Thursday, December 8, 2011

Can You Recommend A Book by Idries Shah?

A colleague, appreciating a comment which I'd posted to a listserve discussion, which included a couple of quotes by Idries Shah, asked me to recommend a book of Shah's for her to read. Here's my reply:

Here's a very brief overview of Shah's writing that might indicate a title you might like to look into.

Shah wrote over 30 books, and the styles vary. He also wrote over a period of thirty years or so, so sometimes his writing might reflect changes in readership, with the later books perhaps written partly for a readership familiar with the earlier books. Which is not to say that the earlier ones aren't full of value; "The Sufis," for example, was his first Sufi book, in 1964 I think, and I am not alone in finding new content whenever I return to it. It lays out a sort of patchwork background of Sufi thought and action over the past thousand years or so, and if you are looking for a historical context, you might find it here. Another earlier book that has some context about Sufism is "The Way of the Sufi," which contains examples of stories, meditation themes, comments from the masters, sort of a representative cross-section of classical Sufi thought. At the same time, it isn't an A through Z genre or catalog; each book stands on its own, so a reader could start anywhere.

"Learning How To Learn: Psychology and Spirituality in the Sufi Way," is based on lectures Shah gave in New York and California (in 1974, as I recall), as is "A Perfumed Scorpion." "Seeker After Truth" came in 1982. "The Commanding Self," and "Knowing How to Know" are later works, and they are all very rich in psychologically and spiritually relevant content, in which the interaction of traditional Sufi attitudes and perspectives and contemporary Western psychological and sociocultural perspectives and behavior are more up front, at least to me. Shah was a great storyteller, and these books, in style, go back and forth between stories and discursive discussion.

The Sufis are preeminent cultivators of stories--Shah coined the term, "Teaching Stories" for a particular genre of tales--seeing story and metaphor as reflecting both reality and processes of thought and perception in ways that logic, analysis, etc., can't. It's not that logic and analysis are discarded, but they have a subordinate role to perception. This makes sense because we have to perceive the context of a situation before we can analyze or measure parts of it. Sufis see our perceptual capacities as capable of being provoked and evolved through various experiences, in which stories can play a part. At the same time, they emphasize the importance of having one's feet on the ground, as it were, in being well integrated into ordinary life.

Shah published several collections of stories without narrative, and little or no commentary, such as Tales of the Dervishes (an early collection of classical tales) and The Magic Monastery (a later one, including modern tales of his own). "Thinkers of the East" and "Wisdom of the Idiots" are others; "Dermis Probe" contains an award-winning script based on Rumi's "Elephant in the Dark" story, and has brief comments in an appendix. "Caravan of Dreams" is another kind of cross-section, containing travel writing, stories, table talk, and more.

Adding to the richness of Shah's work and the complexity of recommending a first book, there are several volumes of stories about Mulla Nasrudin, the wise-fool figure whose antics reflect mental processes, a sort of psychological mirror. Some Nasrudin fans like him right away, for others he's an acquired taste. There's a chapter on Nasrudin in The Sufis which provides context. Canadian storyteller Aubrey Davis posts Nasrudin stories on Facebook, and you can "friend" Nasrudin and receive occasional stories to your facebook screen,at

So, there's a brief overview of some of Shah's work. If you want an introduction with background and context, "The Sufis" is a good place to start. "Way of the Sufi" provides a sort of cross-section of classical Sufi thought. If you prefer a more psychologically oriented presentation, "Learning How To Learn" might provide that; although there's a lot of psychological and social-behavioral insight throughout Shah's work. If you'd like to start just with stories, you might try "Tales of the Dervishes," "Thinkers of the East," "Wisdom of the Idiots," or "The Magic Monastery." If you'd like a later work, starting at the end of his writing career so to speak, "Knowing How to Know," is his last.

Shah's books are not much on the bookstore shelf these days, although you can often find one or two, and you could try your luck with whatever might be in your local bookstore. Amazon and Barnes and Noble carry selections online. More complete catalogs are available in USA through ISHK Book Service,, and also from Octagon Press in London

My colleague replied:

Hello Jay,

What a delightful answer, thank you for spending the time to give me such full information on Idries Shah. I have long been interested in storytelling and so love the tales of Nasrudin. I am also attuned to the mystical traditions in all cultures and would like to read more about Sufi thought. So, I will choose from each genre.

I have a favorite bookseller online, because they use part of their profits to support world literacy: and they have 14 of Shah's books in stock.

Thank you!

Saturday, October 15, 2011

Inspiration and the Creative Spark: at the 2011 Conference of the Institute for Cultural Research, London, Part 2

Sunday’s program began with an experiential exercise in creative perception by the teacher, facilitator, engineer, businessman, artist and musician David Kayrouz (

Perception, Kayrouz said, is both cognitive and affective. Essentially, it is about How do you know. He quoted St. John of the Cross: “To know everything: Does anyone know the end of that? Know nothing.” Kayrouz continued, “Knowing is a way of not knowing because when we ‘know,’ we stop learning.” Similarly, he prefers the verb “knowing” to “knowledge.”

From the stage, Kayrouz held out two pictures, one to his left and one to his right. One was called “old rat,” the other, “old man,” both were quite similar. Then he projected a powerpoint image on the screen and asked the audience what it was. Those on his left said it was an “old rat,” while those on his right said it was an “old man.” Our perceptions of the picture had been shaped by our prior experience.

“We perceive color affectively but read cognitively,” he continued. He showed a slide of a list of color names, in which the letters of each color name were in a different color than the word name of the color, and asked an attendee to say the colors in which the names were written rather than reading the names. The reader had a hard time with that.

Kayrouz then showed a slide of an indeterminate abstract sort, which reminded me of a Rorschach ink blot, and and asked us to write what we saw. Then he rotated it 1/4 and asked us to look and write again, then he rotated it again. Next he asked us to form small groups and discuss what we’d seen. The members of my group found ourselves seeing more in the slide when we looked together and had the benefit of each other’s perceptions, and this turned out to be the experience of other groups as well. This emphasized, Kayrouz said, that creativity is often a group phenomenon, and that the image of the lone creator coming up with great ideas is more myth than reality.

Returning to his theme of contrasting cognitive and affective perceptual processes, Kayrouz said, “Cognitive perception has rules and judgment, affective perception has no rules and suspended judgment. Cognitive perception works with proven results, affective perception involves experiment and play.” Kayrouz showed a slide of a Venn diagram with cognitive and affective circles, and an area of overlap. “Imagination is where the cognitive and affective overlap.”

Kayrouz had one of the shortest session times, just 15 minutes in the program and somewhat longer actually, but he packed a lot of experience and meaning into a short time!

Our next presenter was Simon Elmes, Creative Director of BBC Radio’s Documentaries Unit, associated with such superb projects as “A History of the World in 100 Objects,” in collaboration with the British Museum. His presentation considered creativity at the BBC within two contexts:

• That of a public broadcast organization which identifies creativity as its professional lifeblood, and

•That of a public broadcast organization which is constantly challenged to maintain and improve programming quality in spite of reductions in resources, including personnel

“In some ways, inspiration to order” is his job.

Elmes contrasted ongoing creativity with mission statements and vision statements, which “tend to ring a bit hollow.” Creativity is the lived experience.

“The creative spark doesn’t come from a focus group,” he said. The inspiration for “A History of the World in 100 Objects,” for example, emerged from “a confluence of ideas at the British Museum” during a meeting of British Museum and BBC staff. “Afterward, several people said it was their idea.” In fact it was a creative collaboration between a number of highly professional people.

After giving the audience an exercise in coming up with ideas (“wind tunneling”), Elmes said, about his job and group at BBC: “New ways of seeing things is what we’re trying to do all the time. This applies not only to programming but also to the H.R. (Human Resources) department. B.B.C. as an organization has to be imaginative when we’re making photocopies as well as making programs.”

Elmes repeatedly returned to the theme of the need to live creatively on a day to day basis. “Words like creativity and community can take on a shibboleth value.”

Exercises can be part of the process of creativity. “There are hundreds of names for creative techniques, which unhook the creative part of the brain from the routine perceptive part of the brain.”

Contrasting creativity with genius, Elmes reflected on the great novelist Flaubert, who wrote slowly and complained of being “dazed, bogged, in a swamp of despair” as he struggled with his novel. “Today’s BBC can’t move at that pace,” Elmes commented. “We are working against an incredibly fast-moving and creative environment. All sorts of organizations have to be creative from top to bottom.” When substantial cuts were announced at B.B.C., it was with the slogan: “Deliver Quality First.”

The history of the B.B.C.’s commitment to creativity included a 2-3 year period of deeply studying creativity, which included sending a number of leaders within the organization to creativity training organizations such as the Stanford Research Institute, Creative Problem Solving Institute, IDEO, and WhatIf. This led to a group of trained and eager creative leaders within the B.B.C., but “A few evangelists who have seen the (creative) light are no substitute for senior management buy-in.” Fortunately, support for creativity throughout the organization came from B.B.C. Director General Mark Thompson.

This led to the emergence of “a creative network” of people who work “on a voluntary basis, under the radar and across silos--such as the News, Radio, TV, and Online parts of the B.B.C. “This involves people working creatively with parts of the B.B.C. they don’t know about.”

Elmes discussed some of the pitfalls of what can be mistaken to be creative processes. “When you work with a focus group what you often end up with is what you are already familiar with.” “Brainstorming s often not very well applied,” especially when participants are allowed to interject negative judgments on others‘ ideas (or their own). “Discipline in creative idea generation is absolutely basic. In brainstorming you mustn’t stop ideas, even if they are rubbish,” because a rubbish idea might lead to a better one. “If someone is being negative, you say, with a smile, ‘No negativity.’” Thus, improperly trained coaches could undermine the methods they are using. Creativity involves “the freeing up of the mind in a disciplined way.”

Asked about basing new B.B.C. programs on successful programs on other channels, Elmes said, “We innovate, we don’t clone.”

Writer Kamila Shamsie spoke next about “Finding the Novel Inside the Image.” “What does it mean for a writer to work within a discipline without formulae? How do you piece together a structure as intricate as a novel if your guiding notion is, ‘don’t do it the way you did it before?’

Like Susan Aldrich yesterday, Shamsie emphasized the importance of unplanned happenings in the creative process. In addition to the need for “some sort of structure and thought,” there have to be “some moments of serendipity...I haven’t met a writer who hasn’t been fantastically surprised because something (unexpected) happens” to the novel as it is emerging. “There’s a kind of wildness that happens when you are writing that’s essential, that’s unconscious, you don’t know what you’re interested in.”

Discussing the process of starting to write her most recent novel, “Burnt Shadows”, about the Nagasaki bomb, she said, “It was just one of those things that takes residence in your mind. There are some images, you know, they’re not going to go away. I tried very hard not to write this book.” Committing to a novel is no small matter since “The novel has to be something I’m willing to be obsessed with for two or three years.”

Although she intended to create a short opening to her book which featured the bombing of Nagasaki (most of the book takes place later on), Shamsie had to accomplish it through a nonlinear route. “I couldn’t have done a short opening on day 1.” Instead, she had to do the 80-90 page version, then reduce it to about 25 pages.

Shamsie read extracts, from others work and her own, to demonstrate the relationship between experience, linguistic imagery, creativity, and inspiration. I didn’t make notes from those readings, but came across this in her 2005 novel, “Broken Verses,” the last one of her novels left on the book table when I bought it. The voice belongs to Aasmaani, the 31 y.o. Pakistani woman who is at the center of this story. We find her musing about the many roles of her mother, an activist on behalf of politically charged women’s issues whose disappearance when Aasmaani was 17 has defined her life:

“I entered my flat and locked the door behind me. Here, in my mind, were so many different images of my mother. My mother at twenty-three in a white kurta, lapis lazuli at her wrist. My mother at twenty-six, unable to resist an ex-lover in a grey shawl. My mother at twenty-seven, carrying me into prison. My mother at thirty-four, rallying women together. My mother at thirty-five, running after the Poet to Columbia, leaving the women and me behind. My mother at thirty-eight, her body covered in bruises from a policeman’s lathi, preparing to go out and lead another demonstration. My mother at forty, still dancing to old Donna Summers records. My mother at forty-one, allowing her grief over the Poet to consume her. My mother at forty-two, worse than she had been the year before. My mother at forty-three, gone.
“What connected all the women in these images–the activist, the lover, the mother, the mourner, the dancer, the deserter? What allowed a single ‘version’ to arise from such variedness? There was a word for it: character. That imaginary tyrant. We pretend we all have one, and that it is something to be relied upon, something knowable and true, even when it oppresses and constrains us. When someone behaves ‘out of character’ we frown a little, a voice inside us whispering something that makes us uneasy, but then our brows clear. We’ve found a way to reinterpret the action as being in character. Or we say we were wrong about the person’s character to begin with, and now, magically, our memory is able to furnish us with clues which would have revealed as much had we but picked up on them earlier...we don’t dare consider that the internal voice which makes us uneasy is a voice that whispers: there is no such thing as fixed character, there is only our need to join the dots into a single picture...
“...The joke of it, of course, is that we ourselves become slaves to the stories of our own character. Our invented narratives of self determine our actions and the self-fulfilling prophesy that guides our lives...And all around us, people are reinforcing our notions by telling us, directly and in their treatment of us, who we are, what we believe in. At what point does character-playing become habit, something for which we are grateful because it allows us to go through the world with the ease that comes from being predictable to ourselves, even if that predictability takes the form of neurosis, hysteria, depression? And at what point does that habit turn darkly into addiction...”

Shamsie’s writing suggests that our beliefs about what we’re like both liberate and limit our creativity, and that allowing inspiration to occur and creativity to work its way along implies that we discover ourselves and others in new ways.

Creativity trainer and improvisational actor Greg Fraley gave the final presentation, of the “Mash-Up” method. “Most great ideas tend to be made of mash-ups,” by which he means, roughly, throwing ideas and experiences together and shaking them up to see what comes out. He praised Sunni Brown’s TED talk on doodling ( and then led us in experiential “Mash-Up,” in which we doodled, danced to music, and free-associated about some situation that we were thinking about.

Some participants found it easier going than others. One participant, thinking about how to lose weight, came up with the idea of carrying the food he’d need with him for the day. Fraley pointed out that about half the people find forced associations, which is what his mash-up exercise was, easy, and half find it difficult.

The final event on Sunday was the Panel, on which several presenters took questions in writing from the audience, read by Saira Shah.

One presenter--I didn’t note whom--in response to a question about metaphor, said that “metaphor is a way of communicating experience without being so descriptive as to require the listener or reader to re-live it.”

In response to a question about how to make a better environment, Kamila said, “Stop asking a question like that, and just sit down and do it...You find that space, you make that space.” She quoted someone (again I didn’t not whom) on the importance of will compared to talent and originality, in achieving results.

Simon said, “It’s not so much having an idea as spotting an idea as it goes by. You need to take your will and say, I will spot that idea.”

David said, “Experiments with two groups of equal talent, one of which believes they are know the outcome.”

Simon added, “Ideas cost nothing. People say we can’t afford creativity, but ideas cost nothing.”

Responding to a question about whether there was something in society that stifles creativity, Kamila commented, “There’s something about the incredible response to the death of Steve Jobs, (who was) both very creative and a billionaire.”

Greg added, “Educational systems reward having the one right answer and not the ten possible answers.”

David said, “Even trees are creative.” Saira replied, “Perhaps not consciously creative.”

In a response to a question (which I had submitted) about the effects of creativity in the financial system as they contributed to the global economic crisis, Greg observed that, “One definition of creativity is novelty that’s useful. Some of the new financial instruments that made a lot of money for a few people are creative but not innovative.”

Kamila commented, “There was a lot of imagination on the part of governments.”
David said, “What we want is creativity that’s good for everyone. We need a moral and ethical process integrated with it.”

Kamila observed: “The human imagination is not moral. The atom bomb is an act of creativity in a certain sense.” She referred to the play‘“Copenhagen,” by Michael Frayn, in which physicists Niels Bohr and Werner Heisenberg are in conversation, Bohr asks Heisenberg why he did not do the maths to create the bomb, and Heisenberg says, “Because I didn’t really want to create the bomb.” “An idea can have a life of its own,” she observed, and want to be realized, regardless of its morality.

Greg said that “Creativity comes from very near the soul. When it is negative it comes from a corrupted soul.” Kamila replied, “Beyond a certain point I don’t know that you can stop yourself. You walk down that path far enough, it’s going to happen. Your brain fools itself.”

David recalled a dream of Kamila’s that she had described in her talk, in which she wept at the epicenter of the Nagasaki bomb, where her character died, emphasizing the role of empathy in creativity.

In reply to a follow-up question about whether creativity was always a good thing, Simon said, “Yes, if you’re not creative you’re on a stalled elevator.”

The diversity of backgrounds, interests, personalities and professions of the presenters, as well as the diversity among the audience, made for a great conference; it was good “brain food,” and I expect I’ll be digesting it for some time to come.

Thursday, October 13, 2011

Inspiration and the Creative Spark: At the 2011 Conference of the Institute for Cultural Research, London, Part 1

On October 8 and 9 I attended the 2011 conference of the Institute for Cultural Research, London, entitled “Inspiration and the Creative Spark.” This year’s conference brought together presenters from the worlds of neuroscience, psychology, visual art, fiction writing, corporate leadership, myth and legend, and creativity training, to approach the subject from many different perspectives. So the conference itself was both a source of inspiration and sparks for creativity!

Neuroscientist Adam Zeman, author of Consciousness: a user’s guide, and A Portrait of the Brain, Professor of Neurology at the Penninsula Medical School in Exeter, and former Chairman of the British Neuropsychiatry Association, started the conference on Saturday morning with a look at creativity and brain function.

He addressed three typical misunderstandings about creativity and brain:

•The assumption that culture and biology are separate. They are not: culture influences the brain and the brain influences culture.

•The assumption that the brain is passive. It is not: the brain is continuously active. Even at rest it consumes the largest share of oxygen taken in by the body of any organ, about 20-25%, and that percentage goes up some, but not a great deal, when it is actively focused on a task.

•The assumption that imagination and creativity are rare. In fact, Zeman sees the brain as spontaneously, and more or less continuously, imaginative and creative, even while just doing the ordinary chores of life.

Zeman presented what he called the “Ski-D-y” model of creativity, consisting of three parts:

•Skill: what the brain has learned how to do through its interaction with culture, and it’s ability to continue to extend and modify that learning
•Detachment: the ability to step aside from what one is doing to take another look at both what one is trying to do and how one is trying to do it, in order to adapt, modify and improve both understanding of task and approach to it
•Spontaneity: the ability of the brain to suddenly find new connections within itself and responses to its environment, following the development of skill and a period of detachment (which could be of any duration)

Within the brain, “learning depends on modifying the numbers and strength of synapses.” Each of the one billion neurons in the brain have between 1,000 and 10,000 synapses, so there’s a huge potential for learning.

Digging deeper into his Ski-D-y model, Zeman considered “Skill” in four aspects:

•Language: the unique (as far as we know) ability of the human brain to construct complex and detailed systems of language to communicate knowledge of various kinds

•Learning: all those neurons in the brain creating new synaptic interconnections

•Theory of Mind: the interpersonal skill of creating implicit models of how other people are thinking and experiencing, including how they are experiencing us as we experience them

•Mirror Neurons: there’s a lot of scientific buzz about these recently discovered neurons that become active both when we do activities and when we watch other people doing activities. By including them within his “skill” category, Zeman seemed to be saying that mirror neurons both provide us with a biological model of how we can understand other people, and that we can learn to improve our understanding of other people as a fundamental skill that is associated with creativity and inspiration

Zeman next dug deeper into “Detachment:”

Crucially, detachment “allows us to choose how we want our minds to be engaged,” and is largely associated with the executive functions of the frontal lobes.

The capacity of imagination means that “We have acquired the ability to run our brains offline.”

Turning to a deeper consideration of “Spontaneity,” Zeman emphasized the brain’s continuous spontaneous activity:

The brain at rest uses about 20-25% of the body’s oxygen. When engaged it only increases that utilization by a percent or two. “So the resting brain is very active.”

There are networks of brain regions that are active even at rest, associated with seeing, hearing, moving, and also theory of mind and moral decision-making. Thus, even when we are not actively perceiving, brain regions associated with perception are active. Even when we are not actively interacting with others, brain regions associated with theory of mind (or social-emotional perception) are active. Even when we are not actively making moral decisions, regions of the brain involved in moral decision-making are active.

“When we dream, areas of the brain involved in memory and emotion are very active but parts of the brain associated with logic and laying down memories are not.”

Perception itself “involves ceaseless spontaneous background (activity) in the brain.”

Zeman emphasized the growing role of the brain in pre-human to human evolution. “Over the last three million years, body weight has remained fairly equal but brain volume increased substantially.” He showed a slide indicating increase in brain volume over Australopithecus, Homo Habilis, Homo Erectus, and Homo Sapiens. This evolution has produced a brain which is “intrinsically spontaneous, creative and imaginative.”

Drawing an analogy between the broad sweep of biological evolution and the particularities of human culture, Zeman commented that, “Biology, like human life, shows a tension between rule making and rule breaking. DNA passes on but occasionally mutates.”

Drawing another connection between culture and brain, Zeman noted that “The pressure of culture creates an evolutionary pressure to improve culture. Enriched environments make the brain grow.”

In reply to a question, Zeman commented on the “creative explosion” that has been dated to around 30,000 years ago; more or less at the time that cave paintings and artistic artifacts have been dated to. “The record may be misleading us, because there may have been creativity whose objects have been lost” prior to that time.

I asked Zeman a version of the question that has been at the core of my own interest and career in psychology: If the brain is so continuously spontaneous, creative and active, how is it that so many people live their way into cul-de-sacs, dead ends, which so much of my work as a clinical psychologist is about helping people find their way out of? In reply, Zeman returned to his theme of “rule making and rule breaking: “Rule making itself has to be learned,” and we can learn our way into a cul-de sac, so to speak, rather than refining the learning process and attitude toward learning. “Brain chemistry affects that as depression, which is associated with (excessive) self-criticism, (and) mitigates against creativity.”

Reflecting on Zeman’s answer, it occurred to me that a great deal of the work of Idries Shah, founder of the Institute for Cultural Research (in 1965), was about helping us to “learn how to learn,” to develop an attitude about learning that prevented cul-de-sacs, or at least supported early recognition of them in order to remain psychologically free, and what I might call metacognitively supple. Furthermore, the teaching stories that Shah collected, revised and wrote provide us with a way to recognize the presence of patterns in our lives and cultures, and prepare our minds for new learning.

Artist Susan Aldworth was our next presenter. Misdiagnosed with a possible brain lesion around Christmas of 1999, and hospitalized for diagnostic tests, the experience of watching her brain imaged on a screen while she was experiencing herself in real time was a life-changing and career-changing event for her, as exemplified in this etching from her website (, “Apoptosis 1 (2007).” (I was unable to paste the etching into the blog, but it's worth seeing, along with her other work, on her website).

“I’m a very cerebral artist,” she said, “I think about my work,” but that doesn’t mean that it can be described in words. Aldrich is “interested in celebrating the mystery of brain and consciousness and bringing it out of the labs.”

Aldworth, who also has a degree in philosophy, showed a short film, “Going Native,” and then discussed the brain, science, philosophy, and the human condition, as muse to the artist.

• “The Brain as Muse:” After being discharged from hospital, Aldrich contacted the physician who had worked with her and asked if she could work with him, which led to her spending a day a week watching brain angiograms from behind a screen in the consulting room (with the patients’ permission, of course). Susan read from her diary about waking up in the operating room with her own monitor, watching an image of her brain in action created from a camera in a catheter which had been inserted in an artery in her groin and threaded into her brain.

• “Science as Muse:” Aldworth uses “quasi-scientific images” in her art, for example, “Birth of a Thought.” “We use brain-scans culturally as a kind of sign-post to the person.” She has created art based on the brain images of an epileptic patient, with eyes looking out, back at the viewer. These images had a very discernible and powerful effect on the audience. It was as if the person depicted in the image was both having a seizure and looking out from that experience at the view, simultaneously. Replying to an attendee’s comment about the power of that image, Aldrich commented that the eyes are associated with selfhood.

• “Philosophy as Muse:” Aldworth described the work of two physicians--I didn’t get their names--who weighed terminally ill patients just before and just after death, each of whom found a difference of about 21 grams. “A materialistic shorthand for the soul?”

• “Human Condition as Muse:” Aldworth works with people with Alzheimers, and has a work entitled: “Dissolution.”

Discussing creativity from her perspective as an artist, Aldworth said, “For an artist, creativity comes from being curious and interested. I do my research and then comes the hard work. For an artist, the accidents that happen on the etching plate” can make a profound contribution to the work.

“There’s a huge history to anatomists and artists working together. Before the 20th century, there were very few representations of the brain. Now there are many brilliant artists” working with brain images.

Aldworth received enthusiastic response from the audience when she talked about the deadening of inspiration in school. “In art school, assessment of students and ticking off boxes is killing creativity and inspiration. We have to look to what we’re doing as our culture.” Another attendee commented: “I trained as a teacher and decided not to go into it because it seems to me that we’re preparing sausages rather than human beings.” Aldrich replied, “It’s not done out of maliciousness, it’s done to raise standards, but the overadministration (ends up stifling inspiration and creativity in the name of higher standards).”

I had purchased the book, “Scribing the Soul,” containing essays by a neuropsychologist, an artist/writer, and a curator, around Aldworth’s images. Chatting in a small group afterward, I had mentioned the importance of constructive nagging, and Aldrich inscribed the book, “To my dear Naggers.”

Lunch was enlivened by conversation with attendees with diverse backgrounds, at a little cafe not far from the School of Oriental and African Studies at the University of London, where the conference was held.

After lunch Ilona Roth, Senior Lecturer in Psychology in the Department of Life Sciences at the Open University, and an expert on Autistic Spectrum Disorders, spoke about “Strange Imagination: Insights from Autism.” (I also purchased her book, “The Autism Spectrum in the 21st Century.”)

“Consideration of creativity in people on the autistic spectrum challenges ideas of what creativity is,” Roth said. The autistic spectrum diagnosis is based on:

• Communication difficulties, verbal and nonverbal

• Social interaction difficulties

• The appearance of such difficulties before the age of 36 months

However, “shadow autistic traits,” autistic-like traits which do not rise to the level that would support a diagnosis, can show up early in life and then recede.

Roth showed several slides of drawings of outstanding artistic talent by autistic children. “Artistic talent in autistic children seems to show fully formed right away, rather than going through a developmental process,” she observed. She compared examples of Andy Warhol’s “realistic” art to those of autistic children, and noted that Warhol “seemed to have some autistic traits,” such as liking to talk to people on the phone rather than in person, even if they were close nearby.

“Some preliminary impressions suggest that the brains of people on the autistic spectrum may be more richly wired within local areas but less well wired between areas,” Roth said, which may make for “better attention to detail rther than cognitive flexibility.”

Elizabeth Archibald, Professor of Medieval Literature in the Department of English at the University of Bristol, gave the final presentation on Saturday, on “The Birth of Romance: Creativity and Inspiration in the Twelfth Century.” Archibald noted that there was a sudden flourishing of creativity in twelfth century Europe, in which Lone Ranger knights travelled out in search of adventure and love, featuring women who were suddenly depicted in a new role, as able to choose their knight, sometimes even before or outside of the bonds of marriage, as in some versions of the tale of Arthur, Guinevere and Lancelot. During the question portion of her presentation, Archibald commented that the sudden burst of romance narratives in about the twelfth century might be partially attributable to the sudden increase in need for literacy, following the Norman conquest and the establishment of new administrative processes and controls, in a new language.

This concludes my notes from Saturday’s program. My notes from Sunday’s program will follow.

Monday, September 5, 2011

Hypnosis As A Form of Therapy

“Brian” asks:

“What are your thoughts about hypnosis as a form of therapy? I’m considering seeking out a therapist who specializes in this to help me with some personal stress and issues at home.”

Dr. Einhorn replies:

Thanks for your question, Brian. I think hypnosis can be a very useful part of therapy, but I don’t use it as a form of therapy by itself. I do include it as a part of therapy for some clients, along with talk therapy, which is my main method.

I'll just say a few things about hypnosis and how I use it in my practice. Trance is a natural state which occurs spontaneously, as we can see in animals as well as people, and in children as well as adults. It’s interesting that, for something so important, there’s no universally, or even generally, agreed definition of hypnosis. For purposes of this discussion, I’ll define it as a state of trance involving the partial and temporary suspension of executive functions and a restriction of attention focus to a primary stimulus in the context of a collaborative relationship whose purpose is the healing or improving of the patient or client. Relaxation training is usually a part of hypnosis. Deep relaxation can be an end in itself, or there can be an additional focus on therapeutic work in trance, called hypnotherapy. In hypnotherapy, we can access the unconscious in some respects more directly than in conscious conversation. In fact, we go in and out of trance in ordinary psychotherapy conversation without noticing it. Hypnotherapy is a way of using trance in therapy in a very focused way.

Deep relaxation, usually involving somatic or body awareness and/or guided imagery, is a great stress reducer and health improver, physically and mentally. Practicing deep relaxation for 15 minutes every day or even every other day can have a 24/7 stress reduction benefit. Deep relaxation can help a number of medical conditions, including hypertension and irritable bowel syndrome, as well as reducing anxiety and panic. Deep relaxation supports immune function in general, probably through helping to stabilize mood and generating healing neurochemicals such as endorphins. It's not a magic cure or a one-time one; you have to practice to get good at it, and keep practicing to continue to benefit from it. While it can take shorter or longer periods for different people to learn to relax deeply, once we learne how we can usually put ourselves into a more deeply relaxed state in a few seconds or minutes, depending on how upset or distracted we are when we begin.

Hypnotherapy takes trance into the work of psychodynamic psychotherapy. “Psychodynamic” is another one of those words that means different things to different people. I’m using it here to mean therapy that acknowledges the importance of unconscious processes and works with unconscious as well as conscious mental processes, such as thoughts, feelings, impressions, perceptions, associations, etc. The trance state allows a certain degree of direct access to unconscious process, which can sometimes help identity issues and impasses (an impasse is a place where we’re stuck, we can’t pass through it) in the person’s life or therapy. Those “issues and impasses” can sometimes be partly resolved in hypnotherapy, although more often they are worked through in the talk therapy that follows. Sometimes that working through can be done in a relatively short time, sometimes it takes a longer time. I want to emphasize that because hypnosis has a reputation as a quick fix, but it is not usually one, in my experience, and that is not how I use it.

So, hypnosis can add value to therapy, but I use it as a part of overall therapy and not as a stand alone method. Incidentally, I did write a song to help people relax and go to sleep using hypnotic imagery on my new CD. The CD is "The Elephant In The Dark" (which will soon be available on and the song is "Deeper and Deeper." I recommend that people listen to it four times through, which will be about 16 minutes; and of course not when they are driving or doing anything that they have to be alert for, only when it's safe to relax deeply and even go to sleep.

Monday, July 18, 2011

Logical Nonsense

Words can lose their meaning, and when they do, utterance becomes nonsense, even it it seems logical.

This example of logical nonsense was reported by Peter S. Latham, J.D., and Patricia H. Latham, J.D., in Newsbriefs, the newsletter of the Learning Disabilities Association of America (November-December, 2009, Volume 44, No. 5).

A child with learning and attention disorders in a public school district had been described by his teachers as having trouble paying attention in class and completing his assignments. His problems got worse in high school and his mother asked the school district for a psychological evaluation. School psychologists evaluated the child and concluded that he did not qualify for special education services, in an evaluation which was subsequently found to be legally inadequate. The child’s parents sought private professional evaluation which resulted in a formal diagnosis of ADHD and several forms of learning disability. The private specialist recommended placement in a structured, residential learning environment, and his parents enrolled him in a private academy serving children with special needs.

His parents notified the school district of the private placement and sought a due process hearing to require the school district to pay for it. The hearing resulted in the determination that the school district had not offered an appropriate education and confirmed that the private school placement was appropriate, so the school district had to pay for it.

The school district sought judicial review in U.S. District Court, on the basis--here is the logical nonsense--that the child’s parents were barred from reimbursement for his private special education placement because he had not previously received special education services. Of course, the reason why he had not received special education services was because the school's psychologists had found him ineligible on the basis of an inadequate assessment.

The U. S. District Court, unable to discern between logic and nonsense, agreed with the school district’s reasoning. The parents appealed that ruling to Circuit Court which, restoring sense, reversed on the grounds that eligibility for private special education wasn’t conditional on having first received special education in the public schools. The school district appealed to the state Supreme Court, which upheld the Circuit Court's finding for the parents. So sense won out in the end, this time at least.

D. L. Pendlebury, commenting on the depth of language that he could not include in his translation of sections of the Afghan Sufi poet Hakim Sanai's "The Walled Garden of Truth" (published by Octagon, London), reflects on the way "the hypnotic power of linear verbal communication" underlies the loss of meaning in speech in Western societies. "We are effectively anesthetized to words; and perhaps precisely for that very reason we have been more enslaved by them than any other culture in history..." (p. 62)

I can't help wondering whether the school district's attorneys and administrators really believed their nonsense or whether they felt that they had to come up with something and that was the best they could do. And I can't help wondering whether the U. S. District Court judge who held for the school district really believed the school district's nonsense, or whether he (or she) knew it was nonsense but felt compelled to support the school district for some other reasons.

A lot of psychotherapy is about restoring sense to language from which sense has become separated.

Thursday, June 30, 2011

Client Comments

Among some old files I found a group of notes I’d written of comments that various clients had made, which had impressed me as particularly insightful or pithy, and which I'd written down after asking for, and receiving, permission to quote anonymously:

•“You think, because you’re brought up with a set of rules, that you have a set of values.”

•A client, describing early family history, said: “They were practicing Catholicism at the expense of Christianity.”

•“Her way of healing old wounds is to open them up and play with them.”

•“I’m so open-minded--but with gates.”

•"It's the unquiet spirit that breaks down the body."

•A client said, “You have to think through what you want to do and what goal you want to achieve.” I said, “Let’s do some of that now. What do you want to do, and what goal would you like to achieve?” She said, “That’s a loaded question.”

•Speaking with a client on the autistic spectrum, I said, “I’m trying to teach you that there’s something more to relationships than self-preoccupation and manners.” The client replied, “I don’t agree.”

•A client said, "I know that I've always felt like a dunce in my family. I just never said it out loud." I said, "Congratulations," for saying it out loud. "What difference does that make?" asked the client.

•Palpably describing what psychodynamic therapists call "dissociation," a client described coping with a mother's harangues: "I'd sit tight, put on a face, and not be there."

•A former client who returned to see me, commented: "Gee, the last time I saw you, you had a little more brown in your hair. What'd you do, eat something grey?"

Saturday, June 11, 2011

Coaching and Psychotherapy

A colleague asked how I understand the difference between coaching and psychotherapy, and how I use Skype. Here's my reply:

Dear .......

Sorry for not being able to reply sooner to your question about services I offer to coaching clients, where I draw the line between coaching and psychotherapy, and where Skype fits in.

I offer coaching services to clients who want to improve their personal and professional effectiveness in areas where I can add value. That includes the human relations side of supervision, leadership in organizations, and the learning styles and outcomes side of education. Clients consult with me around career issues, to help them reflect on their careers and see if they might want to modify or change them, as well as for help with job searches. Clients may seek coaching for evaluating and improving their relationship skills, whether personally (with a spouse or partner) or professionally (with a supervisor and/or colleagues). Parents may wish to improve their parenting skills. In the organizational consulting side of my practice, I've learned something about helping people to develop attitudes and skills for having difficult conversations more effectively, and sometimes people come for that. Some clients come for help in understanding their learning styles and how to learn more effectively given their particular cognitive and personality styles. Relaxation training can be a part of coaching, where the client can benefit from it as a health enhancement rather than as a treatment for a diagnosable mental disorder.

Where I draw the line is between these kinds of mentoring/coaching/consulting/counseling (in the sense of providing counsel) activities and psychotherapy as a treatment for a mental illness. Therapy patients qualify for a DSM-IV diagnosis of a mental disorder, and psychotherapy is a treatment for that and has a procedure code on the bill or receipt which patients submit to third party payers.

Sometimes a coaching client is actually in psychotherapy already with another therapist, to which coaching can be complementary, but the foci are different and neither coaching nor therapy replaces the other. In coaching mode, I've said things like, "This is what I advise you to do in order to take the next step toward achieving your goal. If you have a problem doing it, you should talk to your psychotherapist about it." And, while it isn't always the case, my coaching clients often come at less than weekly intervals; semimonthly (EOW), monthly or at even longer intervals, and usually that's fine with me, but I've declined to work with potential psychotherapy patients who weren't available for the session frequency that I felt was appropriate to the presentation and intensity of their symptoms.

About Skype: My current practice is to offer psychotherapy in my office, and only to add remote methods (Skype, telephone) if the person moves out of the area (or, on occasion, is too ill to come to the office) after getting a good start to the therapeutic relationship in person. That's because there are intuitive aspects of the therapeutic relationship that require personal presence; at least as I understand and practice psychotherapy. So I don't offer psychotherapy, in the sense of a treatment for a mental disorder, remotely from the beginning. I do offer coaching, consultation and counsel from the beginning via Skype or telephone. .

I hope that helps.


Sunday, May 1, 2011

Fat, Muscle and Bone

(originally published in the spring, 2011, Illinois Psychologist, the newsletter of the Illinois Psychological Association)

In the early 1980s I was teaching organizational psychology at The Management Center of Aurora University, where my students were mostly first-level through mid-level supervisors and managers from companies and organizations along the Fox River valley. It was the era of leveraged buyouts, and one student spoke simply and eloquently about the effects of multiple takeovers on his company. “The first time we were purchased it was good for us. The new ownership got rid of fat, and we became lean and efficient. The second time we were bought, the reductions and layoffs imposed by the new owners to pay off the debt of the acquisition cut into muscle. Now we’ve been bought again, and this time they’re cutting into bone.”

A decade or so later I was in private practice, on the panel of an insurance company. A parent called me about an adolescent, an early high school student in severe crisis. The adolescent--let’s call him “Jack”--turned out to have an agitated depression with psychotic features. The insurance company’s treatment authorizer, a social worker, was supportive of intensive outpatient treatment as an alternative to hospitalization. Working collaboratively with Jack’s psychiatrist, who prescribed a combination of antipsychotic and antidepressant medications, I began seeing him three times a week in individual and family therapy. Treatment worked, Jack gradually improved, and it became possible over time to discontinue antipsychotic medication and reduce therapy frequency to twice weekly, then to once, over a period of about a year and a half.

Jack began his senior year relatively stable, on once weekly, mostly individual, therapy and 80 mg. of antidepressant medication. I submitted a treatment plan, which Jack, his parent, and his psychiatrist all supported, to continue weekly therapy throughout his senior year with the goal of eventually discontinuing antidepressant medication. By that time a psychologist had become Jack’s treatment authorizer for the insurance company, and he disallowed continuing therapy; explaining that, since Jack was stable on medication, further therapy was not indicated. The fact that weekly therapy was contributing to Jack’s stability wasn’t noted by that psychologist, who was content to leave the patient on antidepressant medications and call treatment complete. What was therapeutic muscle and bone, to me, to the patient, to his parent, and to his psychiatrist, was fat to the psychologist working for the insurance company.

I resigned from that insurance company’s panel, negotiated a fee with Jack’s parent, and successfully completed the treatment plan. At the time I was on the affiliate staff of a hospital where a psychiatrist consulted for the insurance company, and I asked him why the company’s policy had changed so much over the course of a few years. “The company’s been bought twice since you starting treating that patient,” he told me, and it had acquired a lot of debt to pay off. “It’s all about the bottom line, now.”

Most psychologists who provide therapy do so as sole practitioners, in small groups, or in small community agencies. The insurance and managed care companies that provide or manage third party payment, on the other hand, are usually very large organizations with substantial needs to manage costs in order to pay down debt associated with purchase or other expenditures, and reward owners or shareholders for their investments. So when a psychologist-practitioner speaks with a psychologist (or other mental health professional) working for an insurance or managed care company about authorizing psychotherapy, there can be quite a difference of perspective when it comes to perceptions about what is fat, what is muscle, and what is bone, when it comes to patient needs and treatment.

Because of this and similar experiences, addressing the gap between psychologist-providers and psychologists (and other mental health professionals) working for insurance and managed care organizations has been a goal of mine since becoming a Council member a couple of years ago. I am currently facilitating an ad hoc committee of Council members drafting an aspirational statement regarding the relationship between psychologist-providers and psychologists (and other mental health professionals) working for insurance and managed care companies, for presentation to the Council. Surely the foundations of such a relationship include mutual acknowledgement that the patient’s best interests is a core value shared by both providers and payers, and also acknowledgement that we are all stakeholders, as taxpayers and insurance rate-payers, in a system in which we all want to provide necessary services to people who need them in an economically viable way. Let’s see if there’s a middle ground where psychologist-providers and psychologists (and other mental health professionals) working for insurance and managed care organizations can meet collegially, when we discuss the fat, muscle and bone of psychotherapy.

Sunday, April 10, 2011

Marital Therapy and Infidelity

On April 9, 2011, I gave a presentation on marital therapy of infidelity, as part of a series of presentations on couples therapy sponsored by the Illinois Psychological Association. A presentation by Carol Cradock, Ph.D., on counseling couples who are in the process of divorcing, preceded mine. Northwestern University Medill School of Journalism student Helen Adamopoulos was there and wrote an article on our presentations. I've copied the text here. You can access the article itself, with a great picture of Carol in action, at:

Here's the text:

Therapists learn how to counsel couples on divorce, cheating
APRIL 08, 2011

Dr. Jay Einhorn scanned the small classroom, where about 30 psychologists and therapists sat watching him.

“It would be fun to ask for a show of hands,” he said with a grin. “How many people have been unfaithful?”

The room erupted with laughter as people glanced around at each other. No one raised his or her hand.

Although no one in that classroom was willing to admit it, Einhorn said most people have probably been affected by infidelity in some way, whether they have been unfaithful themselves, been cheated on or known about someone else’s affair.

He spoke Friday morning about approaching infidelity from a therapist’s perspective as part of a workshop series on couples counseling hosted by the Illinois Psychological Association. The workshop was the fourth in a series of six sessions the association is holding on the second Friday of each month through June at the Chicago School of Professional Psychology.

Einhorn, a consulting psychologist at Roycemore School in Evanston and an independent practitioner, said there aren’t reliable statistics on the instance of infidelity, but it is evidently a common problem.

“We can estimate that many if not most divorces have to do with infidelity,” he said.

Einhorn said therapists should consider the couple’s developmental history (did they grow up in a family where infidelity was common?) as well as evaluating the relationship according to a concept called the “identity union.” The identity union refers to how the couple view themselves as one entity, rather than two separate people. They view their union as something unique and special.

“That’s what the infidelity hurts most,” Einhorn said.

Whether the couple can stay together depends on reconstructing the identity union. This cannot take place if there is ongoing infidelity, physical violence or ongoing verbal and emotional attacks, he said. The betrayed or “hurt” partner needs to realize that the couple’s former identity union was partly an illusion; the relationship wasn’t what the betrayed spouse thought it was. If the hurt partner can come to terms with that, there is a better chance of healing the marriage, Einhorn said.

In turn, the unfaithful partner should examine how the identity union wasn’t meeting his or her needs. Integrating those needs into the framework of the marriage is a key part of couples therapy, he said.

If a couple decides they can’t or don’t want to salvage their relationship, therapists can employ strategies to try to minimize the personal damage for both people. Chicago psychologist Dr. Carroll Cradock, who has worked extensively with couples in the process of separating, also spoke at the workshop about improving divorce outcomes.

“Divorce is a life transition, one of life’s most difficult transitions,” Cradock said.

She compared the process to “trying to steer a boat across Lake Michigan during a storm.” However, therapists can guide couples and their children through those dangerous waters.

Cradock staged a mock therapy session to demonstrate how to deal with a separating couple. First, she showed a clip from “The Squid and the Whale,” a movie centering on a family dealing with divorce. Then two workshop participants pretended to be the parents from the film, while Cradock counseled them.

She asked them what they wanted for their family, such as both parents maintaining strong attachments with their children. Cradock said that she would also speak to the children alone to find out what they wanted, and then combine that with the parents’ wishes to form a family mission statement.

“It’s a road map for them,” she said.

Rita Guertin, a therapist at Alexian Brothers Behavioral Health Hospital in Hoffman Estates, said she found the workshop useful and engaging.

“I liked doing this little vignette here,” she said of Cradock’s role-playing exercise. “I’m a really visual person.”

Guertin said she was attending the entire workshop series because she wants to open her own practice one day and needs to learn about working with couples first. Clinicians can earn a maximum of 39 continuing education credits (6.5 each day) by participating in the series.

For more information on the workshop series, visit

Saturday, April 2, 2011

Diagnosing Attention Deficit Disorder

Several colleagues on a listserve asked questions or made comments about diagnosing attention deficit disorder, which moved me to write this reply.

When we look at diagnosing attention deficit disorder, it’s important to remember that there are three moving targets.

The first moving target is our knowledge of attention and how attention works in the brain, which is not simple. The frontal lobes are largely involved in deciding what to focus on, maintaining focus, inhibiting distractions, monitoring appropriateness of focus, evaluating effectiveness of focus, and transitioning to a new focus when that is appropriate, within a huge constant stream of perceptual and sub-perceptual inputs from both the world around us and from within our own bodies. (See Elkhonon Goldberg, “The New Executive Brain.”) Our knowledge of what the frontal lobes do and how to evaluate frontal lobe dysfunction is relatively recent and constantly growing.

The second moving target is the definition and description of attention disorders. Society itself is changing, including norms and expectations about how children and adults should behave. Styles of attention that would have been normal throughout most of human history, when children would have been running around the woods, helping around the house or in the fields, or apprenticing in some craft or business, become disorders when children and adults spend most of their time in schools or offices, seated rather than moving and focusing on abstract tasks. And professional culture is continuously modifying its concepts about what qualifies as attention disorder; DSM V is in preparation, for example.

The third moving target is the experience of the diagnostician. If we say, for example, that physicians and psychologists typically diagnose attention disorders, that places the focus on how physicians as such and psychologists as such make diagnoses. However, a closer look at how actual physicians and actual psychologists go about diagnosing attention deficit disorders shows large discrepancies not only between groups but also within them. Much of the training, in fact, is obtained on the job, and experience matters.

It is usually psychologists or physicians who make the diagnosis. Physicians usually make the diagnosis based on a clinical interview, and psychologists usually make the diagnosis based on interview(s) and testing. Both physicians and psychologists may ask third parties (often parents, teachers, spouses, sometimes supervisors, siblings or significant others) for input, either in interviews or by completing rating forms. Among physicians, pediatricians, psychiatrists, and neurologists are the usual diagnosticians, although any physician can legally make the diagnosis. Among psychologists, clinical psychologists and neuropsychologists are the usual diagnosticians, although school psychologists are increasingly making the diagnosis, especially those in private practice.

Because attention is so complex, there are a number of different ways in which it can be disordered, all of which require some compensatory strategies to manage behaviorally, and not all of which respond equally well to medication. What might be called the “classical” hyperactive type of attention disorder, the impulsive, distractible, hyperenergetic presentation, often shows the paradoxical response of slowing down when stimulants are administered. This paradoxical response has been explained by psychologist Russell Barkley’s theory of inhibitory undersupply. The structures in what’s usually called the limbic system send arousing signals to the upper parts of the frontal lobes, which select which signals to attend to and which ones to inhibit, which they accomplish through inhibitory tracts signaling downward. Barclay’s theory is that the inhibitory tracts from the frontal lobes to the limbic system structures are undersupplied with modulating and/or transmitting neurochemicals (probably especially dopamine) in hyperactive people, so they don’t work very well. When stimulant is administered to hyperactive people, his theory goes, it is selectively channeled to the neurochemically undersupplied inhibitory tracts, which creates the paradoxical effect of a hyperactive person being slowed down by taking a stimulant. For that reason, I call stimulants for classically hyperactive people, “brake fluid.” (Elkhonon Goldberg includes limbic structures as part of the lower frontal lobes, in which case we’d be talking about intra-lobe communications, which doesn’t really alter Barclay’s model, just how we talk about it.)

The diagnosis for people within what might be called this original paradigm of hyperactive attention disorder was relatively straightforward. Observation of the child in school, or a good case history supported by observations of parents and teachers, was sufficient to establish the pattern. Some hyperactive kids are obviously hyper in the doctor’s office, others can keep it together for one or several interviews, but the case history, supported by corroborating observations from school and home (or work, in an adult), was sufficient. So an experienced physician or psychologist, doing an office interview, usually with supporting evidence from parents, teachers, etc., can make this diagnosis quite well for the “standard model” of hyperactive patient, as long as there aren’t any significant rule-outs. (The diagnostician may have received the referral from a therapist who already suspects hyperactivity and can supply more background information to support the diagnosis.) But that’s where things can get complicated.

The more we learn about frontal lobe functioning and attention, and the more clinical observations we accumulate as the diagnosis becomes more common, the more obvious it becomes that this original hyperactive syndrome is only one of a wide range of possible issues with attention with which patients present. For example, people with nonverbal learning disorders, in which the relational functions usually associated with the right cerebral hemisphere, and especially the right frontal lobe, are deficient (often accompanied by a substantial discrepancy between higher verbal scores a lower nonverbal scores across a number of tests), often appear disorganized, unable to select and maintain appropriate task focus, distractible, etc., and so they present a behavioral picture very much like that of many hyperactive people; but they are not classically hyperactive, and they do not respond to stimulants by slowing down. People with sequential processing deficiencies (who may or may not have the opposite test score pattern, with higher nonverbal than verbal scores) may have difficulty perceiving information that comes in a series or sequence (as most language does), and have difficulty organizing and following through a multi-step process. Stimulants affect people with such cognitive styles as these like they affect most people; that is, by general arousal. Sometimes that helps--for the same reasons that stimulants can help high school and college students without attention disorders to cram for final exams--but they can also just stimulate the entire system, thus increasing distractibility and disorganization. And issues of stimulant dependence may be of more concern with this population than with the hyperactive folks for whom stimulants act like brake fluid. Although it used to be boys who were mainly found to be hyperactive, as professional awareness of non-hyperactive inattention as a form of attention deficit increases, more girls and women are found to have forms of attention disorder that are not of the classically hyperactive kind and do not respond to stimulants in the paradoxical, efficacious way.

And the picture gets even more complicated by other cognitive information processing styles that can be mistaken for primary attention disorders. For example, some people have a deficiency in processing language which they hear, an auditory language processing disorder, even though their sensory hearing is normal and they are fluent in speaking. This can be due to central auditory processing disorder, which has to be diagnosed by an audiologist who knows how to do it; but there are speech and language tests that can indicate its presence, if the evaluator has learned about it. Some people who seem to have an attention disorder because they don’t retain what they read actually retain better when they read aloud, or use a reading method such as SQ3R to support memory and comprehension. Their disorder is with language processing, a kind of dyslexia, rather than with attention per se; though the child may look inattentive in class or the adult in the office. Some people have limited processing speed--they may have lots of intelligence, but need to learn at a slower pace than most of their peers, although they can learn a great deal if they have the time. Some people have limited processing capacity, their cognitive “house” is like an igloo that can only admit a small amount of information at a time, even though the interior may be quite large. Some people have deficiencies at making new learning automatic (which probably involves circuits extending from the frontal lobes into the cerebellum). Any of these people, in a clinical interview, can look as if they have a primary attention disorder.

It’s not only learning and language disorders that can sometimes look like attention disorders; so can emotional and personality disorders. If someone is anxious, depressed, subject to powerful mood swings, or has a self-defeating personality tendency or disorder of one sort or another, that can show up as underachievement, difficulty focusing, disorganization, etc.; in other words, it can look, on superficial review, like a primary attention disorder. I once evaluated a physician, a very bright person indeed, for ADD/ADHD, and found that he had a writing disorder (a specific learning disability) and a complex personality structure (emerging out of his personal history) that led to undermining himself at key points in his life, but not an attention disorder.

Complicating matters still further, learning and/or language and/or emotional and/or personality disorders can present together in the same person. Patients with attention deficit disorders often present with comorbidities, which just means other clinically significant conditions. I’ve seen estimates ranging from 20% to 50% of persons with attention disorders having significant comorbidities.

That brings us to testing. While there is no test for attention disorder per se (despite the fact that some tests are labeled as tests of attention), testing can paint a picture of a person’s cognitive style, can rule in or out learning disabilities such as verbal or nonverbal disorders that can be mistaken for attention disorders, and can also look more closely at emotional and personality functioning than can be done in a routine clinical interview. The comprehensiveness and extent of testing and interviewing varies a lot among practitioners. I typically conduct a long and structured initial interview, followed up with subsequent interviews of the patient during testing, and supporting interviews with parents and teachers (or spouses, with adult patients), as well as administering neuropsychological, psychoeducational (usually reading, writing, and arithmetic, to which I add expressive and receptive spoken language, which strictly speaking are in the speech and language testing domain), and personality/emotional testing, over the course of which I get to watch how the person applies himself or herself to interviewing and responding to a variety of testing challenges. This is a fairly comprehensive approach, but it obviously involves considerably more time and expense than a single clinical interview. A full evaluation typically involves 10-20 hours of testing and interviewing, after which there’s the work of integrating the test results and preparing a report that puts the test results together with the case history, and behavioral and supporting observations, gives a diagnostic impression and recommendations. A typical report of evaluation runs to 15-20 pages, only a couple of which are boilerplate; most consist of narrative and test scores.

So the issue of diagnosing attention disorders is far from a simple one. Diagnosticians need to learn about different kinds of attention disorders and other learning and emotional conditions that can look like attention disorders. For the patient, as is usually the case with any complex condition, each person and each family has to find his, her or their own way within the educational and health care systems, and will hopefully find the doctor or team which will be able to help them understand their cognitive and personal styles, for better and worse, and find their way to achieve their goals.

Sunday, March 20, 2011

The Importance of Attitude

New knowledge about brain function supports an old-fashioned idea: Our attitude has a lot to do with our ability to learn from experience.

It turns out that how our brains operate when we make a mistake depends a lot on our attitude about ourselves and our mistakes. If we have the attitude that mistakes are inevitable and we can learn from them, the frontal areas of the cerebral cortex, the seat of executive functions, seem to be doing most of the work. This is the area that underlies sequential and relational thinking, and recognition of new patterns in information, so it’s obviously well suited to learning. But if we have the attitude that we should be right and not make mistakes, if we feel ashamed at having made a mistake and beat up on ourselves, then the more central parts of the brain that are involved in emotion become more active, at the expense of the frontal lobes. Our brains generate a neurochemical flood of negative emotion, and our learning efficiency decreases rather than increases. You can’t learn much when you’re flooded with shame and self-contempt.

This research, which was done on learning tasks like those involved in school, turns out to be very relevant for psychotherapy and coaching also. When I am talking with therapy patients or coaching clients about their decisions and behavior, in situations in which they could have been more realistic, more caring and more effective, their attitude toward their mistakes makes all the difference. Of course, nobody is happy to have made a mistake, but the people whose attitude is, “OK, I’ve made a mistake, I regret it, and now I’ll learn from it, with your help,” tend to learn more and faster. The people whose attitude is, “If I made such a mistake, then I’m such a hopeless loser,” or “I’m so ashamed of myself I can’t stand myself,” basically shut down their learning processes, because we can’t learn anything when we are in that state. Then I have to try to help them get out of that state and into a learning one.

People who have a genuine and deep sense of a higher truth, whether they think of that in spiritual or natural terms, tend to have an easier time of getting into a learning attitude. Maybe that’s because being in relationship with a truth that’s higher than we are tends to make us humble, and it’s easier to learn from a position of genuine humility. So we can see that humility is not an end in itself so much as a means of getting somewhere. If you need to learn, and you’re not too self-important, you will learn.

Paradoxically, self-abasement, which is often confused with real humility, emerges from an elevated sense of self-importance. This is what psychiatrist Arthur Deikman refers to as the arrogance of self-contempt. Both too much self-esteem and too much self-abasement emerge from an overvaluing of the importance of self within the personality, and both interfere with learning.

New York Times columnist David Brooks has written a new book emphasizing the importance of the mostly unconscious attitudes and relational skills to individual and group success: “The Social Animal: The Hidden Sources of Love, Character and Achievement.” He talks about it during his book launch at the New York Public Library on a video available through

Sunday, January 23, 2011

Freud and Columbus

There are a lot of similarities between Freud and Columbus. Both were great and bold explorers who discovered new worlds; Freud the unconscious and Columbus the “New World.” Neither man understood what he had found, both were mistaken about most of the details (Freud’s unconscious was mostly a figment of his fertile imagination, Columbus thought he’d landed in India). Both discovered realms which had actually been discovered by others previously, but of which they and their European cultures were ignorant. Both left their epochal discoveries to posterity, which has had to sort out what’s really there from what was incorrectly imagined to be there. Both are worshiped as heros and reviled as evildoers, perhaps more than they are understood as brilliant, bold and limited men in the context of their times.