In the article on physical ailments influencing the brain, "Ruled by the Body," Erich Kasten listed a number of medical conditions that can masquerade as mental disorders. To that list, I would add celiac disease, in which an intolerance to the gluten found in wheat and other grains causes an autoimmune reaction in the gut that prevents the absorption of crucial vitamins and minerals. The resulting malnutrition can cause fatigue, muddled thinking, anxiety and depression, along with many digestive symptoms. Although this condition has become more widely known in the U.S. during the past couple of years, it is not commonly tested for—yet its effects can be mentally and physically debilitating.
Victoria Treder
Chiefland, Fla.

I read with interest Katherine Sharpe’s brief article, "Hyper One Day, Calm the Next" [Head Lines], regarding children who “lose” the diagnosis of attention deficit hyperactivity disorder (ADHD). I am a therapist who works with children with a history of severe childhood trauma. I have learned in my seven years with this population that indeed what looks or tests like ADHD or ADD may not be at all.

Children with early histories of neglect, abuse, abandonment or poor attachment often display behaviors that seem convincingly ADHD-like: distractibility, poor focus, impulsivity, short attention span, and an inability to delay gratification, control aggression, and so on. Traumatized children may also have many ADHD-like symptoms because of delayed cognitive development, hypervigilance regarding possible threats to their safety, and emotional dysregulation (stress hormones remain on alert status). And finally, children with sensory-processing disorders will have behaviors that closely mimic ADHD in their overreaction to hearing noises or being bumped by other kids.

The mental health community is only just beginning to research the impact of these issues—for reference, look up the work of physicians Daniel Siegel, Bessel van der Kolk and Bruce Perry. If a child is being treated, symptoms and behaviors may diminish in time. So it could look like an ADHD child “loses” their diagnosis.
Grace Katzenstein
Clinical supervisor, Kinship Center
Tustin, Calif.

In "Great Pretenders," author Birgit Spinath gives a clear overview of the imposter phenomenon. As a clinical psychologist, I think the research cited here may be complicated or confounded by the fact that some of the patients discussed may have had undiagnosed adult ADHD, which could lead to similar thoughts and behaviors.

Adults with ADHD are often intelligent, talented and creative. Because of experiential learning in school, they frequently and understandably infer that there is something wrong or lacking about them and their abilities. Sadly, this regularly results in a lack of confidence, shame and fear of shame—behaviors hard to distinguish from the imposter syndrome. Applying the practical, useful description of adult ADHD in Married to Distraction, by Edward M. Hallowell, Sue Hallowell and Melissa Orlov (Ballantine Books, 2011), could help therapists and patients make the distinction between the two profiles so that treatment can focus on the real problem.
Bob Dick
Raleigh, N.C

Thank you so much for this helpful article on the impostor phenomenon. For years I have struggled with deep self-doubt in the face of what outwardly looks like success. I have earned an advanced degree, published two books and continued to feel like a failure. Frankly, I had blown off the impostor phenomenon as an explanation for my difficulties. It was not until I read one of the Clance impostor phenomenon questionnaire items in your sidebar that I began to recognize myself. After taking the entire evaluation (available on Clance’s Web site:, I now realize this is the source of my struggle. I am immensely grateful to you for bringing this phenomenon to light so that people like me can find ways to overcome it and enjoy their hard-earned successes with the joy, satisfaction and fulfillment that they deserve.
Tara Rodden Robinson
commenting at

I have been an addictions counselor for several years. I have concerns that the organization of Alcoholics Anonymous (AA) is misrepresented in "Does Alcoholics Anonymous Work?" by Hal Arkowitz and Scott O. Lilienfeld. The authors suggest that AA does not support the use of mental health professionals. This is in direct contrast to the statement in “The Big Book,” AA’s basic text: “God has abundantly supplied this world with fine doctors, psychologists and practitioners of various kinds.” In addition, on page 133 the book indicates that health care professionals, including psychiatrists, are often indispensable in the care of a newcomer. AA’s philosophy is to include the assistance of health care professionals according to the literature that drives the AA program.
Mike Lovett
via e-mail

ARKOWITZ AND LILIENFELD REPLY: The writer is correct in stating that AA does in fact support the use of professional mental health services by members. Our statement that they do not was in error. As we pointed out, a combination of AA and psychotherapy is better than either one singly, and we are pleased that AA does encourage its members to seek this helpful combination.

I found it remarkable that the article on Alcoholics Anonymous did not deal more with the religious aspects of the 12-step credo—for instance, comparing its effectiveness with that of the secular AA-style organizations you listed.

My son attended the Salvation Army version of AA here in Australia, a live-in course provided for a dozen or so men at a time. He is a very intelligent young man and found it difficult to reconcile his atheism with the requirement to submit to an authority that he did not recognize.

During his time in the course, he made a concerted effort to come to an understanding about his beliefs, as well as trying to work with the requirements of the 12-step credo. He suddenly started reading many books on philosophy, mathematics and science; I believe that he was trying to counter the submissive approach of the Salvation Army course.

The religious requirement of the course acted as an impediment to any real progress for my son. Rather than giving the authority for change to someone or something else (God), the organization should give it back to the person and reinforce it as a positive. I am sure there are AA-style credos with these features.
Barrie Collins
Blackheath, Australia

Mind magazine is all I hoped it might be. At age 98 I have let most magazine subscriptions lapse but am keeping Mind, which fills in a good many gaps in my outdated medical education.
Louise Ireland-Frey
via e-mail

ERRATUM The article “What, Me Care?” by Jamil Zaki, that appeared in the January/February 2011 issue, incorrectly stated that Kenneth J. Rotenberg of Keele University in England has shown that lonely people are more likely to take advantage of others’ trust to cheat them in laboratory games. In fact, Rotenberg found that lonely people display less trusting behavior toward others while engaged in laboratory games.