Do things just happen? Yes and no.
COVID-19 is a national calamity that came to the United States from other countries.
It is happening to the nation. Just happening.
Of those infected only a small percentage die because of COVID-19. Why do some get very sick and others not? Why do some die and others not? Do things just happen that way?
Metabolic Syndrome and COVID-19
An article in "Nature Reviews Endocrinology" published April 2, 2020, sheds light, “Type2 diabetes mellitus and hypertension are the most common comorbidities in patients with coronavirus infections.” Further, “Emerging evidence demonstrates an important direct metabolic and endocrine link to the viral disease process.” In other words, metabolic syndrome is correlated with a COVID-19 infection going from bad to worse.
The National Heart, Lung, and Blood Institute’s website, https://www.nhlbi.nih.gov/ states “Metabolic syndrome is the name for a group of risk factors that raises your risk for heart disease and other health problems, such as diabetes and stroke.
The term ‘metabolic’ refers to the biochemical processes involved in the body’s normal functioning. Risk factors are traits, conditions, or habits that increase your chance of developing a disease.”
The NHLBI site continues, “the five factors described below are metabolic risk factors.”
A large waistline.
A high triglyceride level.
A low high-density lipoprotein level.
High blood pressure.
High fasting blood sugar.
The NHLBI site describes, “People at risk for metabolic syndrome have these underlying causes:”
Abdominal obesity(a large waistline).
An inactive lifestyle.
Insulin resistance.
The NHLBI gives direction, “Metabolic syndrome is a lifelong condition. However, lifestyle changes can help you control your risk factors and reduce your risk...”
Heart-healthy eating.
Aiming for a healthy weight.
Managing stress.
Physical activity.
Quitting smoking.
So why do people not follow these suggestions? Why do people allow themselves to be vulnerable to various diseases, including COVID-19? Not always, but more often than not, bad choices. Not over a year. Not over a decade. Over a lifetime.
Are there no underlying reasons for a lifetime of bad choices? Are there no explanations? Do things just happen?
ADHD: A Syndrome and Constructrole in limiting a person's choices. I defer to pastors, politicians, economists, and sociologists to give guidance. As a psychiatrist, a major predictor of bad choices over a lifetime is Attention-Deficit/Hyperactivity Disorder.
ADHD: A Syndrome and Construct
ADHD is a syndrome, an aggregate of patterns, described in the Diagnostic and Statistical Manual of Mental Disorders (DSM), which is the text for diagnosis across medical, rehabilitative, legal and educational professions. I believe that eventually genetic and neuroimaging research will significantly change the criteria sets of DSM, but not yet.
As S. Nassir Ghaemi, M.D. writes in his 2003 book, Concepts of Psychiatry, “The DSM system ensures that we all speak the same language: diagnoses are ‘reliable.’”
Dr. Ghaemi continues “The diagnoses in DSM-IV are not ‘real’ entities: they are abstractions. No single patient exactly meets the specific criteria of any diagnosis; every patient is uniquely different in some way.”
Learning from Dr. Barkley
In 1978 as a child psychiatry fellow in my hometown of Milwaukee, Wisconsin, I was assigned to be instructed by a young man just out of his own training, Russell A. Barkley Ph.D. I joke with my patients that “had I known at the time that Dr. Barkley was to become an internationally known, highly published, frequently quoted expert on ADHD, I would have paid better attention!”
In his 1997 book, ADHD and the Nature of Self-Control, Dr. Barkley writes “Self-Control is any response or chain of responses which serve to alter the probability of their subsequent response to an event and, in so doing, function to alter the probability of a later consequence related to the event.”
In the conclusion of the book he writes, “Moving to the larger societal perspective, I have tried to demonstrate that those with ADHD represent a mirror on ourselves. For they have shown us the nature of our own self-control through their own disability in this area. They have shown us as well that there is probably a universal instinct of self-control enmeshed in our neuropsychological development and that the capacity for this instinct is not uniformly distributed across our species.”
At the time Dr. Barkley was trying his best to convey his insights to me, he began a decade's long study of two groups of boys. Half the boys had what we now call ADHD and half did not. He refers to the study as the “The Milwaukee Study”.
In his 2008 book, ADHD in Adults, he writes of conclusions in part based on “The Milwaukee Study”. He writes, “The diminished regard for the future consequences of one’s behavior that characterizes many adolescents and adults with ADHD led us to predict a reduced concern for health-conscious behavior, such as exercise, proper diet, and moderation in using legal substances (caffeine, tobacco, and alcohol) throughout life with associated greater health and safety concerns in these areas. That is precisely what we were able to document.” What happens over decades if one has “a reduced concern for health-conscious behavior”? Metabolic syndrome for one.
Learning from the MGH Psychiatry Academy
Last month I attended the “Child and Adolescent Psychopharmacology 2020” teleconference. The first time held as a teleconference, sponsored by Massachusetts General Hospital.
From the inception of the course over two decades ago, Joseph Biederman, M.D. has been one of the course directors. He delivered a lecture, “ADHD Across the Lifespan”. He quoted an article by a distinguished group of fourteen researchers surveying over 3000 individuals in the United States. Dr. Barkley and Dr. Biederman were among the researchers, published in the "American Journal of Psychiatry" in 2006. The article noted, “Adult ADHD was highly comorbid with many other DSM-IV disorders...and was associated with substantial role impairment.”
ADHD is connected to a number of mental health disorders. ADHD undermines a person’s ability to take on important adult roles. The first and ultimately the most important adult role is that of self-care.
Changing the Trajectory of ADHD
How can a person respond to the challenge that is ADHD? In the same conference, Aude Henin, Ph.D. presented a lecture, “CBT and Psychosocial Treatment for ADHD”. Cognitive-Behavioral Therapy is a highly researched, effective method of psychotherapy. Dr. Henin spoke to organizational aides, such as calendars, task lists, and smartphone apps.
Since the publication of Driven to Distraction by Edward M. Hallowell, M.D. and John J. Ratey, M.D. in 1994, scores of ADHD self-help books have been published. I counted over twenty on Amazon.
The list of medications approved by the Food and Drug Administration for treatment of ADHD offers dozens of options in the type of molecule, delivery system and duration of action.
Some things just happen. However often choices, good and bad, lead to consequences, good and bad, especially over a lifetime. If one suffers from the patterns of ADHD, one can choose to adaptively respond to the patterns. Life will be better. Life will be longer. More likely good things will happen.