April 2012


In my time working on construction crews in Oregon, one persistent joke was, upon reading the ubiquitous warning “known to cause cancer in the state of California” on a material we were about to use, was announcing, “good thing we’re not in California!” Everyone would laugh and then go ahead using the pressure-treated lumber, or whatever it was, as usual. I was generally alone in taking precautions in these situations, and actually caught significant flack for being paranoid and/or anal retentive. This was not improved by my careful explanation that California was where the lawsuits and legal actions happened which resulted in these warnings, not where the cancer cases were confined!

The bottom line was that precautions (not to mention using less toxic materials) slow down the process for bosses and often seem unnecessary to the crew, so they were not taken. Many of the crew reasoned that since they already smoked and drank, how much could inhaling some fume or touching some chemical really increase their chances of getting cancer?

This was frustrating to hear but is actually an excellent point. Without information about base rates, how can we make good decisions about toxicity exposure? We need specificity and statistics to make good decisions.

For example, Reanna pointed this sign out to me last night:

It is posted on the side of the RV we have been living in during our renovation project. Of what use is this supposed to be? If I was on the fence about whether or not to buy an RV this might be somewhat helpful, but only by increasing a vague sense of fear, possibly to the point that I wouldn’t make the purchase. I want to know by doing what (driving it? sitting in it? licking the walls?) for how long (minutes? years?) and in what circumstances (engine running? after the RV’s a certain age? at certain temperatures?) will increase my chance of developing what cancer by what statistical rate? With that information, I could make a decent decision about how to interact with this RV. Or construction material.

It’s unfortunately true that construction worker and RV buyers (as well as doctors, lawyers, and Americans in general) do not understand statistics, and so for many this information might not be helpful. But it could hardly be less helpful than it is now.

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I gave my first interview a few weeks ago to Peter Kowalke of The Unschooler Experiment. We spent a week together at an east coast session of Not Back to School Camp, but never had a real conversation before this one. He turned the interview into a podcast about my therapy work with unschoolers. I was a little nervous about talking on tape and came away thinking I had rambled too much, but Peter edited it well and I think it came out good. Click on the photo to go to the podcast:

I read Whitaker’s Anatomy of an Epidemic: Magic Bullets, Psychiatric Drugs, and the Astonishing Rise of Mental Illness in America as a counterpoint assignment in one of the diagnosis classes in my Couples & Family Therapy program. It was an excellent book about the history and science of several psychological problems, both as phenomena and diagnoses, including depression, depression, bipolar disorder, ADHD, and schizophrenia. As a university student, I had the opportunity to check out for free any of the many academic citations in the book that piqued my interest, and each one that I looked at seemed indeed to provide the evidence he claimed. I haven’t read anything like all of them (there are nearly 700), but enough to satisfy myself that Whitaker has done some good journalism here, and that his hypotheses are credible.

Two of these hypotheses is about childhood bipolar disorder, the first of which he calls the “ADHD to bipolar pathway.” The side effects of stimulants such as those used to treat ADHD are substantially similar to bipolar symptoms, as shown in the table below, from p. 238. (The formatting is slightly different than Whitaker’s, thanks to an Open Office/Wordpress interaction.) Multiplying the estimated rate of stimulant-induced bipolar-like symptoms by the 3,500,000 children and teens taking those medications, Whitaker estimates we should see approximately 400,000 “bipolar youth” as a result.

The ADHD to Bipolar Pathway

Stimulant-Induced Symptoms

Bipolar Symptoms

Arousal

Dysphoric

Arousal

Dysphoric

Increased lethargy

Intensified focus

Hyperalertness

Euphoria

Agitation, anxiety

Insomnia

Irritability

Hostility

Hypomania

Mania

Psychosis

Somnolence

Fatigue, lethargy

Social withdrawal, isolation

Decreased spontaneity

Reduced curiosity

Constriction of affect

Depression

Emotional lability

Increased energy

Intensified goal-directed activity

Decreased need for sleep

Severe mood change

Irritability

Agitation

Destructive outbursts

Increased talking

Hypomania

Mania

Sad mood

Loss of energy

Loss of interest in activities

Social isolation

Poor communication

Feelings of worthlessness

Unexplained crying

The second part of Whitaker’s thinking on childhood bipolar disorder is an SSRI to bipolar pathway. Estimates of the rate of the well-know SSRI side effect of mania, multiplied by 2,000,000 children and adolescents on the medications, give us the possibility of producing at least 500,000 SSRI-induced bipolar disorders in young people.

If true, these hypotheses could go a long way to explain the skyrocketing rates of childhood bipolar disorder diagnoses, as most diagnoses of childhood bipolar disorder are made on children who are already taking stimulants and/or SSRIs. The primary alternative, and more mainstream, hypothesis is not that stimulants and SSRIs are iatrogenic, but that since those medications solve the problems of ADHD and depression, the symptoms of bipolar disorder that emerge show that the diagnostician had initially guessed wrong, and that bipolar disorder was the previously-existing and underlying cause of the ADHD and/or depression. This, of course, may be true, but it seems very important to discover for certain whether it is!

As a family therapist, when I am presented with a child exhibiting symptoms of ADHD, I am trained to look at the child’s environment and history, especially their family relationships. How is it that these behaviors might be a response to the stresses that the child is experiencing? The point is that I do not just assume that the child has been genetically programmed to disrupt their classroom. I came across this study last year, though, that was a good reminder that “environment and history” are bigger than what happens in-between family members.

It found that children with higher levels of polyfluoroalkyl chemicals (PFCs) in their blood were more likely to have been diagnosed with ADHD. PFCs are long-lasting industrial substances that we accidentally eat and breath into our bodies from various coatings, foams, emulsifiers, and cleaning and personal products. Almost all of us have detectable levels of them in our bloodstreams. They are known to be toxic in other animals to the liver, immune and reproductive systems, and fetal development. It is also starting to look like they are neurotoxins as well.

The study was of correlations, so whether the PFCs caused the children to get ADHD diagnoses remains to be seen. ADHD may turn out to be a PFC-toxity-induced syndrome. Or it could be that PFC levels in mothers correlates with that of children, and that it is in-utero PFC levels that are critical. Or perhaps having an ADHD diagnosis causes children to eat and/or breath more coatings, foams, and emulsifiers. Or who knows what else?

Until the scientists know for sure, here are some ways to limit your PFC exposure, from Environmental Working Group:

Forgo the optional stain treatment on new carpets and furniture.
Find products that haven’t been pre-treated, and if the couch you own is treated, get a cover for it.
Choose clothing that doesn’t carry Teflon® or ScotchgardTM tags.
This includes fabric labeled stain- or water-repellent. When possible, opt for untreated cotton and wool.
Avoid non-stick pans and kitchen utensils.
Opt for stainless steel or cast iron instead.
Cut back on greasy packaged and fast foods.
These foods often come in treated wrappers.
Use real plates instead of paper.

Pop popcorn the old-fashioned way on the stovetop.
Microwaveable popcorn bags are often coated with PFCs on the inside.
Choose personal care products without “PTFE” or “perfluoro” in the ingredients.
Use EWG’s Skin Deep at cosmeticsdatabase.com to find safer choices.