Hey NJ and NY! If you loved or hated the Philip Seymour Hoffman blog, go see this guy!

David Sheff, best-selling author of ‘Beautiful Boy’ and ‘Clean’ will be in Northvale, NJ for a book signing on 3/12 and in Shrub, NY for a presentation about the recent epidemic of opiate overdoses  co-hosted by the foundation Drug Crisis in our Backyard and Phoenix House  on 3/13.

See his website, DavidSheff.com for details.

He’s a great speaker and gives over lots of good information. 5 yrs of research went into his book. Even if you disagree with everything I wrote, he can answer your questions. It was worth every minute I spent in traffic to see him.

Please go, and write me here and tell us how it was for you.  He’s headed for Winnipeg afterwards. Any Canadians able to check him out?


David Sheff signing books @ UCLA


Hey, L.A.! If you loved or hated my blog post on Philip Seymour Hoffman, go hear this guy!

ImageDavid Sheff, best-selling author of the memoir “Beautiful Child” and “Clean” is in town to discuss addiction prevention and treatment. You can catch him on Monday night at a book signing and discussion in West Hollywood and/or Tuesday night in Westwood  on a panel with the Director of UCLA’s Addiction Medicine Clinic.
On Monday evening in LA, please join David Sheff for a conversation about addiction, America’s greatest tragedy, at Book Soup, the awesome bookstore in West Hollywood. 7 PM. — at Book Soup. 8818 Sunset Blvd.
Dr. Timothy Feng and author David Sheff will be in conversation Tuesday evening, 7 PM, at UCLA, presented by the Friends of the Semel Institute. Please join us. They’ll be talking about preventing and treating addiction, America’s greatest tragedy. RSVP @ http://www.friendsofnpi.org in order to get free tickets.
David Sheff is a professional writer whose research and reporting on the science of addiction has placed him on Time Magazine’s list of the world’s most influential people. His writing is NOT clumsy (like mine) and no doubt hearing him speak will clear up any questions or problems you might have with the concept of addicts losing free will and the ability to make good choices in the moment.
I’ve never read him, but I just got a copy of “Clean” and the bibliography has 331 research citations!! For a research nerd like myself, this is as good as it gets. For those of you who don’t have the time or inclination to digest 335 pages, plus 43 pages of appendix, bibliography and index, I’ll be taking notes and boiling it all down as best as I can in future blog posts.
However, if you’re in or near Los Angeles, there’s no need to wait for me to do my homework. Go hear David Sheff for yourself!
FYI: Sheff has a Facebook page where you can find information about speaking engagements in other parts of the country.




What it’s like to lose your free will

I hope you’ll read this riveting account of an acute anxiety attack and what happened to the person who was struck by this brain disorder since addiction is included. It is re-blogged here with the permission of the author.





Anxiety: We worry. A gallery of contributors count the ways.


Anxiety, drugs, panic attacks

Even if I live to be a thousand years old I won’t forget my first panic attack, that first surreal journey into the paranormal dimensions of my cerebral cortex. Decades later, the memory is all white heat and jagged edges. Psychologists call these acute anxiety episodes “little deaths,” but victims of them will tell you there is nothing little about them. Next to a panic attack, death, when it finally comes, will be skipping through tulips.

It was a sweltering July day in 1980 and I was sitting in a Manhattan restaurant a few blocks from the Plaza Hotel with 70 carats of emeralds in my pocket. The stones were fresh from the infamously lethal Muzo mine in Colombia, and as a favor to a good friend who had smuggled them into the country, I’d flown to New York the day before to meet with a gem dealer, the father of a college friend from Brooklyn who had “connections.” Drinks with friends until 3 a.m. the night before was not the best idea, and the pitcher of black coffee I poured down my throat in the Palm Room a few hours later flooded my central nervous system with Jamaican voodoo and high-voltage insults. So after a testy morning of bickering over occlusions and color and squinting through jewelers’ loupes, I was a little on edge when the gem dealer invited me to lunch.

I heard a muffled “linguine Alfredo,” and that’s when the film snapped.


I first noticed the seizures in my fingers when we were seated — bizarre, neurological twitches that made my digits dance like grasshoppers on the linen tablecloth. A tic in my left eye kept shuttering my vision. The dining room was jammed to the fleur-de-lis wallpaper with red-faced white guys in blue suits and harried looking waiters in penguin costumes. Not my crowd. I remember hearing a muffled “linguine Alfredo” and the clinking of glasses at another table, and then the film snaps. This, as I’ve come to think of it, was the moment my first life stopped, where the film broke and the reel spun around and around, flogging itself.

I couldn’t move. I was suddenly, inexplicably, paralyzed with anxiety. As researchers would learn years later when they peered into our brains with PET scans, the electrical messaging between the amygdala and the anterior cingulate in my brain had gone “Tilt!’” The sudden storm of impulses surging between these tiny glands lit up my central nervous system like a Christmas tree hit by lightning. A neurological journey measured in milliseconds launched me across a threshold wider than any ocean, from my happy-go-lucky, anything-goes carnival of a life to a place that was scarier than the hospital scene with Heath Ledger’s Joker playing Russian roulette.

The initial tremor of voltage wormed its way up the back of my neck in a vertiginous rush of heat. Before I could grab the table to steady myself, the snake uncoiled itself inside my head and struck my prefrontal cortex with a ferocity that made my heart pummel my ribs, trying to break out. In a flash, my arms and legs went numb from the elbows and knees down, a band of steel encircled my head, I trembled, sweat poured off my forehead, and the spinning behind my eyes was speeding up.

“Are you all right?” asked the dealer.

“Get me outta here.”

I couldn’t actually shape the word “dying” with my mouth, but that’s what I thought. That’s what I felt. This was it, the Joker, his hot tongue slobbering all over me. I reached for a glass of water but it flew out of my hand and shattered. I pushed back from the table and stood up and my friend caught me before my legs buckled. As we made our way to the door all I could think about was my wife and our 11-month-old son. They were so far away. I would never see them again; this was curtains.

What I couldn’t know at that moment was that I’d crossed a frontera, a border crossing separating my old life from the new, and there was no way back, any more than I could return to my mother’s womb or rewrite my genome. This was the new me, a verdict with no appeals, no chance at parole. My brain had betrayed me, and in this new life I would have to learn how to function in a suspended state between the deadening banality of the exterior world and the theater of the absurd that tormented me from within. I was now living with an intimate stranger, trapped, it seemed, between two profoundly distorted mirrors with no way out.

Once outside, I managed to get my bearings, but the storm raging at the center of my brain was getting worse. Panic deepened with each breath. The dealer took my pulse and blurted an expletive.

“Can you walk? I know a doctor up the street.”

Somehow, we got there. The next two hours are phantom memories. My heart was beating so fast — 220 beats a minute according to the doctor — that very little oxygen was getting to my brain. The doctor, an elderly German with kind eyes and soft, thick hands, laid me out on a bed in his office, covered me with blankets, gave me a shot of a barbiturate, and I was gone. When I came around a little while later, he said, “You have experienced an acute anxiety attack. I think you’re going to be fine, now, but I want you to take one of these if it ever happens again.”

I took the small vial of pills, thanked him profusely, and got up and left.

Thus began my descent into the world of acronyms (EEGs, EKGs, G.A.D.’s, LMNOPs), bewildered doctors, frustrated psychologists, and a three-ring circus of pharmaceutical adventures. Years later, after my second stint in a clinical study on depression and anxiety at the University of Arizona Medical Center, I made a T-shirt that read, “Lab Rat.”

I flew home to Montana with a vial of Valium, a few emeralds and a rationalized story that I had “gotten a bad oyster.” I wanted more than anything to believe that story, but it was only a matter of time before the hair-trigger in my amygdala wasted that fantasy.

The second time the Joker struck was on a snowy evening the following November as I was rocking my son to sleep. The attack was ruthless, without warning, another world-class humdinger of a meltdown. “This is not good,” I told myself as I waited for the doctor in the emergency room, “this will not end well.”

The attacks came in shorter intervals over the next few years, and I soon learned that I knew more about acute anxiety than most of the doctors treating me. Tests revealed nothing abnormal. Their bewilderment was palpable. My refrain, “There has to be an organic source to this,” fell on deaf ears and glazed eyes as they scribbled out yet another prescription. Even 25 years ago, before PET scans and other imaging break-throughs, the inner workings of the human brain were an enigma to medical science. My doctors didn’t know that their best efforts to control the beast in my head were making the beast more and more uncontrollable.

Desperate, I threw myself into my work. Photojournalism forced me to break through the gravitational field pulling me inward, to turn outward and engage the world through the viewfinder. That hope, like so many others, was in vain. Nothing worked. Then one winter evening, a neighbor, a minister’s wife, knocked on our door. I cracked it open a few inches and saw her kind, gentle smile. “I think I know how you’re suffering, and I think this might help,” she said. She slipped a blue clothbound book through the slot: “Peace From Nervous Suffering,” by Dr. Claire Weekes. “This is for you. I have my own copy.” I read it cover to cover, that night, and then I curled up around that book and wept. Finally, someone understood my living hell. I wasn’t alone.

As a journalist I covered wars, presidential campaigns, natural disasters, you name it, all with the Joker on my back and that book in my camera bag. Claire Weekes went everywhere I went. She was a brave and brilliant pioneer in the field of emotional brain physiology, and her fearless insights and calm compassion gave me a fighting chance against the black pit of despair, a place to plant my feet on solid ground when the world all around me was heaving with madness and dissolution. But she, alone, could not stop the attacks. They kept coming, those E-tickets on the Anxiety Express, with varying intensity and varying frequency. You haven’t explored the farthest reaches of the existentially surreal until you’ve had a grand mal panic attack during an 8.2 earthquake in a war zone in the middle of the night. Alone, in a foreign country. Peak experience.


More From Anxiety

Read previous contributions to this series.

Inevitably, the 10-year-long addiction to Valium led to intense medical detox, including a course of Dilantin to stop the seizures, and a year of mind-bending withdrawals from the benzodiazepine curse. Then came the terror of confronting the world metal-on-metal, without a buffer. This was yet another new frontera, the border crossing into my third life. If you survive this last crossing, you’ll always have something to laugh at, yourself, and an experience so absurd in its comedic/tragic dimensions that the only possible venue for objective reflection is in the funhouse mirror of the everyday.

I survived. The Thorazine, imipramine, benzodiazepines, opiates and rivers of alcohol, the serotonin reuptake inhibitors, the uppers and downers, inners, outers, laughers and screamers, are all markers of a distant past. I haven’t had a panic attack in many years, but there’s always tomorrow, or tonight, or 10 minutes from now. Ruthless, unprovoked, no warning.

When I paid my 10 bucks a few years ago to see “Batman: The Dark Knight,” one glance at the hideous feral leer of Heath Ledger’s Joker took me right back to that July day in New York City. Ledger was a brilliant, once-in-a-generation talent beset by the emotional anarchy of acute anxiety and one or more of its sinister first cousins; depression, insomnia, isolation, mania, personality disintegration and O.C.D., and that’s just the front row in the family portrait of demons. By the time the film was released, Ledger had already fallen into the abyss with the help of a cocktail of prescribed remedies, but of this I am certain. His Joker was no illusion, no dark fantasy of his imagination. His Joker, whom he described as a “psychopathic, mass-murdering, schizophrenic clown with zero empathy,” was the real deal, the mocking personification of the intimate beast trapped between two mirrors in both of our heads. When Jack Nicholson — who played the Joker in 1989 — was informed of Ledger’s death, he cryptically told reporters: “Well, I warned him.”

It’s a shame that our six degrees of separation could not be narrowed to one. Maybe, just maybe, I could have thrown that young man a life ring on a stormy night. Maybe I could have slipped a blue clothbound book through a crack in his door and somehow made a difference. And maybe not. We’ll never know. The Joker got there first.

(Anxiety welcomes submissions at anxiety@nytimes.com.)


Paul VanDevelder is a photojournalist, filmmaker and screenwriter, and the author of “Coyote Warrior: One Man, Three Tribes, and the Trial that Forged a Nation” and “Savages and Scoundrels: The Untold Story of America’s Road to Empire Through Indian Territory.”




Addicts still don’t have a choice but you might

Sorry about the headline,  I couldn’t help myself, I like a little shock factor to kick off a conversation.

I haven’t been able to read all of the comments (1475 and counting) that have been posted about my blog on Philip Seymour Hoffman and neurological disorders.  I do intend to get through them all….eventually.  Meanwhile, there is a consistent request among them that I re-blog the essay with citations from research to back up the assertions I made.  

I am flattered to be asked to write again, who wouldn’t be? And, I decided that it had been too long since I last checked the research in the area of neuroscience and addiction.  Oh, and yes, some of the comments had me wondering if I had screwed it all up, only this time, in front of a global audience.  

My research is complete and I will be re-blogging the piece with citations in the next 4-5 days.  And I did make mistakes in my original piece (humble pie is baking in the oven as I write this), all of which I will point out, and none of which detracts from the points I was originally trying to make.  (Whew!)  

The best part of what I learned is that I believe I understand how and why the discussion of addiction gets so convoluted. Which means I’ll have a separate blog where I sort it all out and you can let me know if it helps in your understanding.  Or not. 

And all of you who took the time to post comments, thank you for your interest and your passion in the subject of addiction and other neurological disorders. This conversation is reason enough to be optimistic about positive changes in public awareness, education and the treatment for those who suffer and the people who love them.

May we all be free from pain and suffering.





Fierce Grace for Grieving

There have been many grieving parents and loved ones who have commented on my post about Philip Seymour Hoffman. My heart aches for them.

While watching a documentary the other day about the spiritual teacher Ram Dass, approximately 13 minutes in, parents from Ashland, Oregon tell of the loss of their 11 yr. old daughter. The mother then reads a letter they received from their friend Ram Dass.  I was so moved by the letter that I stopped the film and copied the it word for word (errors in punctuation are mine).Image.  I share it here in hopes that his words also touch the hearts of those who are grieving and have shared their experiences with us all.

Here is the letter in its entirety:

From the 2001 documentary, FIERCE GRACE, about the western Hindu teacher Ram Dass (formerly Harvard professor Richard Alpert, PhD).

Steve and Anita,

Rachel finished her brief work on earth and left the stage in a manner that leaves those of us left behind with a cry of agony in our hearts as the fragile threads of faith are dealt with so violently.

Is anyone strong enough to stay conscious through such teachings as you are receiving? Probably very few, and even they would only have a whisper of equanimity and spacious peace midst the screaming trumpets of their rage, grief, horror, and desolation.

I cannot assuage your pain with any words, nor should I, for your pain is Rachel’s legacy to you.  Not that she or I would inflict such pain by choice, but there it is.  And it must burn its purifying way to completion.

You may emerge from this ordeal more dead than alive, for something within you dies when you bear the unbearable. And it is only in that dark night of the soul that you are prepared to see as God sees, and to love as God loves.

Now is the time to let your grief find expression. No false strength. Now is the time to sit quietly and speak to Rachel and thank her for being with you these few years and to encourage her to go on with her work, knowing that you will grow in compassion and wisdom from this experience.

In my heart I know that you and she will meet again and again and recognize the many ways in which you have known each other.  And when you meet, you will in a flash know what now it is not given to you to know, why this had to be the way it was.  Your rational minds cannot understand what has happened.  But your hearts, if you can keep them open to God, with find their own intuitive way.

Rachel came through you to do her work on earth, which included her manner of death. Now her soul is free and the love that you can share with her is invulnerable to the winds of changing time and space. In that deep love include me too.

So much love,

Ram Dass

Author/Playwright Emmet Rensin writing clearly about craving, please read!

Below is the link to an essay by a professional writer who is oh-so-much-more eloquent and concise in his description of the experience of craving and choice in the life of an addict in recovery. I think he nailed it.




What Happened?! A Word for the Rookie Blogger

I wrote a blog on Monday. The most viewers I’ve ever had was just under 100. I wrote a blog on Monday for my friends and friends of friends. It was off the top of my head but in an arena in which I am pretty knowledgeable. It was too long and not as clear or as concise as I would have wanted it to be. But I write for my friends and friends of my friends. I write for a crowd who don’t need me to dress for the occasion. It’s now Wednesday, early morning, and the blog I wrote on Monday has had more than 30,000 views.

What happened? How is this possible?

Many kind people have been appreciative and many kind people have not understood what I wrote. Many angry people have left angry comments. And a few calm people have left constructive feedback. And some have left comments I had to delete rather than publish. None of these people know who I am. How did they find my too long, off the top of my head, not as clear or as concise as it should have been blog?

If I had known this was going to happen I would have dressed up, cited my research, and perhaps hired a friend to edit for me. If I had known this was going to happen I wouldn’t have posted in my pajamas.

Phillip Seymour Hoffman did not have choice or free will and neither do you.

Phillip Seymour Hoffman 1967-2014

Phillip Seymour Hoffman 1967-2014

In the wake of the tragic loss of Phillip Seymour Hoffman, a great artist, partner, father, brother, and son, I offer the following facts about the neurological disease of addiction.

The overwhelming majority of adults in the western world have passed through experimental stages in their lives where they have dabbled with some kind of brain altering addictive substance, i.e., cigarettes, alcohol, prescriptionpain killers, ADHD medication, anti-anxiety medication, and yes, even marijuana (save the ‘it’s not addictive” arguments for later, please).  And the overwhelming majority of these adults will emerge from their experiments unscathed, believing that their free will and good choices are what saved them from becoming addicted.

The problem with this thinking is that it is factually incorrect.  In other words, they are all wrong.

What saved them (you) from becoming addicted is that their brains did not respond in the same way that an addict’s brain does. They were born with a resistance to addiction. Their free will and good choices had nothing to do with it.

It is time for all of us who got through unscathed to stop patting ourselves on the back for our genetic good luck, and it is time to stop judging those who were not born with the same good genes as defective.

About Phillip Seymour Hoffman, a relapsing drug addict, you may have had the thoughts, “He knew better.” or “Shame on him for throwing his life away.”

Let’s look at these ideas through the lens of how the brain actually works. Yes, he “knew better.” He ‘knew better’ in the frontal lobes of his brain, where we all execute our better judgment and can make calculations of our behaviors and circumstances based on risk and reward.

Here’s the problem, the activity of our frontal lobes can be shut down by the other parts of our brain when there is significant stress in our body. This comes from what is called the “fight, flight, freeze, or faint” mechanism.

This mechanism in the brain is hard-wired into each of us for survival purposes. It is the part of the brain that puts someone into shock when they have been injured and/or traumatized. It is also the part of the brain that can allow a person to lift a car by themselves if their loved one or someone they care about is in danger.

The brain does not analyze the type of stress it is experiencing, that is, this ‘fight or flight mechanism’ is binary. It functions on a “yes” or “no” basis.  “Yes,” there is enough stress to activate the mechanism or “no,” there is not enough stress to activate the mechanism. Human beings have no control over when this mechanism is activated.

This is how PTSD works. Seemingly innocuous sights, sounds, smells or sensations trigger this brain mechanism even when there is no actual threat to the person. The stress in the body is not even consciously recognizable to the person with PTSD. The brain reacts to the trigger and the person is put into the experience of being threatened without choice or control because the frontal lobes cannot get their signals through. When this mechanism is activated free will and choice become impossible. This is true for each and every human being on the planet, whether we like it or not.

The brain of an addict, Phillip Seymour Hoffman in this case, experiences withdrawal symptoms as stress. And since it operates on a binary system, it does not sort out “good” stress (I’m so sick because I’m kicking heroin-good for me!) from “bad” stress (I’m so sick because I’m kicking heroin I’d better call a doctor). The brain only knows if the stress is present or not and how much stress is present.

When withdrawal symptoms, i.e., physical distress, anxiety caused by emotional stress, etc. reach a certain point in the brain, the brain automatically cuts off the access to the frontal lobes (in a manner of speaking) and begins to direct the body rebalance the stress, to find equilibrium, so that the brain can return to “normal” functioning.

“Normal” functioning to the brain of an addict is defined as having the addictive substance in the body. So while any relapsing addict “knows better,” the addict literally cannot access the part of his brain where his/her better judgment is stored. The addict loses his choice and free will and is at the mercy of his brain which is in extreme stress and working to regain it’s equilibrium, at any cost, i.e., get more of the addictive substance.

The idea of losing choice, of relinquishing free will, is unthinkable to most of us, especially those of us fortunate enough to live in the U.S. where we have so many choices in so many areas of our lives. Also, human consciousness defends heavily against the possibility of ‘no choice’ which is paradoxical considering we each carry a brain mechanism that removes choice, but I digress.

Suffice it to say that according to our brain physiology, choice and no choice are equally important to the survival of the species. The problem is that we humans are only conscious of the importance of choice (and the free will to make those choices).

Over the centuries, mankind has had tremendous difficulty acknowledging and treating brain disorders of all kinds.  And we haven’t made much progress in our supposed “enlightened” age of civil rights either.  Consider this, it was less than 50 years ago that 90+% of those born with Down’s syndrome were institutionalized for life.  Also, in spite of (or maybe because of?) a tremendous increase in the diagnoses of brain disorders in the last 40 years, all but a small percentage of treatment centers and publicly funded programs for treatment have been permanently shut down.

What we have on our hands in the U.S. is a mental health, i.e., brain health, crisis. This is abundantly clear to us every time someone with a serious brain disorder buys an assault rifle. Actually, those instances are but the tip of a gigantic iceberg. And even though we have had great breakthroughs in neuroscience, we are woefully lagging behind in treating people who suffer and offering support to their families.

How did this happen? There are more than a few ways to answer that question. One of the important answers is that we are naturally defensive against the idea that brain disorders which disconnect us from our free will exist. It’s too frightening an idea to consider, so we come up with stories.

A century or more ago our stories revolved around the idea that the person suffering was possessed by demons, and that these demons ran in the family. Perhaps the person’s mother was possessed? May she was a witch? Someone in that family must have sinned and now they are being punished, etc.

It was stories like these that ran so strongly through our cultures that families up until, well now, actually hid loved ones away in mental institutions and even disavowed knowledge or connection to them in order to avoid the stigma that would be placed on the healthy family members also.

We have made some progress, but as Mr. Hoffman’s death painfully points out, not nearly enough. We seem to have compassion and some amount of treatment and support available for those who have schizophrenia, psychosis, delusional disorder, autism, and Downs syndrome.  (It’s not nearly enough treatment and support and the families and loved ones of those with these disorders suffer an enormous amount financially, emotionally, and physically with the burden of lifetime care of those who live with these challenges.)

Outside of these few of the many neurological disorders that exist we lose all compassion and concern for people and their families who are suffering, and we tell a modern day version of the demon possession story about them.

We continue to isolate and reject people suffering from a physiological disorder of the brain and force their families and loved ones to bear the lifetime burden of their care in shame and silence, in 2014, in the wealthiest nation the planet has ever known.

Our stories about these people who look so normal, so successful, on the outside but whose lives come crumbling down upon them or are cut ridiculously short no longer revolve around possession by evil spirits but by a defect in their character (selfish, lazy, greedy, arrogant, gluttonous, apathetic, hedonistic, etc.), a defect in their temperament (evil, violent, narcissistic, vain, eccentric, etc.) or a defect in their judgement or intelligence (immature, moron, idiot, being an a**hole).

In the absence of knowledge about how the brain functions these stories created theories about the causes of these behaviors (moral corruption, low character) and consequences which mirrored our cultural value system (it’s their own fault, they got what they deserved).  Out of our stories came ideas on how to avoid these behaviors (work hard, believe in God, be kind to others), consequences of these behaviors (why goes around comes around, God helps those who help themselves) and systems of support to uphold the implementation of these ideas (church, 12 step, therapy). Sometimes the theories, ideas for correction and the support systems even work, but sadly, not most of the time.

All of the above stories/theories are normal individual and cultural adaptations to the unexplainable. This is how we humans learn and grow. Gratefully, these days few if any people think a person with a phobia has had a spell cast upon him by a witch and now needs an exorcism while the family and neighbors have to find and lynch the witch.

Neither is a person with an addiction suffering from poor character, temperament, or judgment from which he can be cured with hard work, belief in God, attendance at church, 12 step and therapy. (Hang in there, recovered and recovering 12 steppers. I’m on your side. See ** below.)

What we fail to see is  a) how self-serving these old stories are, and b) how ineffective our current treatment modalities are (see #a). Our theories about addiction don’t really exist to explain the illogical behavior of someone who is suffering, but mostly to separate ourselves from that behavior with the assurance that what has happened to that “loser” won’t happen to us. And when the need to distance ourselves from that “loser” is satisfied we don’t bother to fact check our theories. Nor to we bother to notice if the treatment schemas we’ve created even work (they don’t).  Rather good proof that our theories are self-serving, don’t you think?

We also fail to notice the fear and sadness that comes up for us when we hear of the tragedies that befall those with high-functioning neurological disorders, especially now. It’s 2014 and tragedies like the death of Phillip Seymour Hoffman have been happening steadily for 40+ years, with no end and no answer in sight. In light of this kind of repetitive hopelessness we are left with little choice but to blame the victims in order to soothe ourselves. And it is difficult, if not impossible to create solutions in the presence of hopelessness.

The mental health/brain disorder crisis we are facing right now, this decades-long epidemic, is with the so-called high-functioning neurological disorders, i.e., depression, anxiety, bi-polar, ocd, anorexia, bulimia, and addiction (I have left out more than a few of the disorders, but these are the most familiar of the lot).

However, neuroscience is offering us the best reason to hope for good treatment outcomes in decades. The more we learn about how the brain works (like when the fight/flight mechanism is activated) and how it works when it is “broken” (fight/flight mechanism too easily triggered in addicts) the easier it will be for people who have these brain glitches to be identified and treated without shame and blame.

The first, most effective way to face our cultural crises of too many people with brain disorders being undiagnosed and untreated is to educate ourselves about these disorders and learn to spot the people who are suffering so that we can help them understand what is wrong with them and help them to agree to receive treatment.  We have to change our cultural view of addiction and the like before we can create more effective treatments for it and the other high-functioning neural disorders.

The change has to come from those of us who either do not have the disorders or have been successfully treated for the disorders because those with the disorders are not able to help themselves.

I like to say it this way, the last person to know that his brain is broken is the person with the broken brain.

This is just the way human consciousness works.  The only organ in the body that seems to make self-diagnosis impossible is the brain. I mean there is no mistaking a kidney stone trying to pass. When someone is in that kind of pain they don’t blame it on their lack of character. But the brain is expert at being able to reframe and explain away its own glitches.

Whatever isn’t working in a person’s brain is that person’s “normal.”  Over time people with high-functioning neurological disorders develop plausible explanations for their symptoms and adapt to them as best as they can.

And when life problems that are obviously (to those around them) connected to their neurological disorders become apparent on the outside of their lives (car accidents, drained bank accounts, lost jobs, broken marriages, etc.) they usually blame their own character defects or someone or something else. Therefore, the person with the problem is the least likely to be able to get themselves the help they need.

The way to begin to help people like Phillip Seymour Hoffman (deceased-drug addiction), actor Cory Monteith (deceased-drug addiction), singer Amy Winehouse (deceased-alcoholism), author David Foster Wallace (deceased-depression),actor Jon Hamm (depression), TV personality Nicole Richie (anorexia), actress Karla Alvarez (deceased-anorexia/bulimia), actress Amanda Byne (bi-polar disorder), actor Howie Mandel (ocd) , reality TV star Vinnie Guadagnino (anxiety disorder),  actress Brooke Shields (postpartum depression) is to become educated about the physiological causes of these disorders so that when you see the behaviors in friends and loved ones you can begin to educate and support them.

Here is where the education begins, when otherwise high functioning people think and act in ways that defy facts and logic and threaten their well-being and the well-being of their loved ones, then we need to understand that they have a brain disorder, not a moral or character disorder; and they need medical treatment, not shaming, blaming, therapy or a sentence to a 12 step program.

This means that alcoholism, drug addiction, eating disorders, suicide attempts, phobias, adhd, anxiety and depression, et al are all disorders of the brain and as such need the treatment of a medical doctor first.

(Read that again. It’s a truth, not a theory. But since the truth is not widely known it will seem counter intuitive. You will want to say, “Yeah, but…..” Read it again. Alcoholism is a brain disorder. Drug addiction is a brain disorder. Let it sink in.)

Here’s why this is true–otherwise high functioning people could not be high functioning without good judgment, good enough character, and at least average intelligence.  If they can hold down a job, go about the activities of daily living, have friendships and loved ones, and display empathy towards others before and during their lapses, melt downs, relapses, et al.,  then their frontal lobes are fully functioning.

The only explanation, for their behaviors then, is that their frontal lobes (where their high-functioning skills are located) have been hijacked by a different part of their brain.  When someone’s brain is highjacking their frontal lobes, they need medical treatment.

Blessedly, neuroscience is catching up with us and giving us facts about how our brains actually work.  So it is time NOW to drop those stories we have made up and begin to apply the facts of neuroscience as we understand them to the untimely deaths of addicts of all kinds and to the public meltdowns of otherwise functioning adults.

And it is way past time that we spread the word about what is really going on with these people who struggle mightily and their families who bear the burden of loving them and having to care for them.

Remember, these people don’t know that their brains are broken.  They are high-functioning and so they blame themselves. And they come to hate themselves for their problems more than you can imagine.  They live in a dark and self-loathing world where they come to believe that they don’t deserve any help which is why they don’t surrender themselves for treatment. They need the help of their friends and families and the world around them in order to get around the obstacles of their broken brains to get help.

When our entire culture understands as common sense that addiction is an individual neurological disorder that requires immediate medical attention then a person like Phillip Seymour Hoffman has a chance to understand that he has “one of those brains” that will shut down his frontal lobes and take away his ability to exercise good judgement and control of his behaviors.  And until he knows this fact about his brain in same the way that he knows a bone sticking out of his leg means he needs to go to the ER, then him and those like him will not be able to ask for help.

And a guy like Phillip Seymour Hoffman isn’t going to know these things until we all know them.  And that time is NOW.

Phillip Seymour Hoffman died from having a combination of sensitivities in his neural wiring that caused his brain to override his better judgement, take away his free will and caused him to take the actions that ultimately killed him. It appears that these sensitivities were unknowingly activated by a prescription of pain killers that were necessary at the time to treat a different medical condition.  Because of his previous 23 years of being clean and sober he was presumed  safe to take the pain medication. And it looks like what he and maybe even his doctors didn’t know about how his brain worked kept him from staying in treatment long enough to allow his brain to rewire itself around those sensitivities and render him clean and sober again. For this, like all addicts in this situation, he deserves our kindness and compassion.

If this post has helped you to understand addiction please do share it.  My passion is to help educate us all so that more people with neurological disorders will get the treatment they need.

Debbie Bayer, MA, MFTI

**A note to my 12-step friends:  There are two caveats to the success of 12-step work 1) It works when you work it. and 2) You have to be honest, and some people are constitutionally incapable of being honest with themselves.  There is no doubt that over the last 70+ years the 12-step community has the highest success rate among alcoholics of any other treatment modality. This community is also incredibly successful in the support of sobriety among drug addicts of all kinds.
The problem lies in the millions of people who cannot meet the two criteria for success in a 12-step program due to other types of brain disorders.  Their suffering demands that health professionals continue to seek out effective treatment strategies for them.  I am certain that you have compassion for their plight and support these more unfortunate folks in their recovery.