I cut and pasted an e-mail from a patient who asked me a question this evening. As soon as I read it, I thought the answer was worth sharing with my readers; both of you.

(I removed all personal identifiers to protect my patient’s confidentiality.)

Dear Dr. Weisberg,

The doctor I worked with before I began working with you almost two years ago gave me a different diagnosis  than you gave me. She said I had LD, a Learning Disability. I looked up in a dictionary what the word disability means and here is one of the definitions that I came across

— state of being disabled or limitation in the ability to pursue an occupation because of a physical or mental impairment. I am struggling to understand this word and how it applies to me. I realize that this definition can just be one of many definitions and I am pretty sure that this definition does not apply to me, but it made me think of a question to ask you. Do you believe that if a person truly has LD, they can outgrow it? Thank you for your explanation.

My response:

Wow! You are asking very difficult questions and I could not be more proud! (Disclaimer: This does not mean that I am always going to answer your difficult questions, but today’s question came at a time when I am in the mood to answer it, and as you are aware, moods are subject to change without prior notice.)

With regards to your question whether someone can outgrow a disability, my short answer is a definite yes but the reasons  for this are many, but I will at least attempt to show you the abbreviated version:

  • Let’s begin, as I always do  when I am solving a problem,  by deconstructing “disability”. Deconstructing, is a method of analysis by which I peel back the layers of any phenomenon, such as a disability, as if I am peeling back the layers of an onion to see what lies beneath the surface. If  we peel back the layers of a person’s disability,  we will see a whole collection of impairments to the person’s ability to function normally. When I translate the process of deconstructing into the language of clinical medicine a disability translates to syndrome and the collection of impairments  roughly translates to symptoms. Before I go too far on this tangent, I am going to personalize it to a topic in which I have an honorary PhD; the science of YOU. Let’s start with your “other” diagnosis, LD and peel it back and take a closer look at the collection of impairments to your ability to learn normally. As I know you will recall, at our first meeting the first thing that I did was peel back your diagnosis, or syndrome to see the next layer. I did this on page two of that megillah of an intake form that I tortured you with even before we had our first face to face meeting (please see OPMD Comprehensive Health Assessment Intake Form) By the end of our first meeting I peeled you back as close to the core as I possibly could. There is no other way, that I can think of, to understand YOU or anyone else, for that matter, who I want to help become abled. By peeling back the of YOU that I first met on 11/17/2011 I discovered that the “YOU Syndrome” was composed of the following impairments to her ability to function normally:
    • Excessive distractibility This is a more efficient way of describing impairments in your ability to pay attention  and your hyperactivity and brings up a teaching point that I cannot resist. Distractibility, or the inability to decide which stimulus or stimuli in one’s surroundings is most important, is the primary malfunction in the brain of the person with  ADHD (Attention Deficit Hyperactivity Disorder). Constantly distracted, a person with ADHD can pay attention, but not to just one particular thing; their impairment is in their ability to filter the unimportant from those stimuli in their environment that are important; and as a result they move inappropriately (hyperactivity also known as hyperkinetic). So, little Tommy is, in fact, paying attention to his teacher, but he is also paying attention to the pretty bow in little Susie’s pretty hair, who is sitting in the seat right in front of him and to his friend little Joey, who he sees outside the classroom window playing soccer. Just a moment ago, little Tommy was paying attention to his teacher, but then he also just had to touch little Susie’s pretty bow and go to the window and cheer on little Joey. Oh yeah, I forgot to mention, little Tommy just got an iPhone for his birthday. I’m exhausted just writing this, I can’t even begin to imagine how little Tommy must feel. OK, back to the YOU Syndrome.
    • Excessive fear and worry, also known as Anxiety

YOUR collection of impairments is not all that long; only two that I could find, but just like that, we deconstructed the YOU Syndrome. We peeled back the layers of YOU, far enough so we could rationally decide which molecules to throw into that bowl of liquid floating inside YOUR skull; a few molecules that cut YOUR distractibility and some molecules that help YOU not be afraid and molecules that help YOU not worry to the point that YOU destroy YOUR new physician’s office furniture. As I am describing this process I cannot help but realize how similar it is to when I take my first spoon full of bland soup and add I a little salt and a pinch of pepper to get it to taste delicious. Which leads me to a new diagnostic insight into the YOU Syndrome. I hope you are ready for this? I am about to update your diagnosis to match your current clinical status. Here it is, 8 years of post-graduate education followed by two decades of clinical experience then 17 months of research into the YOU Syndrome and here it is my professional clinical opinion of YOU:

  • Patient Name: YOU
  • Diagnosis: A Delicious Bowl Of Soup Syndrome
  • Prognosis: Excellent

So, what was your question? Oh yeah, can someone outgrow a disability?

My answer is yes, and YOU are all the proof I need!

END POST

Mitchell R. Weisberg, MD, MP

Founder/CEO, Internist/Psychopharmacologist and Personal Physician at:

Optimal Performance, MD

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A Primer

Imagine the Mental Health Spectrum as a line across this page that spans from Mental Wellness on the left to Psychosis on the right. We all exist somewhere on this spectrum but where? More importantly, how do we achieve mental wellness and support it? To answer this important question, we must first understand just how this mental health spectrum operates:

  • There are two primary symptoms on the mental health spectrum, Depression and Anxiety, and while one of them may predominate, where there is one there is always the other. 
  • Depression has two separate but related components, loss of interest and sad moodas does Anxiety, fear and worry.
  • Depression and Anxiety increase in severity as they migrate from left to right across the spectrum.
  • Physical Symptoms, such as fatigue; muscle pain (fibromyalgia); abdominal and digestive problems (Irritable Bowel Syndrome; Globus); jaw pain (TMJBruxism); headache (Migraine, Tension); difficulty breathing (Hyperventilation); chest pain and neurologic symptoms (paresthesia; light-headedness) often go with Depression and Anxiety.
    • Depression, Anxiety and the Physical Symptoms that go with them, while perceptually distinct from one another, share many common molecular ingredients in their recipes. Thus, while a person with mental illness can have many symptoms, they all originate from a single molecular disorder within his or her Central Nervous System (Brain and Spinal Cord)
  • Since Depression, Anxiety and Physical Symptoms are present along the entire mental health spectrum, it is the severity of these symptoms, and not the symptoms themselves, that determines a person’s diagnosis. As they travel from left to right, or from the least to the most severe along the mental health spectrum, these symptoms form the following syndromes in their wake Dysthymia/NeurosisUnipolar Depression/Anxiety DisordersBipolar DisordersPsychotic Illness.
  • While severity determines their diagnosis, people with a mental illness can express any or all the milder symptoms to the left of their diagnosis on the mental health spectrum. In other words a person with Bipolar Disorder or even with a Psychotic Illness can some days have only  mild symptoms or even be mentally well much of the time.
  • In women, Menstrual Magnification is the increased severity of Depression, Anxiety and Physical Symptoms that occurs several days before their menstrual period.
  • As with all medical disorders:
    • Mental Illnesses is degenerative, becoming more severe the longer it remains undiagnosed and untreated.
    • The most important step in successfully treating it is to first diagnose it.
    • the goal of treatment is complete remission; the “120/80” of mental health.

Conspicuous by its absence on the mental health spectrum is Attention Deficit Hyperactivity Disorder, or ADHD. Unlike all the disorders of the mental health spectrum, people with ADHD were born with ADHD and it exists on its own spectrum from mild to severe. People born with ADHD are more likely to acquire a disorder on the mental health spectrum than those people who were not born with ADHD. As common as ADHD is, we will never see it unless we are looking for it. Stay tuned; this is the topic of my next post.

End

Mitchell R. Weisberg, MD

Internist/Psychopharmacologist

Founder and CEO

Optimal Performance MD

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