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From the Townsend Letter
October 2011

briefed by Jule Klotter
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Diet and Attention Deficit/Hyperactivity Disorder
Diet is a major cause of attention deficit/hyperactivity disorder (ADHD), according to a randomized, controlled study published in the Lancet (February 5, 2011). The Impact of Nutrition on Children with ADHD (INCA) study, led by Dr. Lidy Pelsser, involved 100 children with ADHD, ages 4 to 8 years. During the first five weeks of the study, the children were randomly assigned to follow an elimination diet (which prohibits foods that commonly produce negative reactions) or a healthful diet (control group). Children in the elimination diet group whose symptoms decreased by 40% or more, according to the ADHD rating scale, moved on to the trial's second phase. During this four-week, double-blind crossover phase, each child's diet was modified to include high- or low-IgG foods (based on the child's IgG blood test results). The researchers found that IgG measurement is not a good predictor of which foods will produce ADHD symptoms. The elimination diet works much better. The researchers conclude: "A strictly supervised restricted elimination diet is a valuable instrument to assess whether ADHD is induced by food. The prescription of diets on the basis of IgG blood tests should be discouraged." Pelsser told National Public Radio (US) that "… 64 percent of children diagnosed with ADHD are actually experiencing a hypersensitivity to food."

The assertion that diet underlies ADHD may startle some conventional practitioners, who believe that the diet–hyperactivity link has been long buried. Dr. Ben Feingold first proposed in 1973 the idea that food additives produce hyperactivity in 40% to 50% of hyperactive children. When reviews of controlled studies in the early 1980s failed to confirm Feingold's observations, interest in diet waned. Studies that reportedly disproved Feingold's hypothesis had several flaws, according to Bernard Rimland, PhD. Too often, researchers would focus on a handful of additives rather than recognizing that the typical U.S. diet includes thousands of additives in the processed and "junk" foods that children eat. In addition, some studies challenged their participants with "ridiculously small" doses of the test substances – far below the level actually consumed in a typical diet. In addition, these studies failed to take a child's overall nutritional status into account. The body's ability to deal with foreign chemicals varies depending upon its supply of nutrients.

Sugar is another diet topic that has been linked to hyperactivity and, supposedly, debunked. In their 2006 study, Lars Lien, MD, and colleagues criticize meta-analyses and literature reviews, performed in the 1990s, that found no evidence that sugar contributes to hyperactivity. Like those that looked at the Feingold diet, these analyses and reviews also relied on poorly designed studies. Some, for example, used artificial sweeteners (which can affect behavior) as a control. Others had too few participants. Sometimes, the sugar dosage was far below average, real-life consumption. In their study involving over 5000 teenagers, Lien and colleagues found a direct correlation between hyperactivity and sugar–containing soft drink consumption. (They note that the effect of caffeine in soft drinks may be another contributing factor.)

While much diet-hyperactivity has focused on additives and junk foods, INCA adds another category by looking at nutritious foods that produce symptoms on an individual basis. Pelsser and her Dutch colleagues hope that INCA will encourage doctors to use the elimination diet to identify problem foods before they prescribe drug therapy. "‘We have got good news – that food is the main cause of ADHD,'" Pelsser told National Public Radio. "‘We've got bad news – that we have to train physicians to monitor this procedure because it cannot be done by a physician who is not trained.'"

Lien L, Lien N, Heyerdahl S, Thoresen M, Bjertness E. Consumption of soft drinks and hyperactivity, mental distress, and conduct problems among adolescents in Oslo, Norway.
Am J Pub Health. October 2006: 96(10);1815–1820. Available at: Accessed January 5, 2010.
Pelsser LM, Frankena K, Toorman J, et al. Effects of a restricted elimination diet on the behaviour of children with attention-deficit hyperactivity disorder (INCA study): a randomized controlled trial [abstract].
Lancet. February 5, 2011;377(9764): 494–503. Available at Accessed March 14, 2011.
Rimland B. The Feingold diet: an assessment of the reviews by Mattes, by Kavale and Forness and others.
J Learning Disabilities. June-July 1983;16(6):331–333. Available at Accessed August 8, 2011.
Study: diet may help ADHD kids more than drugs. March 12, 2011.
All Things Considered. National Public Radio. Available at Accessed March 14, 2011.

Energy Psychology
What do acupuncture meridians and muscle testing have to do with psychology? They are tools for accessing and manipulating psychoemotional material in the energetic field, according to practitioners of energy psychology. The most popular forms of energy psychology at this time include eye movement desensitization and reprocessing (EMDR), Thought Field Therapy (TFT), and its offshoot Emotional Freedom Technique (EFT). All, particularly EMDR, have shown documented effects in clinical studies.

In EMDR, patients rapidly move their eyes from side to side, mimicking the movement of REM (rapid eye movement) sleep. The movement tends to bring up painful memories and facilitate a resolution involving an emotional release and, sometimes, a shift in perspective. The technique has proved helpful for the treatment of anxiety disorders and posttraumatic stress disorder (PTSD). A 2009 Cochrane review, conducted by Jonathan Bisson and Martin Andrew, reports that EMDR and trauma-focused cognitive-behavioral therapy are more effective than stress management or non-trauma-focused psychological treatments for PTSD. "One drawback," according to Phil Mollon, PhD, "is that EMDR can plunge the person into a vivid reliving of trauma, or might open the floodgates of multiple traumas; [which] is why careful and thorough training is required."

Behavioral psychologist Allan L. Botkin, PsyD, inadvertently discovered a variation of EMDR while working with combat veterans at the Chicago Veterans Administration Hospital. Botkin asked patients to close their eyes for a while immediately after experiencing their "core sadness." To his surprise, some of his patients reported having a vision of a person who had died during the combat trauma that plagued them. For instance, a veteran who was tortured by the memories of holding a dead child believed that she had appeared to him as a happy, healthy adult and given him a hug. Initially, Botkin viewed these reports as hallucinations brought on by grief. Most patients did not experience positive visions during that silent period. What caught Botkin's attention was the profound and persistent healing effect of these visions in the patients who experienced them. Instead of ignoring these anomalies, Botkin began recording the case histories and asked colleagues for help in investigating the technique.

In his book, Induced After Death Communication: A New Therapy for Healing Grief and Trauma, Botkin "asks that [this technique's] clinical usefulness take precedence, and that therapists be willing to set aside their skepticism in order to explore a technique that is of such great benefit. The combination of grief work using EMDR and the induction of "visions" is a powerful intervention. He says that at this point it does not matter where the visions originate if the therapeutic work can free people from real suffering," writes Celia Coates, MSW. Coates reviewed the book for Bridges, the quarterly magazine for the International Society for the Study of Subtle Energies and Energy Medicine.

Another form of energy psychology is Thought Field Therapy (TFT), developed by psychologist Dr. Roger Callahan. TFT eliminates anxiety and other uncomfortable emotions by tapping specific acupuncture meridians. TFT is based on applied kinesiology developed by George Goodheart, DC. In working with Goodheart's system, John Diamond, MD, "discovered that different meridians are involved in different emotions-and that holding particular meridian points whilst saying specific affirmations could rapidly shift a person out of a negative emotional state," according to Dr. Phil Mollon. Callahan became intrigued by the possibilities of working with acupuncture meridians when a patient's sudden water phobia disappeared, never to return, after she tapped the end of the stomach meridian at Callahan's instruction. TFT uses muscle testing (applied kinesiology) to identify meridian points tied to psychoemotional problems and to determine the order in which to tap them in order to release the problem.

Callahan discovered that some people, for a variety of reasons, do not benefit from TFT. These people muscle test weak when repeating the statements "I want to be over this problem" or "I want to be well." Instead, these patients give a strong response (indicating benefit or truth) when they focus on "I want to keep this problem." Callahan found that tapping on the small intestine meridian on the side of the hand, making a positive statement of self-acceptance, and using Bach Rescue Remedy can override the resistance. Emotional Freedom Technique (EFT), a simplified and very popular derivation of TFT, begins each session by tapping the side of the hand while making statements of self-acceptance.

Despite the growing popularity of techniques like EFT, Mollon points out that energy psychology is not for everyone. It is a new field whose underpinnings are not yet understood. For more information about energy psychology techniques, see Mollon's website ( and the website for the Association for Comprehensive Energy Psychology (

Bisson J, Andrew M. Psychological treatment of post-traumatic stress disorder. The Cochrane Collaboration. 2009. Available at Accessed August 5, 2011.
Coates C. Comments from the guest editor. Bridges. Fall 2005:16(3); 3.
Induced After Death Communication: A New Therapy for Healing grief and Trauma [book review]. Bridges. Fall 2005:16(3);9–10.
Mollon P. Note of caution [web page]. Psychoanalytic Energy Psychotherapy.
Psychoanalytic Energy Psychotherapy: a marriage of Thought Field Therapy and psychodynamics [preprint version]. Therapy Today. September 2007. Available at Accessed August 6, 2011.

Homeopathy and Mental Illness
Brazilian researchers recently performed a randomized, double-blind, double-dummy trial that compared the effectiveness of individualized homeopathic remedies (Q-potencies) against fluoxetine (Prozac) in 91 outpatients with moderate to severe depression. (Fifty-five completed the eight-week study.) The highly-diluted Q-potency homeopathic remedies (also known as 50-millesimal or LM potency) were delivered in an alcohol-distilled water solution, while the fluoxetine (20 mg) was given in gelatin capsules.

To ensure blinding, the Brazilian researchers used a double-dummy model. The patients randomly assigned to the active group (n = 48) received an active homeopathic remedy in a bottle of liquid and a white gelatin capsule filled with celluloses, kaolin, and talcum powder (placebo). The control group received fluoxetine in a white gelatin capsule and a bottle of alcohol-water solution without a homeopathic. All 91 participants underwent a thorough case history, characteristic of homeopathic treatment. Principle investigator Ubiratan C. Adler, MD, conducted the histories. Adler has over 20 years of experience in using homeopathy methods described in Hahnemann's Organon (6th edition). Adler remained blind to patients' group assignments by sending a prescription order for fluoxetine and an order for each individual's homeopathic medicine to the study's pharmacist. ("Twenty medicines were used to treat the 48 patients randomized to homeopathy.") The pharmacist then assigned the patient to the homeopathic group or fluoxetine group, according to a predetermined, randomized schedule. Only the pharmacist and senior author H. M. Calil had access to the code.

For four weeks, the patients took one drop of their homeopathic (or matching placebo) before breakfast on Monday, Wednesday, and Friday and a capsule of fluoxetine (or matching placebo) daily, after breakfast. Adler reevaluated them after four weeks of treatment. He changed the homeopathic prescription (remedy, potency, or dosage) and raised the dosage of fluoxetine to 40 mg (two capsules per day). As before, the pharmacist gave patients the predetermined medicines and placebos.

Using the Montgomery & Åsberg Depression Rating Scale, the research team determined that individualize homeopathic treatment (Q-potencies) was not inferior to fluoxetine treatment. In addition, the response rate was similar in the two groups: 63.9% responded in the fluoxetine group and 65.8% responded in the active group after four weeks. After eight weeks of treatment, 84.6% of the fluoxetine group and 82.8% of the homeopathic group had responded. Remission rates were also similar. More patients in the fluoxetine group were troubled by negative side effects, but reports of side effects between the two groups was not significant.

The authors discuss several study limitations, including the high dropout rate and small sample, the lack of a placebo control arm (prohibited by the National Ethic Council), short period of treatment, and dependence on a single homeopathic practitioner. They would like to see a multicenter trial involving a larger number of patients.

Although this study indicates that homeopathic treatment is not inferior to fluoxetine, questions remain. Are the homeopathic medicines active, or is it the interaction with a practitioner during the case-taking session that empowers treatment (homeopathic and pharmaceutical)? The response rate to fluoxetine was quite high in this study compared with other fluoxetine studies. Commenting on comparisons between homeopathic remedies and conventional antidepressants, the authors state: "… a placebo effect cannot be ruled out, since the homeopathic Q-potencies were compared with an antidepressant. …" They quote from S. M. Sthal's Depression and Bipolar Disorder: Sthal's Essential Psychopharmacology (3rd edition): "…‘it is becoming more and more difficult to prove that antidepressants – even well-established antidepressants – actually work better than placebo in clinical trials.'" Some researchers have wondered whether homeopathy's effect results from the interaction between practitioner and patient during the intensive case history interview rather than from the medications themselves. That question has pushed Adler and colleagues at Charité University Medical Centre in Berlin, Germany, to conduct a new investigation.

 The German team has designed a randomized, partially double-blind, placebo-controlled four-armed trial involving 228 patients with major depression. Patients will be randomly assigned to one of two types of homeopathic case history groups that will differ in the time used for the interview and questionnaire. As in the Brazilian study, Adler will conduct the interview and prescribe the homeopathic medicine (Q-potency). The pharmacy will give each patient the actual medication or a matching placebo, depending on the patient's randomization number. Adler will be aware of each patient's case taking group, but he will not know whether a patient is receiving an active homeopathic or a placebo until the study ends. Patients in each case history will be randomly assigned to take an individualized homeopathic medicine (n = 76) or a placebo (n = 38). The Hamilton Depression Rating Scale, Beck Depression Inventory, and psychiatric evaluation will measure response and remission rates, quality of life, and safety. The primary limitation of the study's design, according to the authors, will be its short length of just six weeks. Selecting the correct homeopathic medicine for an individual can take longer than six weeks, but ethics forbids the use of placebo for a prolonged period.
I will be interested in seeing the results of this study when it is completed.

Adler UC, Krüger S, Teut M, et al. Homeopathy for Depression – DEP-HOM: study protocol for a randomized, partially double-blind, placebo controlled, four armed study. Trials. 2011;12:43. Available at Accessed July 20, 2011.
Adler UC, Paiva NMP, Cesar AT, et al. Homeopathic individualized Q-potencies versus fluoxetine for moderate to severe depression: double-blind, randomized non-inferiority trial. Evid Based Complement Alternat Med. 2011. Available at Accessed July 20, 2011.

Meditation for Mental Disorders
We know that meditation is beneficial for the physical body, but could it also be a feasible treatment for mental disorders? Meditation reduces metabolic activity and shifts the nervous system toward parasympathetic dominance (slows heart rate and increases peristalsis and gland activity), which facilitates relaxation, stress reduction, and healing. In addition, meditation changes brain patterns. Katya Rubia at King's College University's Institute of Psychiatry (London, UK) recently published a literature review of research that supports the use of meditation in mental disorders.

Meditation affects brain wave activity, neurotransmitters, and cognitive function. During meditation, theta and alpha brain wave activity increase in the left frontal lobe. This brain area seems to house positive emotions. People who meditate regularly have consistently higher melatonin and serotonin levels in their blood. Even people who are new to meditation show an acute rise in these mood-stabilizing neurotransmitters. On a cognitive level, long-term meditation practice increases concentration, improves self-control, and improves the ability to focus.

Although research literature clearly documents meditation's ability to affect physiology and cognitive function, its psychiatric benefits are still uncertain. One problem lies in the variety of meditation techniques. In general, most meditation practices involve focusing one's attention on breathing, a mantra, an object, or inner quiet. Some techniques, however, may be more effective in treating mental disorders than others. For example, a small, randomized, controlled study, led by D.S. Shannahoff-Khalsa, compared Kundalini yoga (posture and breathing exercises) with relaxation and mindfulness-based meditation (control). Only patients in the Kundalini yoga group improved: an improvement of 71% on the Yale-Brown Obsessive Compulsive Scale after 15 months of practice. Other meditation practices used in research studies include Sahaja Yoga meditation (for ADHD, anxiety, and depression) and Sudarshan Kriya Yoga (for depression and anxiety). Transcendental Meditation has also been the subject of numerous studies, but Rubia does not include TM in her review.

Rubia would like to see more studies that compare the physiological and clinical effects of different meditation techniques. "Once we have established a more thorough understanding of the specific behavioural and cognitive effects and the underlying neurofunctional mechanisms of action of these different Meditation techniques," Rubia writes, "… there is scope for the use of some of these Meditation techniques as a promising health intervention for specific disorders, either alone or as an adjunct to existing conventional treatment."

Rubia K. The neurobiology of Meditation and its clinical effectiveness in psychiatric disorders. Biol Psychol. 2009;82:1–11. Available at Accessed July 20, 2011.
Shannahoff-Khalsa DS, Ray LE, Levine S, et al. Randomized controlled trial of yogic meditation techniques for patients with obsessive-compulsive disorders [abstract]. CNS Spectr.  December 1999;4(12):34–47. Available at Accessed August 14, 2011.

Psychiatry and Drugs
Last summer, Marcia Angell, MD, reviewed three new books about psychiatry and psychiatric drugs for the New York Review of Books: The Emperor's New Drugs: Exploding the Antidepressant Myth by Irving Kirsch; Anatomy of an Epidemic: Magic Bullets, Psychiatric Drugs, and the Astonishing Rise of Mental Illness in America by Robert Whitaker; and Unhinged: The Trouble with Psychiatry – A Doctor's Revelations About a Profession in Crisis by Daniel Carlat. Her two-part essay discusses the history of psychiatry, its relationship to the pharmaceutical industry, and the flawed rationale underlying the use of psychoactive drugs. Angell, former editor of the New England Journal of Medicine, has long criticized the quality and clinical validity of medical research, particularly pharmaceutical studies.

Until the 1950s, modern psychiatry followed Sigmund Freud's lead and employed psychoanalysis. Freud viewed mental illness as the result of unconscious conflicts, stemming from childhood, that could be resolved with talk therapy. Then, pharmaceutical researchers discovered that drugs being tested to treat infections could alter the mental state. When these drugs, including the tranquilizers chlorpromazine (Thorazine) and meprobamate (Miltown), gained FDA approval in the 1950s, psychiatry headed onto a new path: a biological and, unfortunately, a pharmaceutical track for subduing mental symptoms. When researchers discovered that psychoactive drugs affect neurochemicals, a theory arose that chemical imbalances in the brain cause mental illness. According to this theory, too much dopamine must cause schizophrenia since Thorazine (used to treat schizophrenia) decreases brain dopamine levels. Selective serotonin reuptake inhibitors (SSRIs), which increase serotonin levels by preventing its reabsorption, seem to alleviate depression; so depression must be caused by low serotonin levels. "That was a great leap in logic, as all three authors point out," says Angell. "It was entirely possible that drugs that affected neurotransmitter levels could relieve symptoms even if neurotransmitters had nothing to do with the illness in the first place (and even possible that they relieved symptoms through some other mode of action entirely)." Authors of all three books could find no good evidence that supports the neurotransmitter theory.

Whether the theory is right or wrong, research studies show that psychoactive drugs are effective treatments, right? Not really. Psychologist Irving Kirsch and colleagues acquired FDA reviews of all placebo-controlled clinical studies (positive and negative) that led to the approval of Prozac, Paxil, Zoloft, Celexa, Serzone, and Effexor. "Altogether, there were forty-two trials of the six drugs," Angell explains. "Most of them were negative. Overall, placebos were 82% as effective as the drugs, as measured by the Hamilton Depression Scale (HAM-D), a widely used score of symptoms of depression. The average difference between drug and placebo was only 1.8 points on the HAM-D, a difference that, while statistically significant, was clinically meaningless." Kirsch also found that drugs other than antidepressants – including opiates, synthetic thyroid hormone, sedatives, and stimulants – relieve depression. In fact, any substance that causes anticipated side effects during a clinical trial is perceived to be the active drug by patients and doctors. Since they believe that they are receiving the real treatment, they are more likely to report improvement. Kirsch says that the reason antidepressants appear to be more effective in people with severe depression may be because these patients receive a higher dose and, therefore, experience more side effects. "'Putting all this together,' writes Kirsch, 'leads to the conclusion that the relatively small difference between drugs and placebos might not be a real drug effect at all. Instead, it might be an enhanced placebo effect, produced by the fact that some patients have broken [the] blind and have come to realize whether they were given drug or placebo. If this is the case, then there is no real antidepressant drug effect at all. Rather than comparing placebo to drug, we have been comparing "regular" placebos to "extra-strength" placebos.'"

"When psychoactive drugs were first introduced, there was a brief period of optimism in the psychiatric profession," Angell writes, "but by the 1970s, optimism gave way to a sense of threat. Serious side effects of the drugs were becoming apparent. …" The American Psychiatric Association initiated a public relations campaign to improve psychiatry's image and medical status. Counselors and psychologists could only provide "talk therapy." Psychiatrists, however, had the medical license and scientific training to prescribe psychoactive drugs. Robert Spitzer, a professor of psychiatry at Columbia University, led the revision of the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders, 3rd edition. In this revision, the biological (i.e., pharmaceutical) model took precedence over the Freudian view. DSM lists possible symptoms for each mental disorder. When patients display a predetermined number of symptoms, they are diagnosed with that disorder and qualify for the corresponding drug treatment. "Not only did the DSM become the bible of psychiatry, but like the real Bible,it depended a lot on something akin to revelation," Angell writes. "There are no citations of scientific studies to support its decisions. That is an astonishing omission, because in all medical publications, whether journal articles or textbooks, statements of fact are supposed to be supported by citations of published scientific studies."

Psychiatry has become the pharmaceutical industry's favorite specialty. Psychiatrists receive more gifts, free samples, "educational" materials, and speaking engagements than any other group of doctors. The American Psychiatric Association receives about 20% of its income from drug companies. As former drug sales representative Gwen Olsen explains in her book, Confessions of an Rx Drug Pusher, and in online videos, the pharmaceutical industry is all about making money. (See Pharma's business depends on disease maintenance, not on disease cures. These companies design drug studies to get the positive results they want. They manipulate statistics. They encourage their sales representatives to "skillfully sidestep" doctors' concerns and queries about side effects. Because psychiatric diagnosis relies solely on a set of symptoms, without any objective laboratory evidence of dysfunction, virtually anyone at some time in life could qualify for a psychoactive drug prescription.
"Once you get a child on a drug, especially a psychiatric drug, they are a lifetime consumer," says Olsen in the video "Changing the Paradigm." Getting off these drugs is difficult. The numbers of US children, particularly children in low-income families, on psychoactive drugs is rising: a 35-fold increase between 1987 and 2007. Having family members on psychoactive drugs makes it possible for low-income families to receive Supplemental Security Income. Instead of being so quick to treat children with drugs, Angell says, "… we need to rethink the care of troubled children. Here the problem is often troubled families in troubled circumstances. Treatment directed at these environmental conditions – such as one-on-one tutoring to help parents cope or after-school centers for the children – should be studied and compared with drug treatment. In the long run, such alternatives would probably be less expensive." Research has already shown that nondrug interventions for adults, such as exercise and psychotherapy, are more effective treatments for depression than medication. Advertising, however, has convinced patients and doctors otherwise – at least for now.

Angell M. The epidemic of mental illness: why? New York Review of Books. June 23, 2011. Available at Accessed July 11, 2011.
Angell M. The illusions of psychiatry. New York Review of Books. July 14, 2011. Available at Accessed July 11, 2011.

Spirit Possession
I came across a case study in the International Society for the Study of Subtle Energies and Energy Medicine's magazine Bridges that makes me wonder about the spirit component of the mind-body-spirit paradigm in the field of psychiatry. In "Subtle Energies in Psychotherapy: A Case Study," C. Shaffia Laue, MD, writes about a 19-year-old woman whose eating disorder was being controlled by a voice. Antipsychotic drugs did not silence the voice that told J to stop eating or to overeat and vomit. Following the voice's orders had repeatedly disrupted the young woman's electrolyte balance. Every 30 to 60 days for two years, J had to be hospitalized to stabilize her electrolytes. Before her parents brought J to see Laue, the young woman had been evaluated at two major psychiatric clinics. She was taking antipsychotic, antidepressant and antianxiety medications. Laue noted that unlike most patients with eating disorders, J was not obsessed with her looks. Rather, she was most concerned with this voice, which she called Tammy, located on the right side of her brain. Instead of immediately discounting it as a hallucination, Laue questioned her. The way J described the relationship with the voice caused Laue to observe, "It's as if you are locked in mortal combat for control of your body," a statement that J confirmed. Laue also learned that the voice first presented itself after J had had two major surgeries within three days the summer before entering seventh grade.

Because of her work with subtle energy healing, Laue accepted "… the possibility that while [J] was under anesthesia, with her energy field open and vulnerable, that the 'soul' of a person who had recently died at the hospital in a confused state, had attached to J instead of going to the Light." Laue shared this idea with J and her parents. Laue asked J's permission to speak directly with the voice, without using hypnosis. J agreed, and her parents left the room. The voice, "Tammy," told Laue that she liked being in control of J's body. During her own life, Tammy had been very lonely. She had spent her days overeating and watching television until she killed herself by slitting her wrists. After much reassurance and "cajoling," Laue convinced Tammy to move on to the Light. When J reported that Tammy was gone, Laue sealed off J's energy field. J's parents noticed an immediate difference; for the first time in years, J smiled. At a follow-up call the next day, J's mother "said that it was like living with a different person." Over the next 18 months, J continued therapy to learn better ways to cope with stress. During that time, she discontinued all psychotropic drugs and did not need to be hospitalized.

As an interesting side note, Laue says: "The energy field of a person on anti-psychotic medication … feels almost nonexistent to an observer who is sensitive to the fields of others, because of the way the field is closed off by the medication. This raises an interesting question as to whether 'the voices' come from a biochemical malfunction of the brain, or might be information that these people are taking in through their energy field's sensory apparatus, which is then, traditionally, shut down by medication."

Spirit possession, the idea that nonphysical entities can take over a human body, is accepted in many traditional cultures throughout the world and by some Western religions. Psychiatry categorizes spirit possession, a diagnosis usually made by a traditional healer, as a dissociative disorder. The DSM-IV, which lists defining symptoms of psychiatric illnesses, says that spirit possession is not pathological unless it is foreign to the patient's culture and is causing distress and impairs functioning. Trauma appears to be an instigating factor in spirit possession, even in traditional societies, according to a Dutch study led by Marjolein van Duijl.

Cases like Laue's patient rattle our paradigm, which is primarily grounded in a mechanical-chemical view of the body. At this time, conventional treatment turns to antipsychotic drugs to treat these cases; most of us don't have access to a shaman or doctor versed in energy work. How many cases of spirit possession turn up during a Western doc's medical career? Perhaps more than we recognize. Canadian doctor Amin Muhammad Gadit, MD, in a viewpoint article for the American Psychiatric Association's Psychiatric News said that he had had three patients within two years whose "symptoms did not fit into any of the clinical conditions we come across in everyday clinical practice" and who "firmly believed that they were possessed by jinni [spirit]." Gadit raises the point that shamanic treatment often benefits patients who do not respond to psychiatric drugs. "Scientists continue to argue against possession as an etiological factor responsible for mental illness," writes Gadit, "but the fact remains that refuting something that science cannot prove is inappropriate on the basis of our limited understanding of the world and its creations."

Gadit AM. Demonic-possession phenomenon merits scientific study. Psychiatric News. March 16, 2007; 42(6):12. Available at Accessed August 8, 2011.
Laue CS. Subtle energies in psychotherapy: a case study. Bridges. Fall 2005;16(3):5–10.
Van Juijl M, Nijenhuis E, Komproe IH, Gernaat HBPE, de Jong JT. Dissociative symptoms and reported trauma among patients with spirit possession and matched healthy controls in Uganda. Cult Med Psychiatry. 2010; 34:380–400. Available at Accessed July 20, 2011.

Attachment, Stress, Addiction, and Bullies
Bullying, violence, and addiction result from personal choice, according to the moralist view (used in law). Most medical researchers blame genetics or, depending on their bias, nutritional deficiencies and heavy metal toxicities. Canadian physician Gabor Maté believes that parental stress transmitted to the child and a lack of communal/social attachment to adults are to blame. He bases this on emerging knowledge about epigenetics (the study of environmental factors that affect genetic expression), neurotransmitters, and development. Life experiences change brain chemistry and brain circuitry. In infants and children, environmental factors have a profound effect on their still-developing brains. As examples of the effect of nurturing (or its absence) on young mammals, Maté refers to animal studies in which infant rats develop fewer brain receptors for the body's natural tranquilizer when they receive less grooming from their mothers. In infant monkeys, brain dopamine levels fall when they are separated from their mothers for just a few days. Calm, nurturing interactions with loving parental figures release endorphins in infants' brains (including human infants). Endorphins promote the growth of brain receptors and nerve cells and the release of important neurochemicals.

 Maté told Amy Goodman on Democracy Now: "… the essential condition for the physiological development of these brain circuits that regulate human behavior, that give us empathy, that give us a social sense, that give us a connection with other people, that give us a connection with ourselves, that allows us to mature – the essential condition for those circuits, for their physiological development, is the presence of emotionally available, consistently available, non-stressed, attuned parenting caregivers." Our culture no longer knows what "nonstressed" means. Stress is the norm. Only a minority of children receive the type of caregiving that Maté espouses on a consistent basis. The nurturing human connections, previously experienced through extended family and community, have become increasingly scarce. Despite all the communication technology and media sources (or maybe because of them?), our culture has become one of emotional disconnection.

Even though society has changed, the need for attachment, the desire to be close to another person, has not. Maté says, "… attachment is a powerful force in human relationship – in fact, the most powerful force there is. Even as adults, when attachment relationships that people want to be close to are lost to us or they're threatened somehow, we get very disoriented, very upset. Now, for children and babies and adolescents, that's an absolute necessity, because the more immature you are, the more you need your attachments. ..." Over the past 50 to 60 years, more and more young people are being guided by peer attachments. Ours is a youth culture, devoid of the wisdom and integrity of an adult society. Mature adults can model self-acceptance, unconditional love, and the willingness to sacrifice for the good of others – qualities that most young people do not have and, therefore, cannot teach to each other. Being peer oriented means trying to maintain attachment in a culture rife with negative talk, put-downs, exclusion, and bullying. Peer culture is not a safe environment for being authentic, for opening oneself to the possibility of being wrong or different. "For members of the post-war generations born in England, North America, and many other parts of the industrialized world, our own preoccupation with peers is blinding us to the seriousness of the problem," says Maté.

Maté G. Holding on to your kids in a peer culture. Transition. Autumn 2005:3–8. Available at
. (One link, two lines.) Accessed July 14, 2011.
———. Why punish pain? YES! Summer 2011;24–26. Available at Accessed July 14, 2011.
Maté G., Goodman A. Dr. Gabor Maté on the stress-disease connection, addiction, attention deficit disorder and the destruction of American childhood [interview]. Democracy Now. December 24, 2010. Available at Accessed January 4, 2011.

Virtual Reality Exposure Therapy
Real life (in vivo) exposure to traumatic situations as part of cognitive-behavior therapy is an effective treatment for phobias and posttraumatic stress disorder (PTSD). Recreating in vivotrigger events for people who fear spiders or fires or even crowds is fairly easy. Recreating combat events or air flight is not. Over the past 10 years, researchers have begun developing and testing computer-driven virtual reality exposure programs (VRE) to use in therapy. Virtual reality exposure therapy allows people with phobias and with PTSD to experience anxiety-producing triggers in a controlled environment. In VRE, patients wear helmets that "… [position] goggle-size television screens close to each eye, enabling the patient to see a single image with realism and depth," Patricia Edmonds explains in her article for Washingtonian Magazine. "Headphones supply sound; … joysticks and gloves let the patient manipulate the scene." The patient has all the sensory cues he needs to feel immersed in the triggering environment and yet know that he has ultimate control over the situation. He can stop the therapy whenever he wants. Studies indicate that VRE is as effective as in vivo exposure therapy in treating a variety of phobias, including fear of heights, driving, flying, spiders, and closed spaces, as well as panic disorder, agoraphobia, and PTSD.

A 2007 study involving 37 patients with panic disorder (with or without agoraphobia) compared VRE with in vivo exposure and to a waiting-list control group. This small study found that 100% of patients treated with in vivo exposure therapy, 90.9% treated with VRE, and 28.57% on the waiting list had at least a 50% reduction in panic frequency at the end of the treatment period. At a one-year follow-up, 90% in the in vivogroup and 91.6% of the VRE group were functioning normally.

At this point, most therapists see virtual reality exposure therapy (VRE) as a supplement to rather than a replacement for in vivo exposure. Nonetheless, VRE has several advantages. From the patient's point of view, VRE ensures protection from unexpected adverse events. Agoraphobic patients, who find the thought of going to a shopping mall in real life – even with a supportive therapist – terrifying, are more likely to take part in VRE therapy because they have more control over the situation. VRE also gives therapists the ability to repeat situations until patients' physical responses (heart rate, etc.) indicate a reduction in anxiety. Finally, VRE lets patients learn to deal with their fears in the privacy of an office.

Psychologists at the Virtual Reality Medical Center (San Diego, CA) use VRE along with biofeedback and meditation to help veterans with PTSD. Virtual Reality Exposure Therapy with Arousal Control (VRET-AC) uses veterans' subjective reports of discomfort and objective measurements of stress (e.g., heart-rate variability, respiration rate, skin resistance, and peripheral skin temperature). When the subjective reports match the physiological responses, the psychotherapist knows that the veteran is not suppressing underlying stress. Synchronicity of the two components indicates that the veteran is engaged and immersed in the VRE experience. The goal in VRET-AC is for the veteran to gain "mastery" over experiencing increasingly complex and stressful combat situations by using biofeedback, meditation, and cognitive reframing. If VRET-AC proves to be an effective therapy for PTSD, the suicide rate among combat veterans (an estimated 6000 per year) may finally decline.

Botella C, Garcia-Palacios A, Villa H, et al. Virtual Reality Exposure in the Treatment of Panic Disorder and Agoraphobia: A Controlled Study. Clin Psychol Psychother. 2007;14:164–175. Available at Accessed July 14, 2011.
Edmonds P. Virtual cures for real-world phobias. Washingtonian. March 2004;39–49. Available at Accessed August 15, 2001.
Hotakainen R. Senators, courts tell VA to reduce veteran suicides. News Tribune. May 26, 2011. Available at Accessed June 29, 2011.
Parsons TD, Rizzo AA. Affective outcomes of virtual reality exposure therapy for anxiety and specific phobias: A meta-analysis. J Behav Ther Exp Psychiatry. 2008;39:250-261. Available at
. (One link, two lines.) Accessed July 16, 2011.
Wood DP, Wiederhold BK, Spira J. Lessons learned from 350 virtual-reality sessions with warriors diagnosed with combat-related posttraumatic stress disorder. Cyberpsychol Behav Soc Netw. 2010;13(1). Available at Accessed July 16, 2011.



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