affirming our right to exist.

However, when we live in an environment that is infused with unpredictable stress, chaos, and abuse we spend most of our time trying to restore balance to the cognitive disequilibrium that results in response to these chronic threats.  This is achieved by replacing the current, outmoded schemas with qualitatively different and more advanced and sophisticated schemas.

When our childhood experiences are gentle, we are able to develop more expansive world views in response to our environment becoming larger and less secure. The more secure our environments and attachments are growing up, the greater our ability will be to explore outside of the predictable safety and security of those environments including what we were taught to believe was true about ourselves and the world we live in.

The quality of relationships we form with friends, colleagues and significant others are always a reflection of our schemas because they were formed around experiences we had growing up regarding what it looks and feels like when we love and care about someone. As you can imagine, these experiences can cover a very wide spectrum of expressions of ‘love’ depending on how safe, secure, and loving our childhood environments were.
 
One example:

If, during childhood, our primary caregiver became enmeshed with us in an unconscious attempt to get their emotional needs met in ways they were unable to while in relationship themselves, their friends or significant other; our schemas would have developed around the unconscious belief that we exist for the sole purpose of ensuring the well-being of others. This in turn puts into motion all sorts of pre-determined outcomes including the specific style and patterns inherent in our dysfunctional relationships as well as the need to constantly apologize or explain ourselves because it is understood that our right to exist is always conditional on the other’s well-being.

• Our schemas are the interface between the cellular memories of our experiences and the beliefs and subsequent behaviors that stem from those experiences.
  
  
• All behaviors make perfect sense when we understand the schemas or mental constructs that are informing and influencing those behaviors.
  
  
• Our schemas have developed around our personal experiences which are infused with the social and cultural conditioning inherent in the current dualistic, mechanistic paradigm.
  
  
• We unconsciously participate in the belief that we must conform to this conditioning in order to ensure our survival.
  
  
• The fact that we are the only organisms on the planet that are aware of our own mortality is what makes us receptive and vulnerable to this conditioning.
  
  
• This informs all of our beliefs and perceptions about ourselves, others, and our environment and determines how we attempt to get our emotional needs met including the unconscious need to control or be controlled in order to feel safe and secure.
  

 
Whether concrete or abstract, our schemas develop in response to our curiosity with the external world and our desire to make sense of our experiences in order to ensure that everything in our lives is much more predictable.

The younger we are, the less developed our schemas are allowing us to be more fluid in response to whatever is occurring. This is when ‘magical thinking’ and creativity is at its best because we live in a world full of infinite possibilities.

Much of the healing I facilitate for myself and my clients is designed to re-organize and modify our schemas to include the awareness that we are fundamentally safe and secure even while living in an unpredictable world. From this awareness we can now begin to successfully navigate our environment and the people who inhabit it from a place of unending curiosity and spontaneity thereby increasing our capacity to experience love, joy and fulfillment in all that we do.