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Featuring the therapist whose OCD Camp was profiled in the BBC Documentary

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In episode 7 of The OCD Stories podcast I interviewed Peter Weiss. Pete is a therapist who works with people who have OCD, ADHD and Autism. He is the founder of Blue Compass Camps, and in 2013 the BBC did a documentary about one of his OCD camps.

Pete gives some great advice around OCD and anxiety. We talk about his experiences filming the documentary, experiential therapy for OCD, the power of "maybe", depression and why OCD needs a holistic treatment approach. Pete is a fun and compassionate guy. I thoroughly enjoyed chatting with him, and I know you'll enjoy listening!

To listen on iTunes click the button, or go to iTunes and search " The OCD Stories". If you enjoy the podcast please subscribe and leave a review. It helps us reach more people who need to hear these remarkable stories of recovery!

You can also listen on Android and over devices through most podcast apps, such as Stitcher.
Show notes:

Pete's OCD Story (2:40)

What Pete thinks about the documentary (12:00)

What it was like doing therapy in front of a camera (15:30)

What inspired Pete to help people with OCD and why it's common to have other mental health issues with OCD (19:00)

Why camping in the wild improves recovery times (26:40)

How to speak with people are are anxious (35:25)

The power of "Maybe" (38:00)

ERP is important, but it is only a tool (43:00)

The importance of assessing the ERP challenge before you attempt it (47:50)

How to boost self-esteem for OCD treatment (52:00)

How to not let anxiety get to you when you are helping someone who is anxious and parenting a child with OCD (1:01:20)

The challenges facing someone who has OCD and depression. Also Pete's advice (1:06:30)

The future of OCD Camps (1:09:45)

Pete's one piece of advice (1:13:40)

What Pete would have on his billboard (1:17:40)

Find out more about Peter:
Pete's private practice - Seattle Child Therapy
Resources mentioned: Travis Osbourne
Extreme OCD Camp documentary - Part 1/ Part 2

Jeffrey Schwartz - Brain Lock ( Amazon UK/ Amazon US) & You Are Not Your Brain ( Amazon UK/ Amazon US)

The CBT article on The Guardian
Dr Steven Hayes
International OCD Foundation - IOCDF.org

To your success,
Stuart and The OCD Stories team

Support our videos and get rewards by becoming an The OCD Stories patron: https://www.patreon.com/theocdstories

Stuart blogs on OCD and mental health issues. He is the founder of The OCD Stories, which he created to guide other OCD'ers towards recovery. In 2014 he released his debut book 'Challenge Yourself, I Dare You'.

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Peter Weiss On The BBC Documentary Extreme OCD Camp

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In episode 7 of The OCD Stories podcast I interviewed Peter Weiss. Pete is a therapist who works with people who have OCD, ADHD and Autism. He is the founder of Blue Compass Camps, and in 2013 the BBC did a documentary about one of his OCD camps.

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Part 2/2
Extreme OCD Camp Episode 2
Documentary following six British teens and young adults with obsessive-compulsive disorder as they embark on an incredible journey to the American wilderness for treatment.

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Obsessive Compulsive Cleaners S04E01 Country House Rescue

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Extreme OCD Camp Episode 2 2013 BBC Three Documentary Trekking into the americal forest

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Extreme OCD Camp Episode 2 BBC trek deep into the American forest;

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Part 1/2
Extreme OCD Camp Episode 1
Documentary following six British teens and young adults with obsessive-compulsive disorder as they embark on an incredible journey to the American wilderness for treatment.

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Obsessive Compulsive Cleaners S04E01 Country House Rescue

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Extreme OCD Camp Episode 1 BBC documentary 2013  journey to the American wilderness

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Extreme OCD Camp Episode 1 Documentary following six British teens and young adults with obsessive-compulsive disorder as they embark on an incredible journey to the American wilderness for treatment. During the week-long intensive camp, the group undergo exposure therapy, where they are challenged to confront their greatest fears.

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How much money do we spend on prescription drugs?

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This provides excellent background knowledge of different medications and disorders they help to treat.

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Medications can play a role in treating several mental disorders and conditions. Treatment may also include psychotherapy (also called "talk therapy") and brain stimulation therapies (less common). In some cases, psychotherapy alone may be the best treatment option. Choosing the right treatment plan should be based on a person's individual needs and medical situation, and under a mental health professional's care.

The National Institute of Mental Health (NIMH), a Federal research agency, does not provide medical advice or referrals. Resources that may help you find treatment services in your area are listed on our Help for Mental Illnesses web page.

NIMH also does not endorse or recommend any particular drug, herb, or supplement. Results from NIMH-supported clinical research trials ( What are Clinical Research Trials?) that examine the effectiveness of treatments, including medications, are reported in the medical literature. This health topic webpage is intended to provide basic information about mental health medications. It is not a complete source for all medications available and should not be used as a guide for making medical decisions.

Information about medications changes frequently. Check the U.S. Food and Drug Administration (FDA) website for the latest warnings, patient medication guides, or newly approved medications. Brand names are not referenced on this page, but you can search by brand name on MedlinePlus Drugs, Herbs and Supplements Drugs website. The MedlinePlus website also provides additional information about each medication, including side effects and FDA warnings.

Understanding Your Medications

If you are prescribed a medication, be sure that you:

Tell the doctor about all medications and vitamin supplements you are already taking.

Remind your doctor about any allergies and any problems you have had with medicines.

Understand how to take the medicine before you start using it and take your medicine as instructed.

Don't take medicines prescribed for another person or give yours to someone else.

Call your doctor right away if you have any problems with your medicine or if you are worried that it might be doing more harm than good. Your doctor may be able to adjust the dose or change your prescription to a different one that may work better for you.

Report serious side effects to the FDA MedWatch Adverse Event Reporting program online at http://www.fda.gov/Safety/MedWatch] or by phone [1-800-332-1088]. You or your doctor may send a report.

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Medications can play a role in treating several mental disorders and conditions. Treatment may also include psychotherapy (also called "talk therapy") and brain stimulation therapies (less common). In some cases, psychotherapy alone may be the best treatment option. Choosing the right treatment plan should be based on a person's individual needs and medical situation, and under a mental health professional's care.

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This is in response to the Esquire article "The Drugging of the American Boy."

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When a headline features the word "drugging," the report about ADHD that follows will not be well-balanced. Such was the case with Esquire's recent salvo into the topic, " The Drugging of the American Boy."

Esquire joins The New York Times in treating one of the most well-researched and documented conditions in medical history as a piñata. Bash ADHD and all the goodies fall out. Web traffic soars.The immense anti-psychiatry blogosphere races to showcase the latest proof that they've been right all along. Esquire actually calls this piece a "blockbuster investigation" - just in case the ASME judges missed it.

Lost in the shuffle: Accurate reporting on a critically important public health issue affecting millions of Americans.

Never considered by the editors or the writer, Ryan D'Agostino: the story's compounding of stigma already suffered by millions of children, teens, and adults with ADHD and the people who love them. Hammering on the themes of misdiagnosis and side effects, Esquire overblows these issues while delegitimizing the diagnosis itself and the medications often used to treat it. As veteran journalist Paul Raeburn put it, blogging for MIT's Knight Science Journalism Tracker:

D'Agostino then discusses the potential dangers of ADHD drugs using guilt-by-association. Stimulants used to treat ADHD are Schedule II drugs, he reports, a classification that includes "cocaine, methamphetamine, Demerol, and OxyContin." Are you frightened yet? Don't worry, you will be.

The fact that clinical treatment standards around ADHD are problematic, at best, is no secret. Advocates, including myself, have been calling this out for years. Almost never mentioned in the "progressive" media's predictable screeds, including those in The New York Times, however: the devastating financial and human costs of unrecognized, untreated ADHD. Instead of acknowledging these and other facts about the disorder, sided with deniers of ADHD - the "anti-vaxxers" of psychiatry- despite the fact that it is considered the most highly impairing outpatient psychiatric condition.

At last count, 10,000 published studies substantiate ADHD as a valid diagnosis, with many of them demonstrating the efficacy of stimulant medications but many others studying behavioral approaches. I cannot emphasize this enough: There is no controversy about ADHD among the thousands of researchers and clinicians worldwide or the millions of people who have embraced the diagnosis because it is the first thing that has made sense of their lives and offered a better path. Over roughly 10,000 words, Mr. D'Agostino plucks the low-hanging fruit from anti-psychiatry blogs and ideological conspiracy lunatics to come up with the following:

The Feminists dominating our nation's schools are obsessed with emasculating our boys, simply for not being girls.

Complicit is Big Pharma, which has co-opted the medical establishment into chemically imprisoning young males with highly addictive pills.

The Establishment metes out harsh punishments to mavericks who dare say, "Hey, let's be careful before cramming mind-altering drugs down innocent boys' throats."

Only one man, Esquire reports, bravely says, "Stop drugging our boys!" He learned about ADHD not by studying it (that's obviously the girly way) but by having it himself. (Never mind that what he describes is not necessarily ADHD.) His cure? Bombarding our "intense" boys with a steady diet of praise-and never, ever criticizing or punishing them. Forget that "intense" is not even an accurate diagnostic criterion for ADHD. And never mind that overpraising is likely the last thing you want to do with the "intense" kids whose ADHD is complicated by the not-infrequent co-existing conditions of oppositional defiance and conduct disorder-not unless you want to create narcissistic sociopaths.

That man at the center of Esquire's article isa counterculture figure with no academic or professional training in the field:Howard Glasser, the Queens-based author of 101 Reasons to Avoid Ritalin Like the Plague. In addition to waxing poetic about his unproven approach (actual ADHD experts must provide peer-reviewed proof of their claims) the magazine provides him with a platform to answer reader questions about ADHD. Unfortunately, only readers with Facebook accounts could comment on the story. While a few adults with ADHD did so, many more wrote to me privately, saying they did not want to risk divulging their diagnosis publicly and in such a hostile venue.

A few days later, the magazine ran an "update" (A Plea To Slow Down the Drugging of the American Boy ). Among other rejoinders to reported reader feedback, Mr. D'Agostino writes, "I also never argued against the use of drugs for a properly diagnosed disorder"-a ham-handed, have-it-both-ways attempt to deny the the original text and headline, which remained intact for anyone who cared to read it. It would take at least 10,000 words to thoroughly rebut the original Esquire piece and place the various issues in context. Yet "Drugging the American Boy" can easily be taken down by addressing only its major points:

Never considered by the editors or the writer, Ryan D'Agostino: the story's compounding of stigma already suffered by millions of children, teens, and adults with ADHD and the people who love them.

Esquire : "...The shocking truth is that many of those diagnoses are wrong... " Shocking? Hardly. Misdiagnosis of all medical conditions is rife within our healthcare system-an estimated 10-20 percent, Kaiser Health News reports. Perhaps we should stop diagnosing everything right now. What's more, Mr. D'Agostino cannot substantiate how many of these diagnoses are wrongly made. This is his opinion.

Esquire : "Millions of those boys will be prescribed a powerful stimulant to 'normalize' them. A great many of those boys will suffer serious side effects from those drugs. The piece confuses "normalizing symptoms" (clinical language) with "normalizing people." People taking medication for ADHD remain unique individuals; the difference is that they become less at the mercy of their symptoms and better able to individualize using their own free will. Side effects are to be expected from any medication. With careful trial and error over time, the medications can be adjusted to maximize positive effect and minimize negative effect. Consider the side effects of not medicating ADHD at all: Higher-than-average rates of school dropout, car accidents, brain injuries from too-risky sports and other accidents, under- and unemployment, divorce, bankruptcy, job termination, absentee parenting, and incarceration. It's estimated that about half of our prison population has untreated ADHD.

Esquire : "... most of those boys are being drugged for no good reason-simply for being boys. ....It's time we recognize this as a crisis." Mr. D'Agostino offers no evidence that these boys have been diagnosed for "simply being boys." After all, what about the majority of boys who are not diagnosed? Is implying they are not "real" boys? Is it somehow not manly to succeed in school and to get along with others?

In children and teens, males are diagnosed at greater rates than females. But by adulthood, the number is more even. Girls typically lack the physical boisterousness that call attention to many boys with ADHD; so girls often fall through the cracks. Many women with late-diagnosis ADHD have told me they worked ferociously to hide their difficulties and "please" their teachers until the added pressures of college or entering the workforce overwhelmed their capacity to compensate.

As for the "crisis" Esquire declares, educational and occupational experts have for decades pointed to the real crisis: boys underperforming in school and, increasingly, in the world a large. This is a separate issue from the claims that is making: that the schools and society are refusing to accept that "boys will be boys."

Every time I read a disparaging "boys will be boys" story about ADHD, I think of the hundreds of e-mails I've received from men in their 50s and older, finally diagnosed with ADHD and learning why they had so many intractable problems in life despite the best of intentions. I particularly recall, though, my young friend Sam. He's graduated from college now and successfully making his way in the world, but years ago he was a newly diagnosed high school student. He wrote to me, a community volunteer offering support groups and lectures to the public, because he was angry that for years he'd been dismissed as a "dumb jock."

Was his athleticism the trade-off for classroom smarts? All those around him seemed to think so, until one teacher reached out to him and changed the course of his life quite dramatically:

I am a 16-year old sophomore diagnosed last summer with ADHD. Receiving that diagnosis was a very positive event in my life, because it helped explain so many frustrations I'd had in school since early elementary school. Since being diagnosed, I've worked very hard learning the skills I could never seem to sustain before being diagnosed: how to study, how to organize myself, how to take tests, how to be a better writer, how to make fewer careless mistakes, how to focus, how to ask for help when I need it, etc.

After several trials, we've found the right stimulant medication, and my grades in school are finally improving. My struggles started early. My parents tell me that I was a late talker, and that as a young boy I would get very frustrated trying to find the words that I wanted to say. By 3rd grade, I remember being so frustrated because I hated reading and just couldn't understand what I read. I also had trouble following the stories that were read to me.

To report compassionately about ADHD and all brain-based conditions requires a degree of empathy absent in the many articles that follow the formula of "The Drugging of the American Boy."

By middle school, I had to resort to becoming more of a talker in class, but was never seriously disruptive. Still, I was never organized, I often forgot homework, I couldn't plan long-term projects, I made silly mistakes on my math even though I understood it, and my English teacher told my mom that my writing was immature, I still hated reading, I struggled with remembering things, and I still struggled with finding the words I wanted to say. For years, not one teacher or pediatrician ever suggested learning or processing issue, much less ADHD. I was judged as a "classic boy."

Finally, my 9th grade math teacher, a friend of my mom's, suggested to her that I might have ADD. I was 15 years old at the time, and the idea had never been suggested before. But the testing was irrefutable: I have ADHD-Inattentive [one of the three sub-types of ADHD, which presents with no hyperactivity]. Being diagnosed as late as I was had a pretty bad effect on my self-esteem. For all my life to that point of diagnosis, I constantly felt stupid and embarrassed about my work.

Inside my head, I knew I wanted to do well in school, but no matter what I did, I couldn't perform the way I thought I could. That's why I now want to help others. I want to help kids not feel badly about themselves as I did, to know that life can be better for them. I've seen some classmates who reacted to their own ADHD differently than I did, acting out and rebelling, perhaps to hide the fact that they felt like such failures. I'd like to help teachers and school administrators know how to recognize the "non-hyperactive" types of ADHD. They never understood that all of my organizational problems exactly fit the profile of ADHD.

They seemed to think that because I was a good athlete that my mind was always on that. Perhaps if the name of ADHD were changed to a term that more accurately reflected its symptoms (i.e., Executive Function Disorder), then teachers and parents could better detect the problem earlier.

Where is the concern about the Sams of the world? To report accurately about ADHD requires a sophisticated intellectual curiosity and a grounding in science, not sensationalism.

To report compassionately about ADHD and all brain-based conditions requires a degree of empathy absent in the many articles that follow the formula of "The Drugging of the American Boy." Consider this a plea to think of the stigma and confusion created by cynical coverage, itself the biggest threat to public health.

__________________

Gina Pera is the author of the four-time award-winning bestseller I s It You, Me, or Adult A.D.D.? and the co-author of the ADHD-Focused Couple Therapy: Clinical Interventions (Routledge, 2015) .

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When a headline features the word "drugging," the report about ADHD that follows will not be well-balanced. Such was the case with Esquire's recent salvo into the topic, " The Drugging of the American Boy." Esquire joins The New York Times in treating one of the most well-researched and documented conditions in medical history as a piñata.

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UPDATE: A plea to slow down the drugging of the American boy.
If you have a son, you have a one-in-seven chance that he has been diagnosed with ADHD. If you have a son who has been diagnosed, it's more than likely that he has been prescribed a stimulant-the most famous brand names are Ritalin and Adderall; newer ones include Vyvanse and Concerta-to deal with the symptoms of that psychiatric condition.

The Drug Enforcement Administration classifies stimulants as Schedule II drugs, defined as having a "high potential for abuse" and "with use potentially leading to severe psychological or physical dependence." (According to a University of Michigan study, Adderall is the most abused brand-name drug among high school seniors.) In addition to stimulants like Ritalin, Adderall, Vyvanse, and Concerta, Schedule II drugs include cocaine, methamphetamine, Demerol, and OxyContin.

According to manufacturers of ADHD stimulants, they are associated with sudden death in children who have heart problems, whether those heart problems have been previously detected or not. They can bring on a bipolar condition in a child who didn't exhibit any symptoms of such a disorder before taking stimulants. They are associated with "new or worse aggressive behavior or hostility." They can cause "new psychotic symptoms (such as hearing voices and believing things that are not true) or new manic symptoms." They commonly cause noticeable weight loss and trouble sleeping. In some children, some stimulants can cause the paranoid feeling that bugs are crawling on them. Facial tics. They can cause children's eyes to glaze over, their spirits to dampen. One study reported fears of being harmed by other children and thoughts of suicide.

Imagine you have a six-year-old son. A little boy for whom you are responsible. A little boy you would take a bullet for, a little boy in whom you search for glimpses of yourself, and hope every day that he will turn out just like you, only better. A little boy who would do anything to make you happy. Now imagine that little boy-your little boy-alone in his bed in the night, eyes wide with fear, afraid to move, a frightening and unfamiliar voice echoing in his head, afraid to call for you. Imagine him shivering because he hasn't eaten all day because he isn't hungry. His head is pounding. He doesn't know why any of this is happening.

Now imagine that he is suffering like this because of a mistake. Because a doctor examined him for twelve minutes, looked at a questionnaire on which you had checked some boxes, listened to your brief and vague report that he seemed to have trouble sitting still in kindergarten, made a diagnosis for a disorder the boy doesn't have, and wrote a prescription for a powerful drug he doesn't need.

If you have a son in America, there is an alarming probability that this has happened or will happen to you.

On this everyone agrees: The numbers are big. The number of children who have been diagnosed with attention-deficit/hyperactivity disorder-overwhelmingly boys-in the United States has climbed at an astonishing rate over a relatively short period of time. The Centers for Disease Control first attempted to tally ADHD cases in 1997 and found that about 3 percent of American schoolchildren had received the diagnosis, a number that seemed roughly in line with past estimates. But after that year, the number of diagnosed cases began to increase by at least 3 percent every year. Then, between 2003 and 2007, cases increased at a rate of 5.5 percent each year. In 2013, the CDC released data revealing that 11 percent of American schoolchildren had been diagnosed with ADHD, which amounts to 6.4 million children between the ages of four and seventeen-a 16 percent increase since 2007 and a 42 percent increase since 2003. Boys are more than twice as likely to be diagnosed as girls-15.1 percent to 6.7 percent. By high school, even more boys are diagnosed-nearly one in five.

Almost 20 percent.

And overall, of the children in this country who are told they suffer from attention deficit/hyperactivity disorder, two thirds are on prescription drugs.

And on this, too, everyone agrees: That among those millions of diagnoses, there are false ones. That there are high-energy kids-normal boys, most likely-who had the misfortune of seeing a doctor who had scant (if any) training in psychiatric disorders during his long-ago residency but had heard about all these new cases and determined that a hyper kid whose teacher said he has trouble sitting still in class must have ADHD. That among the 6.4 million are a significant percentage of boys who are swallowing pills every day for a disorder they don't have.

On this, too, everyone with standing in this fight seems to agree.

But on the subject of attention-deficit/hyperactivity disorder, that is where the agreement ends.

For example: Doctors, parents, and therapists give a lot of different explanations for the sharp rise. Increased awareness-that's a big one. We know more now. Other possibilities put forth: Too many video games. Too much refined sugar. Pharmaceutical companies pushing ADHD drugs. Lack of gym classes at schools. All of these factors are cited. And people have a lot of different ideas about what to do for the children who receive these diagnoses. Many believe that medicine should be the first treatment, either combined with behavioral therapy or not. Others feel that drugs should be a last resort after making every other alleviative effort you can find or think of, from hypnosis to herbal treatments to neurofeedback.

Given today's prevailing pharmaceutical culture, clinicians who believe that drugs should never be used to treat ADHD in children are very much in the minority. Marketing is powerful, and blockbuster drugs like Ritalin are big business. Business booms, market share grows when scripts are written, and countercultural doctors and therapists who advocate caution and who believe that diagnoses are made too easily-doctors and therapists who preach alternatives to drugs-are finding themselves the butt of jokes.

But more about them shortly.

The United States government first collected information on mental disorders in 1840, when the national census listed two generally accepted conditions: idiocy and insanity. A century later, psychiatrists knew more. They had options when making diagnoses, and by the 1940s difficult kids were classified as "hyperkinetic." Other terms would follow, like minimal brain dysfunction. In 1955, there came a pill doctors could prescribe for these children to temper their hyperactivity and make them behave more like "normal" children. It was a stimulant, so called because it heightened the brain's utilization of dopamine, which can improve attention and concentration. The active ingredient was a highly addictive compound called methylphenidate. The drug was called Ritalin.

By 1987, the American Psychiatric Association (APA) had settled on a more refined name for a disorder among children who exhibited the same set of symptoms, including trouble concentrating and impulsive behavior: attention-deficit/hyperactivity disorder. ADHD. At the time, in American schools, it was still considered unusual for a child to take Ritalin. It was, frankly, considered weird.

Today, it has simply become a default method for dealing with a "difficult" child.

"We are pathologizing boyhood," says Ned Hallo-well, a psychiatrist who has been diagnosed with ADHD himself and has cowritten two books about it, Driven to Distraction and Delivered from Distraction. "God bless the women's movement-we needed it-but what's happened is, particularly in schools where most of the teachers are women, there's been a general girlification of elementary school, where any kind of disruptive behavior is sinful. What I call the 'moral diagnosis' gets made: You're bad. Now go get a doctor and get on medication so you'll be good. And that's a real perversion of what ought to happen. Most boys are naturally more restless than most girls, and I would say that's good. But schools want these little goody-goodies who sit still and do what they're told-these robots-and that's just not who boys are."

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Especially when they're young. One of the most shocking studies of the rise in ADHD diagnoses was published in 2012 in the Canadian Medical Association Journal. It was called "Influence of Relative Age on Diagnosis and Treatment of Attention-Deficit/Hyperactivity Disorder in Children." Nearly one million children between the ages of six and twelve took part, making it the largest study of its kind ever. The researchers found that "boys who were born in December"-typically the youngest students in their class-"were 30 percent more likely to receive a diagnosis of ADHD than boys born in January," who were a full year older. And "boys were 41 percent more likely to be given a prescription for a medication to treat ADHD if they were born in December than if they were born in January." These findings suggest, of course, that an errant diagnosis can sometimes result from a developmental period that a boy can grow out of.

And there are other underlying reasons for the recent explosion in diagnoses. Stephen Hinshaw, a professor of psychology at the University of California, Berkeley and the editor of Psychological Bulletin, the research publication of the American Psychological Association, presents evidence in a new book that ADHD diagnoses can vary widely according to demographics and even education policy, which could account for why some states see a rate of 4 percent of schoolchildren with ADHD while others see a rate of almost 15 percent. Most shocking is Hinshaw's examination of the implications of the No Child Left Behind Act of 2001, which gave incentives to states whose students scored well on standardized tests. The result: "Such laws provide real incentive to have children diagnosed and treated." Children with ADHD often get more time to take tests, and in some school districts, tests taken by ADHD kids do not even have to be included in the overall average. "That is, an ADHD diagnosis might exempt a low-achieving youth from lowering the district's overall achievement ranking"-thus ensuring that the district not incur federal sanctions for low scores.

In a study of the years between 2003 and 2007, the years in which the policy was rolled out, the authors looked at children between ages eight and thirteen. They found that among children in many low-income areas (the districts most "targeted" by the bill), ADHD diagnoses increased from 10 percent to 15.3 percent-"a huge rise of 53 percent" in just four years.

Source: Psychiatry, April 2010; The Canadian Journal of Psychiatry, October 1999.

And yet among many of the people interviewed for this story, the most common explanation for the staggering increase in diagnoses is that doctors know more now. Great strides have been made. "I don't think there's an epidemic of new cases," says Mario Saltarelli, a neurologist and the senior vice-president of clinical development at Shire, which manufactures Adderall and Vyvanse. (Since our interview, he has left the company.) "It's always been there. It's now more appropriately understood and recognized." Instead of lumping together all the kids with high energy and bad behavior and calling them hyper, many experts say, doctors can identify the children who exhibit the symptoms specific to ADHD and treat them accordingly. "We were paying attention," says Jeffrey Lieberman, the president of the American Psychiatric Association and chairman of psychiatry at Columbia University Medical Center. "We [now] have reliable descriptions and the means of diagnosing."

Every fifteen years or so, the APA publishes a book called the Diagnostic and Statistical Manual of Mental Disorders, which doctors around the world use as a guide for diagnosing mental disorders in their patients. Known as the DSM, it has been published seven times, first in 1952 and most recently in 2013. For each revision, a new task force of psychiatrists tweaks, refines, and often expands the descriptions, definitions, and symptoms of hundreds of psychiatric disorders. It's not uncommon for definitions to be written more broadly, thus broadening the universe of people who might be diagnosed with a given disorder.

In the DSM-5, the 916-page version that came out last year, there was one important change made to the section on ADHD. The age at which a child can be diagnosed with ADHD was raised from seven to twelve. In the previous edition of the DSM, in order to meet the criteria for diagnosis, several symptoms of ADHD had to be present by age seven. Citing "substantial research published since 1994," the authors increased the window for diagnosis by five years, meaning that twenty million more children are now eligible to be told they have ADHD.

And so if a child is deemed to meet the criteria for ADHD as defined in the DSM, even by a rushed pediatrician after a cursory twelve-minute examination, the clinical-practice guidelines strongly recommend medication as part of the first step in treating kids starting at age six. (Behavior therapy is recommended as a first step for four- and five-year-olds, followed by methylphenidate, or stimulants, if the behavior therapies "do not provide significant improvement and there is moderate-to-severe continuing disturbance in the child's function.")

A cynical person might wonder whether the task forces who write the DSM are influenced by pharmaceutical companies, seeing that with each new disorder they add and each new symptom they deem valid, more people can get expensive prescriptions. ADHD drugs alone were a $10.4 billion business in 2012, a 13 percent increase over the year before.

"I think it happens in an indirect but nonetheless powerful way," says Lisa Cosgrove, a clinical psychologist who is an associate professor at the University of Massachusetts, Boston and a fellow at the Center for Ethics at Harvard. In a study of the DSM-5, she found that 69 percent of the task force acknowledged ties to the pharmaceutical industry. Many of these were likely indirect affiliations, but Cosgrove says that doesn't matter. "It's not that I think there's this quid pro quo kind of corruption going on. But when the individuals who are charged with the responsibility of developing criteria or with changing the symptom criteria-I don't think they are consciously aware of the way in which industry affiliations create pro-industry habits of thought." Cosgrove points to what she calls a "major gap" in the APA's disclosure policy for doctors who worked on the DSM-5: It allows unrestricted research grants from drug companies. "Now, 'unrestricted' means that the pharmaceutical company cannot in-house analyze the data...but there's a wealth of social-psych research that shows that when you are paid even small amounts-and there's the potential for future payment-it affects your behavior. If I get an unrestricted research grant from Pfizer for $500,000, and I'm hoping to get a $2 million grant, at some level I'm going to be aware of how I talk about the results."

The journal Accountability in Research chose Cosgrove's paper "Commentary: The Public Health Consequences of an Industry-Influenced Psychiatric Taxonomy" for publication in 2010, when a first draft of the DSM-5 was made public. In the paper, Cosgrove and her coauthors lambasted the psychiatric community for supporting a manual that largely ignores side effects and promotes diagnosis by constantly adding symptoms and disorders. "A psychiatric taxonomy [i.e., the DSM] which touts indication for medications, but is effectively silent about their associated risks, is evidently unbalanced and raises questions about undue influence," they wrote. "The time has come to seriously reconsider whether the heavily pharmaceutically funded APA should continue to be entrusted with the revision of the DSM."

Dr. Allen Frances, professor emeritus at Duke University School of Medicine, the former chairman of its psychiatry department, and the chairman of the DSM-IV (1994) task force, feels the problem is not corruption but the slow creep of misinformation. "I know the people. They're not doing it for the drug companies-they really believe what they're doing is right. They really believe ADHD is underdiagnosed, and they want to help people who should be getting medication. I just think they're dead wrong."

Frances points to the fact that in August 1997-the same year the CDC first started tallying ADHD cases in the United States-the Food and Drug Administration made it easier for pharmaceutical companies to advertise their drugs to consumers. Spending on direct-to-consumer drug advertising increased from $220 million in 1997 to more than $2.8 billion by 2002.

It's not that Frances believes ADHD is not a real and valid diagnosis; he just believes that these days it's made so frequently it has been rendered meaningless. "It's been watered down so much in the way it's applied that it now includes many kids who are just developmentally different or are immature," he says. "It's a disease called childhood."

Falsely diagnosing a psychiatric disorder in a boy's developing brain is a terrifying prospect. You don't have to be a parent to understand that. And yet it apparently happens all the time. "Kids who don't meet our criteria for our ADHD research studies have the diagnosis-and are being treated for it," says Dr. Steven Cuffe, chairman of the psychiatry department at the University of Florida College of Medicine, Jacksonville and vice-chair of the child and adolescent psychiatry steering committee for the American Board of Psychiatry and Neurology.

The ADHD clinical-practice guidelines published by the American Academy of Pediatrics-the document doctors are supposed to follow when diagnosing a disorder-state only that doctors should determine whether a patient's symptoms are in line with the definition of ADHD in the DSM. To do this accurately requires days or even weeks of work, including multiple interviews with the child and his parents and reports from teachers, plus significant observation. And yet a 2011 study by the American Academy of Pediatrics found that one third of pediatrician visits last less than ten minutes. (Visits for the specific purpose of a psychosocial evaluation are around twenty minutes.) "A proper, well-done assessment cannot be done in ten or fifteen minutes," says Ruth Hughes, a psychologist who is the CEO of Children and Adults with ADHD (CHADD), an advocacy group.

Only one significant study has ever been done to try to determine how many kids have been misdiagnosed with ADHD, and it was done more than twenty years ago. It was led by Peter Jensen, now the vice-chair for psychiatry and psychology research at the Mayo Clinic, but at the time a researcher for the National Institute of Mental Health. After a study of 1,285 children, Jensen estimated that even way back then-before ADHD became a knee-jerk diagnosis in America, before one in seven boys had been given the diagnosis-between 20 and 25 percent were misdiagnosed. They had been told they had the disorder when in fact they did not.

Part of the problem is subjectivity, and the power of a culture that has settled on a drug-based solution. Decades of research have gone into trying to define the disorder in a clinical way, and yet the ultimate diagnosis-Your son has ADHD-is inherently subjective. And insurance companies don't reimburse or reward doctors for time spent doing the diligent work involved in giving a proper opinion. "You have to observe the behavior of the child over different environments. You have to talk to the parents. You have to talk to the teachers. I don't know an insurance company out there that pays for a pediatrician to call and talk to the teachers. They just don't," says Hughes.

Ned Hallowell does not accept insurance in his private psychiatry practice, which he says allows him to spend more time with patients. "But for the average person, it's the luck of the draw," he says. "Do they have a good, savvy pediatrician who can be careful about the diagnosis, or do they have somebody who just hears 'ADD' and writes a prescription?"

Lieberman, the APA president, says most doctors try to get it right. "Are there pressures that are packed on clinicians that make them less than optimally rigorous [in making a diagnosis]? Unfortunately, there are," he says. "But I mean, you have our health-care financing system that's quite dysfunctional, and it's created a situation where doctors have to spend a certain amount of time with bureaucratic, administrative paperwork and regulatory-compliance stuff.... We also have a culture where there's pressure, both from schools as well as from parents, to do something-to alleviate the problem and enhance the performance of the child. That's no excuse, and doctors shouldn't succumb to that. But, you know, doctors are human.... We'd like everybody to be these heroic figures who fulfill the virtues of the Hippocratic oath. I think most doctors aspire to try to do that. But human limitations being what they are... caveat emptor."
Ask Glasser all your ADHD questions...
One man believes that drugging children's brains is too risky. That until we get a lot closer to achieving a foolproof diagnosis for ADHD, we need to think twice about giving a single pill to a single child. He believes that what is called attention-deficit/hyperactivity disorder might in fact be a boy's greatest gift, the gift of energy. And that the best way to treat it is to first teach the boy to control the energy all by himself, because by learning to control it all by himself, a boy can channel that energy to help him succeed. That the responsible thing to do is first to see if there is some problem with the boy's heart-not with the way it pumps blood, but with its ability to show and accept love. The man's name is Howard Glasser, and he is one of those countercultural clinicians who, as American society has become inured to giving psychotropic drugs to kids, has built a practice predicated on opposing the very idea.

If he were a child today, Glasser would be given a prescription for a stimulant in about five minutes. Little Howie was a wired kid. Obstreperous. But good. A good kid. And when he grew up and became a family therapist-he has applied to earn his doctorate in education from Harvard starting this fall-he created a way of dealing with wired, obstreperous, uncontrollable kids who are, beneath all that, good. And he believes all of them are good.

He calls the method the Nurtured Heart Approach, and it seems simple on the surface: You nurture the child's heart. If a child is hyperactive and defiant and has trouble listening and concentrating, Glasser feels it is our responsibility as a society-as grown-ups-to do everything we can for a child's heart before we start adding chemicals to his brain, because what if his brain is fine? What if the diagnosis isn't right? And even if it is, what if something else works?

Hyperactive, defiant-he was all those things. At home-the apartment his parents rented in Kew Gardens, a leafy, almost suburban corner of Queens-he was sometimes so defiant that his mother would shout into the air, asking what she had done to deserve this, her face brightening with incarnadine helplessness. His father was a salesman of electrical supplies, and he and Howie used to go at it pretty good. Sometimes, when it was his turn to teach Howie a lesson, his father would reach for the rubber machine belt. Howie took that punishment laughing. Heartbreaking laughter.

At school he would sit in the back of the class, cracking jokes until his teachers were overcome with that unique kind of exasperation that results from feeling outrage and disappointment at the same time. Outrage because you wouldn't believe the mouth on this kid. Disappointment because he was so smart. Because he had so much potential.

Man, was Howie Glasser smart. That was the problem nobody saw: He was a funny, clever kid who scored high in both English and math without much studying. School bored him. The teachers, though, had to teach to every student in the class, and Howie felt forgotten. He didn't need to listen, so he sat in the back of the room and goofed off, his gangly frame folded awkwardly into a too-small wooden chair. Kids would laugh, and he'd do it more. And every time the teachers got angry and pointed their fingers toward the principal's office, struggling to keep from screaming at Howie-to keep from smacking him, probably-they were only feeding his recalcitrance. Finally, someone was paying attention to him! Deep down Howie didn't like the negative attention, but it was better than no attention at all.

In junior high school, they wanted to hold him back. He couldn't handle the next grade, they said-he couldn't concentrate, he was hanging around with the wrong kids, he just wasn't ready. But then Howie took a test, and his score surprised even the teachers who knew he was smarter than he let on. He scored high enough to skip ahead and graduated high school at sixteen.

Glasser graduated from City College with a degree in psychology, then got a master's in counseling at New York University. He had started work on a Ph.D., also at NYU, but after a year or so he dropped out to do the thing he loved most, the thing that made all the noise go away, all the trouble, all the teachers who couldn't figure out how to harness and channel his energy, his hollering parents who didn't understand why he couldn't be more like his older brother: He worked with wood.

Howie's Woodworking opened on Third Avenue and East Twelfth Street in New York in 1980. He collected wood around the city-old floorboards from gutted townhouses, planks, pallets, scraps. He made planters and mosaics and odd pieces of furniture. People would see the sign and come in and ask if he could do bigger jobs-cabinetry, fine furniture, storefronts. Glasser would always tell them he could do it, even though he had no idea how. Then he'd hire people who could show him.

After a few years, Glasser moved out west, far from the overdrive of New York, to the Arizona desert. On his way out, in Boulder, Colorado, he got to know a man named Michael Davis, who, with his wife, Anita, was raising four sons, two of whom were adolescents at the time. The first time Glasser visited Davis's house, there was some kind of minor drama unfolding that day, the kind of argument that periodically bubbles up in a house where teenagers live.

And the way the Davises handled it made Glasser weep.

"Michael and Anita were talking to their kids in the most loving way. I had never until that day-ever-encountered anybody who talked to their kids that way. I had tears streaming down my face," he says. "In my world, in my circumscribed world, it was not the culture. It's kind of breathtaking to me now." Even as he tells this story almost thirty years later, Glasser has to pause, swallow hard, and clear his throat.

He eventually moved to Tucson with the woman who would be the mother of his only child, a daughter. Almost as soon as he arrived, he found a job at a family-therapy institute where he could use his psychology training. "It was like the sea parted," he says. He felt as if he was doing what he needed to be doing. He got a second job at a clinic that was known for helping kids with behavior problems. Many of them had been diagnosed with ADHD.

"I had been one of these kids," he says. "And here I am with twelve preadolescent kids who aren't on their meds on the weekends-I would meet with them on Saturday mornings. So you get to see: These are very interesting human beings. I got to experience the truth of these kids off medication."

Glasser would open up group discussions by asking what the rules should be. The children half-raised their hands and called out predictable answers: no hitting, no yelling, no bad words, no this, no that. The first time it happened, Glasser was seized with memories, a darkness moving over his brain like a shadow. "It was PTSD for me. I grew up with rules that start with no, and I hated rules that start with no. They always led to me getting in trouble, and ultimately getting hit," he says. "It got my attention that kids saw rules that way."

The clinic and the therapy institute both employed other bright young therapists, and they all called on their state-of-the-art psychology training to try to help the troubled families in their care. They used positive reinforcement. Instead of rules that started with no, they set rules like "Be respectful" and "Use nice words." This was all fine and hewed closely to the education and therapy trends of the day. Kids behaved better. Families improved. But they didn't change. Positive reinforcement is great, but there was only so far it could go with a difficult child. Glasser knew he hadn't truly scraped away the artifice of defiant behavior to get at whatever pain was festering inside these kids. He wasn't finding whatever it was that stirred them to yell and swear and make the grown-ups think they needed medication.

The problem with the positive rules was that there didn't seem to be a very good way to teach them. The old rules were mostly taught when children broke them. If the rule is "No hitting" and one kid hits another, you'd teach the child the rule in that moment. "What you just did was wrong." You'd tell him to go sit in the corner, or go to his room, or apologize. But in those moments, everyone's upset. The kid who got hit is crying, the hitter is angry and scared, and the grown-up is amping up the authority. The offending child gets all the attention. The rule doesn't stick.

Still, Glasser saw that kids seemed to like "no" rules because they're clear. The line of transgression was definite. He had an idea: What if he told the children how great they were when they didn't break a rule? It would be like a video game. When you do something great while playing a video game-when you simply do what the game expects-you get points and you get to keep going. When you go out of bounds or break one of the game's rules, no one yells at you or reminds you what rule you've broken. You simply miss a turn or lose points. And there is no grudge once you pay the fine. As Glasser wrote in his first book in 1999, Transforming the Difficult Child, "When the consequence is over, it's right back to scoring."

Kids love video games. "They don't need us to figure out a video game for them," he says. "They figure it out in three minutes, and then they become stars. The beauty of those games is the energy of success is so strong, consistent, reliable, available. If they break a rule in the next two seconds, the game unplugs momentarily. Grown-ups look at the consequences in these games and we don't always see the truth of what's going on. It looks to us like, Oh my God, huge consequence-blood spurting, heads rolling. But actually, the kid's out of the game for two seconds but it feels like an eternity to them because they've become such a devotee of being plugged in to success, and they vividly feel the energy of missing out. When the consequence is over, they don't just come back into the game, they come back ever more determined: I'm not gonna break another rule."

And so he thought, What if a child was sitting quietly, not bothering anyone, and you went out of your way to congratulate him on that, very specifically, by telling him how proud you are that he's not hitting anyone, not screaming, not throwing toys, but just sitting quietly? What if you gave a child the equivalent of points-what if you thanked him or hugged him-for not putting his feet on the couch? How would he respond to that?

He'll like it, it turns out.

"I started accusing kids of being successful for not breaking rules. Nobody ever in my professional career had done that," he says. "All of a sudden-and it was as weird as it could be-I knew I was speaking to some level of a kid's soul. I knew it was nourishing them in some way. It was like me weeping at Michael Davis's house. In my professional career, no kid had ever been told they were successful when it came to rules."

Many of the people I interviewed who have had direct experience with ADHD-parents of children who'd been diagnosed, psychiatrists, adult ADHD patients-assured me, within the first minute of our conversation, that ADHD is a real disorder, not some made-up condition.

"It's important to understand that ADHD is a very real, serious, neurobiological disorder," said Saltarelli, the neurologist who was formerly senior vice-president of clinical development at Shire, maker of Adderall and Vyvanse, which is now the most common brand of stimulant prescribed for ADHD. He repeated this point several times during our hour-long conversation.

"I don't think in the medical community or in the research community there is any question that this is a brain disorder. I really don't think that is in question," Ruth Hughes, the CHADD CEO, told me after I asked her about the validity of brain scans that purport to show ADHD, which have been disputed by other scientists.

"There is no doubt in my mind that I really believe this is a disorder, disease, condition, whatever you do-like, it is for real," said Tracie Giles, a parent of four children, two of whom have been diagnosed. She is the coordinator of the local CHADD chapter in Wayne County, Michigan.

The interesting thing is I never asked any of these people whether ADHD is real. But their defensiveness is understandable. ADHD isn't strep throat-there's no culture, no test. To find out if you have it, or if your son has it, or if your daughter has it, you just need a human being to say so-a physician or a psychiatrist-and that makes some people skeptical. Google "Does ADHD exist?" Up pop the detractors who call the very disorder into question.

ADHD has become the most controversial medical topic in America when it comes to children. In 2000, Bob Schaffer, then a Colorado congressman, called a hearing about ADHD medication before the House Committee on Education and the Workforce. "I had been in politics a long time even before I had this hearing," he says. "And you would think that with issues of national missile defense, the space program, the billions we spend on public education, the China trade bill I voted on-that something else would have resulted in more blowback, but I can't think of anything else that did. It inspired more personal hostility and defensiveness than anything else I'd ever been involved in."

The biggest reason: Managing ADHD, for most people who receive the diagnosis, includes taking medication. If the diagnosis is real, a prescription can turn around a child's life in an instant, improving his ability to concentrate and jacking up his self-esteem. Denying a child who needs the medicine is as cruel as forcing it on a kid who doesn't. Even Howard Glasser is not anti-medication-not entirely. He believes that in rare cases it can be effective as a temporary measure. But it's a terrifying choice to make for many parents.

Ned Hallowell once famously said that stimulants were "safer than aspirin," a statement he has since backed off of. ("That's almost a preposterous statement for anyone to say," says Saltarelli.) "I think that was misleading," Hallowell says now. "I was dealing with people who thought these medications were extremely dangerous, and if they're used properly, they are not. But now I don't say that anymore because I'm worried about high school students taking them without any medical evaluation." But Hallowell stands by his assertion-widely corroborated-that it's silly to try to treat ADHD without medicine. "I certainly am not gonna try to persuade you to use medication, but once you learn the facts, chances are you will want to. Because doing a year, say, of non-medication is sort of like saying, Why don't we do a year of squinting before we try eyeglasses."

In 1999 the National Institute of Mental Health published its landmark study "Multimodal Treatment of ADHD," which was led by Peter Jensen; 579 children ages seven to nine took part. The study declared that the best treatment, across the board, is medication combined with behavioral therapy-but that the combination works only marginally better than medication on its own, with no behavioral component. This made a lot of parents feel better about accepting a prescription for their children, and the study is frequently cited by pharmaceutical companies, psychiatrists, and organizations like CHADD.

Research published since the multimodal study, however, suggests that treating kids who have ADHD with cognitive behavioral therapy can have the same positive effect as stimulants. A new study in the Journal of Abnormal Child Psychology shows that behavioral therapy, alone or in combination with stimulants, is far more effective than medication alone. The children in the study-forty-four boys, four girls, all diagnosed with ADHD-were given varying doses of medication and behavioral therapy, and researchers monitored their episodes of "noncompliance" each day. The worst-behaved children were the ones receiving only drugs and no behavioral therapy. Even kids given a placebo while also receiving some behavioral therapy behaved far better than kids being treated with drugs alone. The sweet spot was a low dose of medication plus behavioral therapy.

William Pelham of Florida International University, the lead author of the study and one of the original investigators on the multimodal study, says that these findings show that psychosocial treatments "are the key to long-term success. Medication alone is not the solution to the long term."

I wanted to talk to an actual person at a drug company about the difficult choice. I called Novartis, which manufactures Ritalin and Focalin XR. A media-relations specialist, Julie Masow, declined to make anyone from the company available to me for an interview, citing the fact that it was summer and people were traveling, and instead provided me with a vague written statement. But eventually Masow agreed to provide written answers to any questions I wished to send her via e-mail. It was a fairly fruitless exercise-a lot of anodyne corporatespeak about how "ultimately, the decision to prescribe an ADHD treatment for a child with ADHD is between the physician and the patient's parent/guardian" and "Patients and parents/guardians also receive a copy of the medication guide included in the drug package insert."

Novartis is right, to a point-pharmaceutical companies do not prescribe the drugs they manufacture. So do they care what happens once the drugs leave the factory? When I asked Saltarelli of Shire whether drug companies should do anything to make sure their products are used correctly, he said, "It is our responsibility to make sure that the drugs are being appropriately utilized. It's obviously impossible for us to be in any way involved in diagnosis, let alone in every doctor's office where diagnoses are being made. But we do feel an ethical obligation-and we've actually invested quite a bit to do whatever we possibly can through educational efforts to make sure that these drugs are being used appropriately." When I asked the same question of Novartis, the answer (via e-mail) was "Novartis supports only the appropriate use of ADHD medicines as indicated and prescribed by qualified, licensed health-care providers. Novartis does not participate in the diagnosis of patients with ADHD, as the diagnostic criteria..."

Karen Lowry, a nurse in Medford, New Jersey, helps run a local CHADD chapter. She has four children, the youngest of whom has ADHD. "When he was first diagnosed, we were adamantly against medication. No, it might prevent his brain growth. We'll deal with behavioral programs. It's not happening," she says. "But as first grade progressed and we saw our child with an ADHD diagnosis experiencing hyperactivity, impulsivity, and inattentiveness in a classroom setting with a teacher who was really not very understanding, we saw a kid who was falling through the cracks. We saw a kid who was not developing friendships, peers who were always blaming him for everything that was going on around him. So my husband and I looked at each other again and said, Oh my gosh, we need to rethink this. Are we not being fair to him? What's worse? Not fully understanding the medication and what can happen in a positive way, or just standing our ground saying, We're unsure about this?"

Lowry and her husband ended up putting their youngest son on a stimulant. His behavior improved vastly, and the ADHD seemed to be under control. But toward the end of the school year, he developed severe facial tics, a side effect of some ADHD medications. They took him off the medication for the summer, a decision many parents make at some point. "He's adjusted pretty much," she says. "He's on a very low dose because he does get the headaches. It's sometimes hard to balance, you know, the side effect with the effects of the drug." Overall, Lowry thinks they made the right call. It's a question she gets a lot from other parents of children with ADHD. "I would never tell anyone to put their kid on medication. All I will say is look at the results. And I always commend the parents who come to our classes, even if they're frantic: Your kid will be okay because you're here."

Ruth Hughes, CHADD's CEO, finds herself defending-or justifying-ADHD as a diagnosis regularly. More than twelve thousand people are members of the organization. Its annual budget is about $3.5 million, of which up to 30 percent can come from the pharmaceutical companies that manufacture ADHD drugs, according to Hughes.

During our phone interview, I asked Hughes whether CHADD could be classified as pro-medication. "Well, I'm going to reframe this a little bit," she said. "We are pro-science, pro-research. Our issue is to make parents or adults who potentially have ADHD to be very well informed consumers of medical services."

I told her I was asking because while there are lots of books and articles out there about how to treat ADHD without medication, you hardly ever see anything about that on CHADD's Web site or in its bimonthly magazine, Attention.

"You don't," she said.

If we don't know what we're doing, maybe we shouldn't be doing it. Putting a child on highly addictive psychotropic drugs ought to be very difficult, not shockingly easy. And yet even if Peter Jensen's twenty-year-old estimates about misdiagnosis are still correct, an astonishing 25 percent of today's 6.4 million kids, overwhelmingly boys with developing brains, might be experiencing side effects for no reason. Because he made that assumption long before ADHD became such a popular diagnosis, the number could be far higher now.

Yes, the drugs these children consume may work. They help them focus for longer periods of time. They help them do better in school. But consider this: Stimulants work on just about anyone. "These are powerful drugs," says Bob Schaffer, the former Colorado congressman. "They would work on me. They would make anyone more focused. And everyone's happy because the kid is now under control." The fact that the drugs would help you perform better at work doesn't mean you should take them. And it certainly doesn't mean a seven-year-old boy who doesn't suffer from a psychiatric disorder should be taking them.

Why not, if they help him do better? Because, for one thing, an important study of four thousand children published last year concluded that children who took stimulants didn't do any better in school than kids who didn't. But also, and perhaps more important, because he might not be the same seven-year-old boy once he starts, and he may never be the same boy again.

Another little-examined feature of these drugs is the global changes in personality that they can cause. Jim Forgan is a psychologist in Jupiter, Florida. The first thing you see on his Web site is an ad:

"Dr. Jim Forgan's Parent Support System

10 Easy to Use Modules

Over 80 Educational Videos

Downloadable Resources

Online Access 24/7

And Much More!"

The video support system is available for a one-time fee of $49.97. Forgan is the coauthor of a book called Raising Boys with ADHD, also available for purchase. He speaks from experience. His son has been diagnosed with ADHD. Forgan knows all the warning signs, and he tells parents about them. He's in favor of drugs when they're administered correctly-starting with low doses, watching vigilantly for side effects, stopping use if the side effects outweigh the benefits.

How do you know if the side effects outweigh the benefits?

"Careful monitoring," says Forgan. "And for me personally, with my son being on the stimulant medications, those are medications you don't have to take every day, so we would give him the holiday breaks on the weekends and spring break and summertime, just so that he didn't have the medication all the time. And yeah, there's a difference, he has more energy. My son doesn't like to take the medications because he feels like it makes him feel flat, and he doesn't like what it does to his personality. And he says he's not the same fun person that he is when he's not on the medication. And some of that fun gets him in trouble at school, because he's funny and knows how to entertain people. But at the same time, he likes that characteristic about himself-that he is fun and knows how to get people laughing and working together and bring energy into a room. Kinda like the life of the party."

I tell Forgan that there is something heartbreaking about the fact that such a lively part of his son's personality disappears when he's on medication, and that his son knows it disappears. "Is it just that he was getting into too much trouble?" I ask.

Forgan pauses and says, "Right. Yup, it gets him in trouble and he hasn't-when he was in elementary school, he didn't have his own ability to have the self-control not to say impulsive things and do impulsive things that other people find funny but the teacher finds very annoying."

"And you see the fun part of him reemerge during breaks from the medicine?"

"Right."

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Howard Glasser's biggest fear in life is that a child might grow up not knowing how great a person he is. It keeps Glasser awake at night sometimes, this image of a kid thinking he's no good. It lodges a pit in his throat.

Ned Hallowell, the ADHD expert who has the disorder, writes books about it, has talked about it on Dr. Oz, and thinks medication usually gets good results, feels the same. "The medical model is so slanted toward deficits that it excludes strengths-and it also reinforces stigma, that this is shameful, this is bad, this means you're a loser. And that becomes a self-fulfilling prophecy. It's the old line of whether you think you can or you think you can't, you're right. And what breaks my heart is how these kids, and the parents along with them, get broken in school, and they come out of twelfth grade believing that they're stupid. Believing that they're defective. But this trait, these are the people who colonized this country! Just think of it: Who in the world would get on a boat in 1600 and come over here? You had to be some kind of a nut. You had to be a visionary, a dreamer, an entrepreneur-you know, a risk-taker. That's our gene pool. So this country is absolutely full of ADD."

So there is something great about having ADHD. The question is how to treat the difficult parts in a way that pushes the greatness forward.

"I confront kids with their own greatness," Glasser says. "Because that's what I think allows a kid to go from an ordinary life to a purposeful life. To see who they really are. The worst-case scenario in life is that a boy grows up thinking: Who I really am is a kid who annoys everybody."

In 1994 Glasser opened the Center for the Difficult Child in Tucson, his first effort to teach therapists his Nurtured Heart Approach. In 1999 he published Transforming the Difficult Child, which has quietly sold nearly 250,000 copies. Today he runs an organization he named the Children's Success Foundation, which is an expanded effort to teach educators and therapists around the United States how to use what he has found from twenty years of practicing the Nurtured Heart Approach.

"It's much more about reaction than attention." That sentence appears on page 10 of Transforming the Difficult Child. It's a profound distinction, and there is no deeper nor more simple understanding of a child's needs. Parents of intense boys can shower their children with love and attention, and still the boys might be difficult boys. What's important is how you react to what a child does, good or bad, Glasser says. Mostly, we get animated when our kids do something bad. We get worked up, and we give them energy-negative energy, but energy nonetheless. But when a difficult child is sitting quietly, playing or writing or drawing, not disturbing anyone, not throwing food, not picking on a sibling-we do nothing. We don't acknowledge it at all. The way a difficult child gets a parent's energy, then, is to do something bad.

"Most parenting approaches have you giving a strong punitive consequence that's all energy and that confirms that, as a parent, you're highly available through negativity-you're a toy that works when they push buttons," he says. "And you work if and only if they act out bigger."

Watching Glasser work with a child is a marvel.

He is sitting on the carpeted floor of a family's basement playroom, his lanky frame contorted into what passes for comfort for a sixty-three-year-old man sitting on the floor. He is watching a sandy-haired boy of seven play with his toys. A few minutes before, the boy had been hitting his younger brother, and he had been scolded, hit his brother again, and been banished from the kitchen. Now he plays peacefully.

"I see that you are very calmly building with your Legos," Glasser says to the boy, in a smooth and even voice, as if he were commenting on clouds moving across the sky. "That's really great to see. It shows that you respect your mom and dad, because they love it when you play nicely."

The boy just nods without looking up, like, Sure, thanks mister. So Glasser keeps at it.

"So I assume you heard what I said. And I just want to elaborate a little more. Because here's what's great: You have this wonderful quiet way of thinking things through. I can tell that you're thinking about what it means to be calm. And maybe you don't quite know what calm means. Let me tell you how great calm is. What does it take to be calm?"

The boy looks up now. Words are starting to register with him. His face is blank, but he's thinking. This is unusual for him-getting attention, getting a reaction, for being so good.

"Well, while you're thinking about it, let me tell you. It takes wisdom, for one thing, because you could be yelling. You could be annoying people. Have you ever been annoying? Well, you're not being annoying. You're not running around the lunch table. You're not throwing your food or hitting your brother. All these things that kids your age could do, you're not doing. That's being calm. That shows me you're being thoughtful. That you care about other people, and that you're in control of your body. Being in control takes a lot of concentration and effort. Doesn't it?"

The boy nods, just barely. He is looking right into Glasser's eyes. For years, since he was two, the boy has had trouble controlling his body sometimes. Sometimes the energy inside him is just too much, and it builds like gas trapped in rock until it bursts forth in a violent, painful mess. At times he has driven his parents to a crisis of helplessness. The heartbreaking part is the boy has tried so hard to control his energy, and he's gotten better at it. But sometimes he still just can't. Once, in the middle of the night, when he was four, he wouldn't go to sleep and kept throwing toys at the door until his mother cried and his father yelled, and then through the tears streaming down his tiny cheeks he looked up at his father over the plastic gate that was jammed in his bedroom door and, in a moment of astonishing self-awareness, pleaded, "I need to calm my body down!" When he started school, his parents mentioned to the school psychologist that their son sometimes had an issue with impulsive behavior. The psychologist, who had never met him-who had never met the boy-told the parents that it sounded like he probably had ADHD. The parents had had their son evaluated by child psychologists, pediatricians, teachers, and independent therapists, and not one person had ever suggested ADHD, and in fact, the boy's pediatrician and the rest of the school's counseling, teaching, and professional staff said resolutely the boy showed no signs of it. (When he heard that a school psychologist had said this, Glasser wasn't surprised. "Sure. Your son is intense. If you wanted to go out and get him a prescription for ADHD medication, you could do it tomorrow," he told the parents.)

"That's right," Glasser says to the boy. "It does take a lot of effort. And I want to tell you something: A few minutes ago, you hit your brother. And he started crying, and then you got really upset when your parents told you to stop. You were really mad at him and at them. But look at you now. Look at yourself! You calmed yourself down so beautifully. And that was an amazing, amazing thing to do, because it's hard to calm yourself down when you're so upset. But you figured out how to control your body in a really bad moment. You did that yourself. No one did it for you. And that shows greatness. That shows me and everybody else that you have greatness inside you."

The boy is looking at him still, locked in.

And, slowly at first, the boy begins to smile. And then the smile spreads across his whole, beautiful seven-year-old face. His teeth, missing here and there and sticking out in gaps where he used to suck his thumb, shine across the room, and he lets out a giggle, and the giggle turns into the kind of proud, embarrassed laugh kids do when they haven't learned how to take a compliment. His face is lit up-he is shocked by what he has just heard, and shocked by his own joyful reaction. He's laughing, looking at this man who has just told him that he has greatness within his soul, and the kid slaps the floor, then crosses his skinny arms on top of his head, and smiles with pride. He is euphoric.

It is almost as if he has been drugged.
QUESTIONS? Ask ADHD Expert Howard Glasser >> PLUS: David Granger on Medicating Boyhood >>
Plus: Email Us Your Story
ADHD can feel like a lonely place.
The parents of millions of American boys have been told their sons have ADHD, and yet many of those parents will tell you they struggled with what to do when they got the news. Trust it? Get a second opinion? Put their son on medication? Try something else? But what?

There are forums and support groups, chat rooms and books to read, but on Esquire.com, our hope is to collect stories that may be of use to parents (or aunts or uncles or grandparents or caregivers) of boys. Because while ADHD is a growing fact of life among American children, the statistics show that among boys, it is a crisis.

What has been your experience with ADHD? Has your son been diagnosed? What was the experience like for you and your family? Which of your questions went unanswered? Did ADHD drugs work? Would you handle it the same way a second time?

Email it to editor@esquire.com. Maybe it will help someone who's just been told their son has ADHD and should be medicated, and who wants to make sure, beyond all doubt, that this is the right thing to do.

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UPDATE : A plea to slow down the drugging of the American boy. If you have a son, you have a one-in-seven chance that he has been diagnosed with ADHD.

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This blog post discusses the fallout from the "The Drugging of the American Boy" Esquire article and the "How Esquire got ADHD Wrong" Observer response.

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As if people with a mental illness didn't have enough to worry about.

One of the favorite media topics to write about is attention deficit hyperactivity disorder ( ADHD), a potentially serious mental illness that affects millions of Americans. It causes them to not be able to focus on everyday tasks that most of us have little trouble with. Many people with ADHD can't sit still, interrupt others, and can't wait their turn. Others find any kind of task that requires sustained attention simply impossible.

In the modern world, with so many devices and services competing for our attention, ADHD is at the heart of a perfect storm for those afflicted. While most of us juggle our attempts at multi-tasking seemingly well, those with untreated ADHD have a hard time just getting started.

So it makes me wonder: why are so many journalists quick to pick on ADHD?

It would be pure speculation as to why a journalist finds the topic of attention deficit disorder so sexy. Perhaps it's because there are medications available to treat it (unlike another childhood disorder that's on the rise too, autism). Perhaps it's because it seems like the criteria for ADHD - which up until last year hadn't changed for nearly two decades - are ever-changing and easier to meet.

Or perhaps it's just because ADHD calls out to lazy journalists looking for a sensationalistic story to tell - "the drugging of our children" (nevermind that children have been taking all sorts of drugs for decades, from antidepressants to pain relievers).

Gina Pera, writing over at the New York Observer, is one expert who's noted the uncalled-for sensationalism in a piece published by Esquire entitled "The Drugging of the American Boy:"

Never considered by the editors or the writer, Ryan D'Agostino: the story's compounding of stigma already suffered by millions of children, teens, and adults with ADHD and the people who love them. Hammering on the themes of misdiagnosis and side effects, Esquire overblows these issues while delegitimizing the diagnosis itself and the medications often used to treat it.

Paul Raeburn sums up the real ADHD story quite brilliantly over at the Tracker blog from the Knight Science Journalism:

Some kids get medicine when they shouldn't. And some kids don't get medicine when they should.

The first of those is reported over and over and over again. The second is almost never mentioned.

Isn't that interesting? That journalists - even from venerable institutions like The New York Times - can sometimes be pursuing their own biased agenda, too, with the reader none the wiser?

Raeburn sums up my view quite nicely too:

I'm urging reporters to look at ADHD more carefully and consider that perhaps the most important problem with children and mental illness is not overmedication, but the sad fact that many of them get no treatment whatsoever.

I would love to read the story in the NYT about this issue. About the issues of stigma and discrimination that still run rampant in American society.

About the shame many young adults feel for their illness. And how they are meant to feel guilty or someone looking to "game" the system in order to get needed treatment for their serious mental illness.

I would ask any journalist who thinks they're being fair, unbiased and not discriminating against this mental illness - would you write these sames kinds of pieces about children diagnosed with leukemia? Or lupus? About how they are "drugged" in order to "normalize their symptoms?"

Ryan D'Agostino's piece in Esquire is just another example of the low bar that's been set for what passes for modern journalism today. It does little to illustrate the real problem in overdiagnosis - diagnostic criteria not being properly applied by clinicians, mostly ill-trained family docs and general practitioners - and says nothing about the other side of the coin of this problem: people who don't get treatment for ADHD (because it was never properly diagnosed, they couldn't afford it, or they failed to followup with treatment recommendations because of the stigma associated with the condition).

Perhaps some day a journalist will take a stab at an actual balanced piece about mental illness in children.

Read the full article at the New York Observer: How Esquire Got ADHD Wrong

Read the full article at the Tracker blog from the Knight Science Journalism: Esquire tracks "the drugging of the American boy."

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Scapegoating ADHD - Because It's Popular | World of Psychology

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As if people with a mental illness didn't have enough to worry about. One of the favorite media topics to write about is attention deficit hyperactivity disorder (ADHD), a potentially serious mental illness that affects millions of Americans. It causes them to not be able to focus on everyday tasks that most of us have little trouble with.

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Are anti-depressants an effective treatment option?

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Are anti-depressants an effective treatment option?

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Most anti-depression prescriptions are given without a psychological diagnosis.

(This peer reviewed journal article is available via Google Scholar and the Medline database in EBSCOhost)

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Proportion Of Antidepressants Prescribed Without A Psychiatric Diagnosis Is Growing

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Over the past two decades, the use of antidepressant medications has grown to the point that they are now the third most commonly prescribed class of medications in the United States. Much of this growth has been driven by a substantial increase in antidepressant prescriptions by nonpsychiatrist providers without an accompanying psychiatric diagnosis.

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"Jogging as medication"

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Aerobic activity has shown to be an effective treatment for many forms of depression. So why are so many people still on antidepressants?

Jim Young/Reuters

Joel Ginsberg was a sophomore at a college in Dallas when the social anxiety he had felt throughout his life morphed into an all-consuming hopelessness. He struggled to get out of bed, and even the simplest tasks felt herculean.

"The world lost its color," he told me. "Nothing interested me; I didn't have any motivation. There was a lot of self-doubt."

He thought getting some exercise might help, but it was hard to motivate himself to go to the campus gym.

"So what I did is break it down into mini-steps," he said. "I would think about just getting to the gym, rather than going for 30 minutes. Once I was at the gym, I would say, 'I'm just going to get on the treadmill for five minutes.'"

Eventually, he found himself reading novels for long stretches at a time while pedaling away on a stationary bike. Soon, his gym visits became daily. If he skipped one day, his mood would plummet the next.

"It was kind of like a boost," he said, recalling how exercise helped him break out of his inertia. "It was a shift in mindset that kind of got me over the hump."

Depression is the most common mental illness-affecting a staggering 25 percent of Americans-but a growing body of research suggests that one of its best cures is cheap and ubiquitous. In 1999, a randomized controlled trial showed that depressed adults who took part in aerobic exercise improved as much as those treated with Zoloft. A 2006 meta-analysis of 11 studies bolstered those findings and recommended that physicians counsel their depressed patients to try it. A 2011 study took this conclusion even further: It looked at 127 depressed people who hadn't experienced relief from SSRIs, a common type of antidepressant, and found that exercise led 30 percent of them into remission -a result that was as good as, or better than, drugs alone.

Though we don't know exactly how any antidepressant works, we think exercise combats depression by enhancing endorphins: natural chemicals that act like morphine and other painkillers. There's also a theory that aerobic activity boosts norepinephrine, a neurotransmitter that plays a role in mood. And like antidepressants, exercise helps the brain grow new neurons.

But this powerful, non-drug treatment hasn't yet become a mainstream remedy. In a 2009 study, only 40 percent of patients reported being counseled to try exercise at their last physician visit.

"People will take the disease and treatment lightly," he said, "if they know Paxil is coming."

The insurance challenge

When it comes to non-drug remedies for depression, exercise is actually just one of several promising options. Over the past few months, research has shown that other common lifestyle adjustments, like meditating or getting more sleep, might also relieve symptoms. Therapy has been shown to work just as well as SSRIs and other medications. In fact, a major JAMA study a few years ago cast doubt on the effectiveness of antidepressants in general, finding that the drugs don't function any better than placebo pills for people with mild or moderate depression.

The half-dozen psychiatrists I interviewed said they've started to incorporate non-drug treatments into their plans for depressed patients. But they said they're only able to do that because they don't accept insurance. (One of the doctors works for a college system and only sees students.)

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A Desk Built for Sleep
That's because insurers still largely reimburse psychiatrists, like all other doctors, for each appointment-whatever that appointment may entail-rather than for curing a given patient. It takes less time to write a prescription for Zoloft than it does to tease out a patient's options for sleeping better and breaking a sweat. Fewer moments spent mapping out jogging routes or sleep schedules means being able to squeeze in more patients for medications each day.

"[Psychiatrists] can probably do four medication-management visits in an hour," said Chuck Ingoglia, a senior vice president at the National Council for Behavioral Health. " If they were doing therapy, they might see one person for 50 minutes."

"They were all just throwing medication at me," she said. (She asked that I not use her last name). "I said I don't want medicine, but they didn't want to talk about a long-term therapeutic plan."

She went through eight different providers before finally finding a psychiatrist who helped her establish a plan to do yoga several times a week to manage her panic disorder. Those psychiatrist appointments are 90 minutes long.

Exacerbating all of this is the fact that there's a shortage of psychiatrists, and the needs of people with mental health issues are increasingly being addressed by primary-care doctors, who now provide over a third of all mental health-care in the U.S. Sixty-two percent of all antidepressant prescriptions are now written by general practitioners, ob-gyns, and pediatricians.

But general practitioners aren't always as equipped as psychiatrists to diagnose and treat depression. In 2007, 73 percent of patients who were prescribed an antidepressant were not given psychiatric diagnoses. In other cases, primary care doctors may balk at the idea of prescribing any interventions because they don't feel they know enough about depression.

Writing in The New Yorker last year, primary care internist Suzanne Koven said she's often at a loss when faced with "the lawyer who's having trouble meeting deadlines and wants medication for attention-deficit disorder. Or the businesswoman whose therapist told her to see me about starting an antidepressant."

She feared she lacked "the time or training to diagnose and manage many psychiatric disorders," she wrote.

Managing life's roadblocks

Let's say you're a psychiatrist who has managed to start incorporating sleep, exercise, and other non-drug remedies into a patient's depression treatment. Congratulations! You now face a patient who is, very possibly, lethargic, unsatisfied, and lying about how many times he or she went running last week.

That is, if you can convince the patient to try anything other than drugs in the first place.

Julia Samton, a psychiatrist who practices in New York City, said she prescribes medications as a "third-tier resort" after lifestyle changes and therapy have been ruled out. She spends 45 minutes on each appointment, attempting to punch through her patients' stony Manhattanite exteriors and expose the foundations of their agony.

"There are some people who say all they want is medication," she said. "But they are the ones who are suffering tremendously and have a difficult time accessing their mental life. They want things fixed, and fixed right now."

She said some of her patients are lured by the drug ads they see on TV- charming little spots that make it look like a gloomy day is nothing an SSRI can't handle.

"It's evocative to see a commercial where your world could change from black and white to color," she said.

An insurance company might pay an internist and a psychiatrist both $100 for an appointment, but a primary care check-up might take 15 minutes while a thorough conversation with a psychiatrist takes 40 or more.

Because of these constraints, psychiatrists are among the least likely specialists to accept insurance- only about 55 percent of them do. Henry David Abraham, a psychiatrist in Lexington, Massachusetts, said he stopped accepting insurance once he realized his patient visits were becoming too rushed.

Mateus Felipe C./flickr

"I was seeing patients for 15 minutes each to give them drugs," he said. "What would my mentors say about that quality of care? They would say, 'Horrible!'"

He now sees patients on a sliding scale, with the wealthy essentially footing the bill for the poor. His sessions include a range of treatment options, including therapy.

"One patient lost a husband to cancer, and medication may take the edge off of some of those emotions, but the process she requires is to work through the elements of grief," he said. "There's not a pill for that."

Meanwhile, psychiatrists who take insurance are increasingly less likely to offer talk therapy-or longer appointments of any kind-because licensed social workers and psychologists can offer the same types of sessions at lower rates.

"If you're an insurance company, and you can get a social worker to do therapy for $50, that becomes the floor," Ingoglia said.

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When Brittany, a woman who lives in northern Virginia, first began experiencing panic attacks a few months ago, she turned to a series of providers in her insurance network. None of the doctors she saw wanted to discuss anything but drug options, she said.

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For Depression, Prescribing Exercise Before Medication

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Aerobic activity has shown to be an effective treatment for many forms of depression. So why are so many people still on antidepressants? Joel Ginsberg was a sophomore at a college in Dallas when the social anxiety he had felt throughout his life morphed into an all-consuming hopelessness.

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A peer reviewed medical Journal, published 9 times per year by the American Psychosomatic Society

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The Japanese prevention medicine of shinrin-yoku, or Forest Bathing.

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Get full access to Outside Learn, our online education hub featuring in-depth fitness, nutrition, and adventure courses and more than 2,000 instructional videos when you sign up for Outside+.

I was supposed to be listening to the cicadas and the sound of a flowing creek when a Mitsubishi van rumbled across a small steel bridge just downstream. It was probably depositing campers at a nearby tent village, where kids were running around with their fishing poles and pink bed pillows. This was nature, Japan style. I was in Chichibu-Tama-Kai National Park, a 75-minute train ride northwest of Tokyo, with half a dozen other hikers out for a dose of shinrin-yoku, or forest bathing. The Japanese go crazy for this practice, which is standard preventive medicine here. It essentially involves hanging out in the woods. It’s not about wilderness; it’s about the nature-civilization hybrid the Japanese have cultivated for thousands of years. You stroll a little, maybe write a haiku, crack open a spicebush twig and inhale its woodsy, sassy scent.

“People come out from the city and literally shower in the greenery,” our guide Kunio explained. “This way they are able to become relaxed.” To help us along, Kunio—a volunteer ranger—had us standing still on a hillside, facing the creek, with our arms at our sides. I glanced around. We looked like earthlings transfixed by the light of the beamship. Or extras in a magical-kingdom movie. Kunio could have been one of the seven dwarves. Elfin, with noticeably large ears, he told us to breathe in for a count of seven, hold for five, release. “Concentrate on your belly,” he said.

We needed this. Most of us were urban desk jockeys, including Tokyo businessman Ito Tatsuya, 41, standing next to me. Like many Japanese day hikers, he was carrying an inordinate amount of gear, much of it dangling from his belt: a cell phone, a camera, a water bottle, and a set of keys. The Japanese would make great Boy Scouts, which is probably why they make such fervent office workers, logging longer hours than almost anyone else in the developed world. They’ve even coined a term, karoshi, meaning death by overwork. Since he began lollygagging in the woods and picnicking on octopus, Ito’s shoulders seemed to be unclenching by the minute.

“When I’m out here, I don’t think about things,” he said.

“What’s the Japanese word for stress?” I asked.

“Stress,” he said.

WITH THE LARGEST CONCENTRATION of broad-leafed evergreens in Japan, mountainous Chichibu-Tama-Kai is an ideal place to put into practice the newest principles of wellness science. In a grove of rod-straight Japanese red pine, Kunio pulled a thermos from his massive daypack and served us some mountain-grown, bark-flavored wasabi-root tea. The idea with shinrin-yoku, a term coined by the government in 1982 but inspired by ancient Shinto and Buddhist practices, is to let nature enter your body through all five senses, and this was the taste part. I stretched out across the top of a cool, mossy boulder. A duck quacked. I was feeling pretty mellow, and tests would soon validate this: between the beginning and the end of the two-hour hike, my blood pressure had dropped a couple of points. Ito’s had dropped even more.

We knew this because we were on one of Japan’s 48 official Forest Therapy trails, designated for shinrin-yoku by Japan’s Forestry Agency. In an effort to benefit the Japanese and find nonextractive ways to use forests, which cover 67 percent of the country’s landmass, the government has funded about $4 million in forest-bathing research since 2004. It intends to designate a total of 100 Forest Therapy sites within 10 years. Visitors here are routinely hauled off to a cabin where rangers measure their blood pressure, part of an effort to provide ever more data to support the project.

The Japanese have good reason to require unwinding: In addition to those long workdays, pressure and competition for schools and jobs have helped Japan achieve the third-highest suicide rate in the developed world (after South Korea and Hungary). Ten percent of the country’s 128 million residents live in greater Tokyo, where rush hour is so crowded that white-gloved workers shove people onto Metro trains, leading to another coinage, tsukin-jigoku—commuter hell. On top of all that, the small island nation trembles and yaws with more than 1,500 earthquakes a year. The tsunami that hit in 2011 killed 20,000 people, the Fukushima Daiichi nuclear plant suffered a triple meltdown, and now some of the country’s prized rice has radioactive cesium in it.

So it makes sense that Japan’s scientists are in the vanguard of knowing how green spaces soothe the body and brain. While a small but impressive shelf of psychological research in recent decades suggests that spending time in nature improves cognition, relieves anxiety and depression, and even boosts empathy, scientists in Japan are measuring what’s actually happening to our cells and neurons. Led by Yoshifumi Miyazaki from the University of Chiba and Qing Li from the Nippon Medical School in Tokyo, they’re using field tests, hormone analysis, and new brain-imaging technology to uncover how the magic works on a molecular level. Once we know that, it’s news we can use.

“The Japanese work is essential, a Rosetta stone,” says Alan C. Logan, co-author of the recent book Your Brain on Nature. “We have to validate the ideas scientifically, through stress physiology, or we’re still stuck at Walden Pond.” Americans have often relegated nature to the romantic realm of Thoreau and Abbey. Viewing it as medicine is still largely foreign. “Studying the impact of the natural world on the brain is actually a scandalously new idea,” says Richard Louv, author of the 2008 bestseller Last Child in the Woods—the book that minted the term nature deficit disorder—and The Nature Principle, his 2010 follow-up about adults. “It should’ve been studied 30 to 50 years ago.”

But the Japanese evidence is appearing at a good time. Books like Louv’s, combined with an explosion in new digital distractions and malaises, are helping to define a cultural moment, what might be called a new slow-nature movement. We are rediscovering our inherent biophilia—what Harvard entomologist E. O. Wilson and Yale social ecologist Stephen Kellert defined as humanity’s affinity for nature. And we see now that we have become what John Muir described as “tired, nerve-shaken, over-civilized people.”

Indeed, in 2008, the world reached a curious milestone: more people lived in urban areas than outside of them. In the U.S., urban areas grew faster in 2010 and 2011 than suburban regions for the first time since the 1920s. According to Nicholas Carr’s 2010 book The Shallows, the average American spends at least eight hours a day looking at some sort of electronic screen. Then we try to relax by watching TV. Bad idea. Research shows that this only makes us crabbier. Logan asserts that, since the age of the Internet, North Americans have become more aggressive, more narcissistic, more distracted, more depressed, and less cognitively nimble. Oh yeah, and fatter.

And don’t think you’re off the hook if you exercise outdoors. You are quite likely still tethered to civilization. Perhaps you’re strapped to a heart monitor or headset. Admit it: Have you brought your phone? Are you clocking wind sprints? Sure, you are deriving some mental and physical benefits, but evidence is mounting that to get the most out of nature, you really need to be present in it, not distracted by your own great story of self.

I reflect most of these trends. I spend too much time sitting inside. I maintain multiple social-media platforms, and I’ve recently moved from idyllic Boulder, Colorado, to Washington, D.C. Now my morning walk takes place directly under the flight path of Reagan National Airport. I dodge surly bike commuters and professional dog walkers, then cross a car-clogged parkway that sets me grumbling and obsessing over my fate, my relationships, and my kids’ new schedules, which require military precision and Euclidean traffic calculations. When I walk under a bridge to get to something resembling a trail, I pass graffiti that reads PUSSY FUDGE. I’m feeling a bit. On. Edge.

IF THE JAPANESE EMBRACE of forest therapy can be attributed to one man, it’s Miyazaki, a physiological anthropologist and vice director of Chiba University’s Center for Environment, Health, and Field Sciences, located just outside Tokyo. Miyazaki believes that because humans evolved in nature, it’s where we feel most comfortable, even if we don’t always know it. “Throughout our evolution, we’ve spent 99.9 percent of our time in natural environments,” he says. “Our physiological functions are still adapted to it. During everyday life, a feeling of comfort can be achieved if our rhythms are synchronized with those of the environment.”

To prove it, Miyazaki has taken more than 600 research subjects into the woods since 2004. He and his colleague Juyoung Lee, also of Chiba University, have found that leisurely forest walks, compared with urban walks, yield a 12.4 percent decrease in the stress hormone cortisol, a seven percent decrease in sympathetic nerve activity, a 1.4 percent decrease in blood pressure, and a 5.8 percent decrease in heart rate. On subjective tests, study participants also report better moods and lower anxiety.

As Miyazaki concludes in a 2011 paper, “This shows that stressful states can be relieved by forest therapy.” And the Japanese eat it up, with nearly a quarter of the population partaking in some way. Between 2.5 million and five million visitors walk the Forest Therapy trails each year.

The science is so convincing that other countries are following Japan’s lead in studying and promoting nature as a cure. Lee just got hired away by the South Korean government, which is pouring more than $140 million into a new National Forest Therapy Center, expected to be completed in 2014. Finland, an empire of boreal spruce and pine, is also funding numerous studies. “Japan showed us that there could be cooperation between forestry and medical fields,” says Liisa Tyrvainen of the Finnish Forest Research Institute. “Now we are conducting similar research.”

I met up with Miyazaki at the country’s newest proposed therapy site, Juniko, a leafy network of trails and lakes near northern Japan’s Shirakami Mountains. The scientist was swatting mosquitoes from his face and neatly trimmed gray hair. In fact, he wasn’t looking relaxed at all. He was worried that the trail might be too muddy for his latest experiment, which would inaugurate the new field version of a brain-oxygen measuring, near-infrared spectrometer. He was kicking rocks out of the way and overseeing the setup of a netted, canopied mini-lab. The next morning, he and Lee would bring 12 male college students here, to measure their brain activity and vital signs after walking and sitting and generally forest bathing. They’d repeat the experiment in downtown Hirosaki, a city of 175,000 about two hours away. I would serve as one of Miyazaki’s stressed guinea pigs.

With the details worked out, several of us retired to a quiet restaurant across from Hirosaki’s Dormy Inn. We removed our shoes and sat cross-legged on the floor while Miyazaki distributed a baffling array of dishes involving runny eggs, seaweed, and gelatinous balls.

“Why do the Japanese think about nature so much?” I asked Miyazaki, who was preparing to eat his modest slab of manta ray.

“Don’t Americans think about nature?” he asked me.

I considered. “Some do and some don’t.”

“Well,” he mused, “in our culture, nature is part of our minds and bodies and philosophy. In our tradition, all things are relative to something else. In Western thought, all things are absolute.”

Maybe it was the sake, but he was starting to lose me.

“The difference is in language,” he continued. “If I ask you, ‘A human is not a dog, is it?’ you say, ‘No, a human is not a dog.’ In Japan, we say, ‘Yes, a human is not a dog.’” The great sensei of nature studies peered at me over his chopsticks. I was reminded of the story of the Zen student who asks his teacher, “How do you see so much?” and the teacher responds, “I close my eyes.”

Miyazaki, I understood, was like a koan, impenetrable. But you had to trust that the guy was onto something.

ON THE MORNING OF the forest experiment, the college kids and I took turns sitting in the mobile lab at the trailhead. The boys were skinny, sleepy-eyed, and unfailingly polite. As if we were receiving sacrament, we placed hard cotton cylinders under our tongues for two minutes, then spit them out into test tubes. Once analyzed in a lab, these samples would reveal our levels of salivary cortisol, a stress hormone made in the adrenal cortex and sent to the brain. Lee, exuding calm and efficiency, hooked us up to other electrodes and devices that would track changes in blood pressure, pulse rate, and heart rate, gauging our physiological responses to the forest and the city.

These are standard measurements the team has used for years. But today they also pulled out the new battery powered spectrometer, which, when deployed, gave me a sensation of leeches sticking to my forehead. It’s designed to measure hemoglobin levels (a proxy for blood and oxygen) in the prefrontal cortex. This is the brain geography that deals with cognitive and executive functions, such as planning, problem solving, and decision making. When aggregated, these metrics paint a picture of our bifurcated nervous system.

The researchers want to know if being in nature gives these frontal lobes a much needed rest. When we are relaxed and at ease in our environment, our parasympathetic system—sometimes called the rest-and-digest branch—kicks in, stimulating appetite. This is why food tastes better in the outdoors, explained Miyazaki. But the constant stimulus of modern life triggers our sympathetic nervous system, which governs fight-or-flight behaviors. And triggers it, and triggers it. A long trail of research dating back to the 1930s shows that people with chronically high cortisol levels and blood pressure are more prone to heart disease and depression.

When it was my turn to wander through the forest for 15 minutes, I was happy to break free from the wires. The loud pulse of cicadas echoed through the woods. Light filtered gently through the beeches and Japanese horse chestnuts, and the earth smelled like, well, earth. An elderly couple ambled by, assisted by walking sticks and a bear bell. I was briefly mesmerized by a yellow butterfly. I could see why Juniko is a candidate for the country’s next forest-therapy station. Local and park officials are seeking the designation because, where there’s forest therapy, there are tourists and their yen. Miyazaki may have a mystical side, but what drives him is the data he gets from these parks. It’s a convenient arrangement.

This isn’t an entirely new idea. Beginning in the 1970s, researchers at the University of Michigan, led by Rachel and Stephen Kaplan, noticed that psychological distress was often related to mental fatigue. Modern life demands what the Kaplans call sustained directed attention on tasks both important and mundane—checking email, working a desk job, finding a parking spot. What leads to resting our brains’ directed-attention function? “Soft fascination,” explains Rachel Kaplan from her plant-filled university office. This is what happens when you watch a butterfly or the sunset or rain. You can’t help but stop multitasking or kvetching. That’s why Kaplan recommends a decidedly nonathletic approach to the outdoors, at least at times.

“When you’re pursuing a sport, you get cardiac points, but you’re not necessarily getting nature points,” she says. Research by her colleague Jason Duvall suggests that when you are distracted outside—running with an iPod, say—you may be more irritable and impatient later, less able to stay on task, focus, and plan than your nature-engaged peers.

Studies by the Kaplans and others show that after short walks in greenery, or even spells of looking at nature images in a lab, subjects’ directed-attention capabilities at least partly recover—people perform significantly better on cognitive tests and report feeling happier. They behave less selfishly when playing computer games. Turning down the front-brain disco ball also seems to improve creativity. And the more time in nature, the better. A recent pilot study by psychologists Paul and Ruth Ann Atchley of the University of Kansas and David Strayer of the University of Utah found that after three days of hiking and camping in the wilderness, participants in an Outward Bound course improved their scores on tests of creativity by 50 percent. “I’ll admit I’m a believer that there’s something profound going on,” says Strayer.

Yet, it’s been hard to see inside the brain to observe these processes at work. Neuroscientists want quantitative visuals. That’s starting to happen, mostly in labs in South Korea and the U.S. Studies have shown that when subjects look at pictures of nature, hemoglobin levels drop in the prefrontal cortex, meaning that the home base of executive function has switched a few lights off. (Similar effects have been seen in the brains of Tibetan monks, who appear to dim their brain wattage through meditation.)

Where’s the action going instead? To other parts of the brain, like the insula and the basal ganglia, says Kaplan protégé Marc Berman, now at the University of Toronto’s Rotman Research Institute. These are areas sometimes associated with emotion, pleasure, and empathy.

Berman has recently begun using functional MRI to watch people’s brains as they look at images of nature through virtual-reality glasses. “What we’re trying to find out is, what does a restored brain look like, and what does it look like as it’s getting restored?” says Berman. In the real world, filled with real nature, he would expect the effects to be even more pronounced. Miyazaki and Lee, with their hemoglobin-measuring spectrometer, intend to find out.

TWO WEEKS AFTER OUR experiments at Juniko and Hirosaki, Lee sent me preliminary results from my brain spectroscopy. Brightly colored squiggly lines on a graph show that my oxyhemoglobin concentrations indeed appeared lower in the forest than in the city. Lee said that results from me and the college boys would require more analysis, but for first-time field work he was optimistic. “I am very excited,” he said.

The results didn’t surprise me. My urban peregrination hadn’t been nearly as pleasant as the soft green trails of Juniko. Downtown Hirosaki is, like a lot of midsize cities, more functional than attractive. Walking on the hot asphalt, I passed four parking lots, two taxi stands, a bus station, and two loudly idling buses belching fumes. The results showed that my nervous system had responded. My systolic blood pressure had dropped six points after walking in the forest; obligingly, it went up six points after walking in the city.

But how long do the feel-good effects of nature last? Are they simply wiped out by the first traffic jam or cell-phone ditty?

One of Miyazaki’s collaborators, Qing Li, an immunologist in the department of hygiene and public health at Nippon Medical School in Tokyo, had the same question. The chairman of the Society of Forest Medicine, a small but growing international group of academics, Li is interested in nature’s effect on the human immune system. A person’s natural killer immune cells (NK cells for short) can, like cortisol and hemoglobin, be reliably measured in a lab. A type of white blood cell, NK cells are handy to have around, since they send self-destruct messages to tumors and virus-infected cells. It’s been known for a long time that factors like stress, aging, and pesticides can reduce your NK count, at least temporarily. So, Li wondered, if nature reduces stress, could it also increase your NK cells and thereby help you fight infections and cancer?

In 2005 and 2006, Li brought a group of middle-aged Tokyo businessmen into the woods. For three days, they hiked in the morning and again in the afternoon. By the end, blood tests showed that their NK cells had increased 40 percent. A month later, their NK count was still 15 percent higher than when they started. By contrast, during urban walking trips, NK levels didn’t change.

Since most of us can’t spend three days a week walking in the woods, Li was curious to know if a one-day trip to a suburban park would have a similar effect. It did, boosting the levels of both NK cells and anticancer proteins for at least seven days afterward.

What was going on? Li suspected that trees were important. Specifically, he wondered if NK cells are affected by “aromatic volatile substances,” otherwise known as scents, sometimes called phytoncides. These are the pinenes, limonenes, and other aerosols emitted by evergreens and many other trees. Scientists have identified 50 to 100 of these phytoncides in the Japanese countryside and virtually none in city air that’s not directly above a park.

This wasn’t a totally left-field idea. Studies have attributed healthful properties to soil compounds like actinomycetes, which the human nose can detect at concentrations of 10 parts per trillion. And since the mid-1990s, researchers have been studying pinene for its antimicrobial properties and limonene, which is given off by citrus and other trees, as a possible tumor suppressor in cancer patients.

To test the phytoncide theory, Li sequestered 12 subjects in hotel rooms. In some rooms, he rigged a humidifier to vaporize stem oil from common Hinoki cypress trees; other rooms got nothing. The results? The cypress dwellers had a 20 percent increase in NK cells during their three-night stay and reported feeling less fatigued. The control group saw almost no changes.

“It’s like a miracle drug,” said Li.

It sounds hokey that evergreen scents—the kind of thing given off by those cardboard trees dangling from the rearview mirrors of taxicabs—could help us live longer. But Li found similar results with NK cells in a petri dish: they increased in the presence of aromatic cypress molecules. So did anti-cancer proteins and proteases called granulysin, granzymes A and B, and perforin, which act by causing tumor cells to self-destruct. Li’s olfaction theory is unconventional, but it contains some of that Zen five-sense wisdom. While American researchers are mostly showing people pictures of nature, the Japanese are pouring it into every orifice.

Li invited me to his lab to have a sniff. The building was practically empty—the medical students were on break—and eerily dark, the result of power shortages in the wake of the Fukushima nuclear disaster.

He held up a small cinnamon-colored glass bottle filled with oil. “This is very toxic!” he said, giggling. “It’s very good but very toxic.” Phytoncides, from the Greek and Latin for “plant” and “killer,” are antimicrobial compounds that ward off pests. At low levels, though, we find them pleasant, and sometimes we don’t consciously detect them at all. Li believes that, while being around big trees in forests offers us the greatest benefit, flora from other landscapes, and possibly even houseplants, release these substances, too.

Before taking a drag, I stuffed my right arm into yet another blood-pressure machine. Then we unscrewed the cap of the forest elixir and I inhaled. The oil gave off a nice pitchy, vaguely turpentine scent. We put the cap back on and read my blood pressure again. It had dropped 12 points.

I looked at Li, who nodded delightedly. “This is a very big effect, bigger than people get with pharmaceuticals,” he said. “In fact, I use a humidifier with cypress oil almost every night in the winter.” You don’t need to harvest your own, Li said. Standard health-store aromatherapy oils work fine.

“What else do you do?” I asked the middle-aged man with the bowl haircut.

Clearly, Li gets asked this a lot. He had a small list. “If you have time for a vacation, don’t go to a city. Go to a natural area. Try to go one weekend a month. Visit a park at least once a week. Gardening is good. On urban walks, try to walk under trees, not across fields. Go to a quiet place. Near water is also good.”

My morning walk back in D.C. was transforming before my eyes.

WE DON’T NEED A scientist to tell us that flowers and chirping birds make us feel good. But if the benefits of getting outside are so intuitive, why don’t more of us do it? Nature-based recreation has declined 35 percent in the U.S. in the past four decades, according to the Proceedings of the National Academy of Sciences. We underestimate the curative effects, or perhaps we’re just too readily beguiled by the easy entertainments of technology. But will having more data about how nature works on our bodies lure us into the woods? We know we’re supposed to eat more leafy greens, but most of us don’t.

The kale analogy is pretty apt, because it turns out that even when we don’t enjoy spending time in nature, like during lousy winter conditions, we benefit from it just the same. At least that’s what Toronto’s Berman found when research subjects took walks in an arboretum on a blustery winter day. The walkers didn’t really enjoy themselves, but they still performed much better on tests measuring short-term memory and attention.

Japanese researchers understand our draw to nature, but American researchers understand our pull away from it—our distractions, inertia, and addictions. They want to help motivate us, to make our doses of nature so palatable and efficient that we hardly notice them. This is the next frontier in forest-therapy science, all aided by brain imaging.

Berman, for example, wants to figure out exactly which features (ponds, trees, biodiversity) yield the biggest bang in the brain. The idea is that once researchers know more about what makes our brains happy, that information can be fed into public-policy decisions, urban planning, and architectural design. The research has profound implications for schools, hospitals, prisons, and public housing. Imagine bigger windows, more trees in cities, and mandatory lie-on-the-grass breaks.

This approach, of course, is classically Western. Manipulate the environment; feel nature without even trying. As for me, I’m going to be looking for a more East-meets-West approach. I’ll try harder to quit checking my text messages and instead watch for rock bass jumping in the C&O Canal. Scratch and sniff some pine cones. Run my hands through the moss. Maybe even drink a little bark tea.

After all—yes, I am not a dog.

Contributing editor Florence Williams (@flowill) is the author of Breasts: A Natural and Unnatural History.

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Take Two Hours of Pine Forest and Call Me in the Morning

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These days, screen-addicted Americans are more stressed out and distracted than ever. And there’s no app for that. But there is a radically simple remedy: get outside. Florence Williams travels to the deep woods of Japan, where researchers are backing up the theory that nature can lower your blood p…

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"Can nature compete with Xanax?"

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When Stacy Bare returned from his deployment to Baghdad in 2006, he struggled with a host of problems: alcoholism, a cocaine habit, and suicidal thoughts, to name a few. It wasn't until 2010, when a fellow veteran took him rock climbing on First Flatiron, in Boulder, Colorado, that things began to turn around. "If I hadn't started climbing, I'd probably be another sad statistic," says Bare. "The focus it gave me let me leave my troubles on the ground."

The idea of a nature cure isn't new. Groups like Outward Bound have been bringing veterans on expeditions for years, and we all know the psychological benefits of a simple walk in the woods. But Bare wanted to take things a step further.

He thought that if there were enough scientific studies that put adventure therapy on par with pharmaceutical treatments, doctors would start prescribing it as a cheaper, safer alternative. Physician-recommended outdoor recreation, says the 38-year-old Bare, who is now the director of Sierra Club Outdoors, would result in less dependence on medications and lower health care costs. He also hopes that it might usher in a time when "you can use a prescription copay to cover the price of guides and specific gear."

In 2013, Bare partnered with University of California at Berkeley psychologist Dacher Keltner to found the Great Outdoor Lab, a think tank with the goal of researching and ultimately proving the health benefits of being outside. Bare hopes the studies will establish nature as a viable therapy for a range of ailments, from depression and post-traumatic stress disorder to traumatic brain injury and dementia. More important, he wants to establish credibility with the mainstream medical community and insurance companies.

Keltner was a natural choice to help lead the effort. He studied psychological and physiological responses to nature for two years in the lab by exposing subjects to pictures, films, and, in some cases, a eucalyptus grove on the UC Berkeley campus. He and his colleagues found that those stimuli lowered levels of the stress hormone cortisol as well as inflammatory cytokines. (Inflammation is a common pathway for depression, heart disease, and diabetes.) "Most people have the sense that after a good dose of the outdoors, they feel stronger and healthier," Keltner says. "We're just starting to marshal more controlled scientific evidence."

In 2014, Bare convinced Keltner to take his studies into the field, running two-day rafting trips on California's American River with Sierra Club youth and veterans groups. Bare chose rafting because it's an immersive outdoor experience without a high fitness requirement. "It's important for the study to isolate the effects of outdoor adventure from the effects of exercise," says Bare. "We have to hold our research to the same standard as a pharmaceutical company."

The three-year study, currently under review by several academic journals, corroborated Keltner's lab findings and showed that veterans experienced a 35 percent decrease of PTSD symptoms after a single two-day rafting trip. "We have pharmaceutical solutions for health problems that can be solved by the great outdoors," says Keltner. Bare describes one vet who took up kayaking and reduced the amount the Department of Veterans Affairs was paying for his medication from $25,000 per year to $5,000.

Keltner and Bare are already collaborating with other researchers, including Dr. Nooshin Razani at the University of California at San Francisco's Benioff Children's Hospital Oakland, as well as health care providers like Kaiser Permanente. They're also in discussions with the VA.

"The quality of the science and what we are learning is encouraging," says Tyler Norris, vice president of total-health partnerships at Kaiser Permanente. "If we could package the outdoors and call it a pharmaceutical, it would be sold widely." He notes that several more studies need to replicate the findings before it's considered a therapy on par with acupuncture and support groups, which are commonly included in health-insurance plans. And Norris stops short of predicting that insurance might someday pay for a rafting trip or a new pair of hiking boots, as Bare hopes.

Others disagree. "Insurance companies are all about managing risk and reducing costs," says Stephen Lockhart, chief medical officer at California-based Sutter Health. "So if outdoor adventure is seen as a way to do that, they'll adopt it." Lockhart envisions mechanisms like rebates on premiums if you spend a certain amount of time outdoors, in the same way nonsmokers and runners can receive a reduced rate.

Bare is certain that the system will go further eventually. "No one questions using sick time to go to the therapist. If you end up healthier and more productive by taking a powder day, it just makes sense. Xanax isn't seen as an extravagance, and time outdoors shouldn't be either."

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It's Time for Doctors to Prescribe Outdoor Therapy

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When Stacy Bare returned from his deployment to Baghdad in 2006, he struggled with a host of problems: alcoholism, a cocaine habit, and suicidal thoughts, to name a few. It wasn't until 2010, when a fellow veteran took him rock climbing on First Flatiron, in Boulder, Colorado, that things began to turn around.