Salerian Brain Laws #1 and #2 (SBL1 and SBL2):

Frontal Cortex Function and Dopamine Govern Mood and Executive Function

By Alen J. Salerian, MD

I am excited to share two of my discoveries of brain function and dysfunction, two novel theories I advance about the essence of all neuropsychiatric disorders.  Region specific dysfunction and abnormal neurotransmission regulated by thermoregulation laws govern all neuropsychiatric disorders.

The precise scientific details of my theories are going to be published in peer-reviewed journals by the end of 2009, yet my wish to help people with serious neuropsychiatric disorders prompted me to immediately reveal my findings.

Salerian Brain Law #1 suggests two factors govern all neuropsychiatric disorders:  region-specific brain dysfunction and abnormal neurotransmission mediated by thermodynamic laws.  In essence, Salerian Brain Law #1 proposes that the laws which govern neurological disorders also govern neuropsychiatric illnesses as diverse as schizophrenia, bipolar disorder, depression, post-traumatic stress disorder, addictions.  Thus, Salerian Brain Law suggests the majority of neuropsychiatric disorders are biological in origin, the presenting symptoms, the severity and the course of the disorder defined by a specific region of the brain influenced by the specific neurotransmitters responsible in regulating the neuropsychiatric function of that particular brain region.

The second Salerian Law of the Brain suggests that the prefrontal cortex dictates human mood and executive function, consistent with its evolutionary neurobiological supremacy over the rest of the brain.  Thus, only when the prefrontal cortex function is less than perfect or only when the prefrontal cortex function is dysfunctional that a Homo sapien brain exhibits any mood or executive dysfunction.

In essence, the prefrontal cortex is the king with full authority over a chemical cocktail of complex neurobiological homeostasis, and hence, no mood or executive dysfunction can develop in the presence of a robust and functional prefrontal cortex.

The above-mentioned interactions frequent occur in lower species, yet they are not as profound for the extraordinary superiority of the prefrontal cortex to perceive, process, mediate and master the sensory input from other parts of the brain as they are in Homo sapien brain function.  This is precisely why, for any clinical entity with diminished executive function, compromised initiative and lowered energy, motivation, mood and self-confidence to develop, there must always be some disturbance or dysfunction of prefrontal cortex function.

As to the notion of complexity of brain function, mental state and the countless factors that may influence neurobiology, hence the prefrontal cortex, one can merely state that the final outcome remains the same; to use a common if not so scientific language that the bottom line does not change the evolutionary superiority of the prefrontal cortex over the rest of the brain.

The use of the Salerian Laws or any section of this paper without the written consent of Alen J. Salerian, MD and Washington Center for Psychiatry is prohibited.

GABA (GABA-GAMMA-AMNIOBUTYRIC ACID)
GABA is an elegant force of your calm and inner peace.  For example, a brain with sickly GABA has recurrent seizures and is almost always irritable, edgy, and combative.  In less traumatic cases, sickly GABA may make you fearful, easily reactive, and may cause insomnia.

DOPAMINE
Dopamine gives you energy, concentration, alertness, initiative, and perhaps most importantly the ability to enjoy life.  When your dopamine is out of sorts, so is your joy.

NOREPINEPHRINE
Norepinephrine is a good friend of dopamine and offers you energy, alertness, and concentration.

ACETYLCHOLINE
Acetylcholine is the champion defender of your memory.  For example, a brain with Alzheimer’s disease has lost its acetylcholine.  However, there are lesser degrees.  Perhaps acetylcholine is just getting tired with age.  Maybe you lose your keys more often, can’t always remember what you just said, forget phone numbers you always knew by heart or annoy your daughter by calling her husband George when his name is Bill.

SEROTONIN
So what do you say to a woman who is irritable, easily frustrated, and highly moody for a week before her menstrual cycle?  Your serotonin is low!  Serotonin is a brain fuel which helps you cope with anger, irritability and fear.  If you are phobic about flying or public speaking, feel plagued with unnecessary worry, get mad at red lights, fight road rage, or become overly agitated at every little thing your partner does, any pill that normalizes your serotonin will help relieve your symptoms.

The influence of these brain fuels does not negate the impact of life events or behavior.  These angels, however, often play a defining role in all areas of your behavior.  In a genetically predetermined manner, your angels often function in concert with one another and silently relay messages back and forth in response to input from the outside world.  In other words, like our height, skin, or eye color, the general traits of your particular angels are programmed at birth. In essence, the brain fuels are the genetic color of your brain and have a profound impact on you and your environment.

No one would challenge the fact that an individual’s sensitivity to sunlight depends upon skin color.  People with fair skin are more susceptible to sunburn and skin cancer than people of darker complexion.  In a similar manner, the brain’s chemistry determines sensitivity to rejection, mood, fear, irritability, and concentration.  It is critical to understand the specific functions of each chemical fuel.

Rats Have Angels (Every Living Creature Does!)
Your brain fuels are highly sensitive to external and internal events:  they expand or shrink, grow stronger or weaker, depending on your overall health, diet, exercise, sunlight exposure, and conflicts or tension in your life.

What are your brain fuel’s greatest friends and worst foes?  Exercise, sunlight, and good health are the angels’ best friends.  Their enemies include chronic unresolved anger, frustration, and any circumstances that trigger real or imagined feelings of being entrapped.  No other human dynamic is as universally toxic and potentially deadly to the human spirit and your angels as the perception of entrapment.  This dynamic, with its multiple faces – such as people in miserable marriages or financial desperation, or hostile job environments, people living in poverty, or children of abusive homes – directly and mercilessly assault your angels.

The collapse of hope is a serious injury to your angels and depletes their power and functionality.

Let me share a study about rats.  Rats are great teachers if we learn from them.

Put some rats in a cage and separate them from their food source.  Create a path to the food source but make sure there is an obstacle such as a glass gate which keeps them from their food. Watch the rats: observe how many times and for how long they will try to get to the food before giving up.

The rats have two challenges:  physical stamina and mental determination (potentially including willpower, drive, confidence, and mood).  Age is a factor as well:  if you give them a temporary break and let them dine even once, they will renew their efforts.

The main lesson: the majority of rats stop trying after a predictable number of times, well before they are physically incapable.

Simple enough. So, where are their angels?

Evidence suggests that after repeated failures, the angels shut down.  They collapse. Their magical powers suddenly disappear.  The angels stop flying, communicating or showing any signs of life.

The Similarities Between Rats and Humans

Entrapment equals hopelessness.  Hopelessness equals death.

People who haven’t experienced clinical depression may not easily appreciate the fact that severely depressed people, unable to see their way out of psychological torture, will seriously consider suicide.  It’s not hard to find thousands of examples of suicide where the act was an expression of entrapment and hopelessness rather than depresion.

Rats, humans, and your angels are all controlled by life, emotions, chemicals, and our perceptions.  When you feel trapped, your angels are injured; when they are sick you end up feeling trapped even if you aren’t.  Your brain is you; your angels are you; and your life affects your angels.

Pills, Angels, and Rats
What if you gave a rat a pill to replenish his brain fuels?  He would try harder and longer and not give up as his unmedicated counterparts do.  It’s as if the medicated rats have thicker skin against frustration, disappointment, and early resignation because the now healthier angels can provide them with extra protection.

We know that what occurs in the human brain is similar to actions and reactions in rat brains. It should not surprise you that the majority of newly introduced medications for sleep, mood, anxiety, and energy disorders were first studied and discovered in pre-clinical rat studies.

In an America where guns are easily accessible and where there are a large number of people with psychiatric vulnerabilities, we have a combustible problem for our society.

Tomorrow’s killers are predictably going to be people suffering from severe psychiatric disorders. In the United States, which is basically an armed nation, 3% of the population suffers from a bipolar illness, one in five people will have severe depression during their lifetimes, and 30,000 people commit suicide every year. It is estimated that every year 1000 homicides are committed by people with mental illness.

The numbers are astounding. Psychiatry has learned that some mentally ill people are desperate enough to make up their minds to get rid of their imaginary or real enemies, a core dynamic that did contribute to the massacre at Virginia Tech.

This behavior is the result of a complex illness, which has predictable outcomes and, most important, which has predictable solutions to prevent those outcomes.

Today, there are some 60 million Americans who own more than 200 million firearms. We are an armed nation. Indeed, we have the largest number of guns in private ownership of any country in the world.

The fact is that this situation is not going to change soon. Moreover, the Second Amendment to the U.S. Constitution guarantees Americans “the right of the people to keep and bear arms.”

What then is the solution to preventing predictable killings by mentally ill individuals who easily get access to guns?

Federal law prohibits anyone who has been judged by a court of law to be a danger to himself or others from purchasing a gun. Yet, Seung-Hui Cho’s name was not in the federal database maintained by the National Instant Criminal Background Check System, and so he was able to buy the guns he used to go on a killing spree at Virginia Tech.

The problem is that there is frequently a disconnect between state requirements for reporting on mentally ill people and the federal requirement that mentally ill people should be prohibited from buying firearms. Some states have rules that prohibit the reporting of names of mentally ill people to a federal database. In other cases, states’ standards for reporting mentally ill people to the database are different from the federal standard. Obviously, the system that is meant to prevent mentally ill people from buying firearms does not work.

The young English major who turned into a mass murderer proclaimed in his video, “I have given you billions of chances.” Indeed, he did give unmistakable warnings of his diseased mind. His writings and his behaviors scared his fellow students and his teachers. In one instance, he was psychiatrically evaluated and even hospitalized. Yet, he was allowed to purchase two guns, several clips and ammunition.

The solution that would have prevented Seung-Hui Cho from purchasing those handguns, clips and ammunition – and the solution that would prevent others with psychiatric disorders from purchasing guns in the future – would be to make a simple psychiatric test a prerequisite for the purchase of guns in this country.

Such a test would have prevented Cho from getting the guns to act out his homicidal behavior.

In order to drive a car in this country, you have to take a vision test and a driving test in order to prove that you will not be a danger to yourself or others when you drive.

True enough, many drivers, after passing the test, go out on the highways and drive recklessly and cause great harm to themselves and others. However, the driving test serves as a barrier and as a legal standard, which serve as significant limitations on bad driving.

In the case of guns and people with psychiatric disorders, we know that a simple test administered by a paraprofessional, which would take all of 30 minutes, could screen out those with psychiatric disorders and prevent them from buying guns.

A combination of the BPRS (Brief Psychiatric Rating Scale) test, which takes about 15 minutes; the Overt Aggression Scale Test, which takes about 10 minutes; and the California Risk Estimator for Suicide Test, which takes about 5 minutes, would suffice. The results of these tests are fairly reliable predictors of homicidal or suicidal behavior.

America needs to come to terms with the simple fact that the mixture of guns and people with psychiatric disorders is a predictably violent mix. If America does not take steps to prevent this mixture from occurring, we can count on more massacres in the future.

Requiring purchasers of guns, gun accessories, and ammunition to show evidence they have passed a psychiatric test would have prevented Cho from getting the guns and ammunition he needed to kill 32 people and himself. It would also prevent countless future mass killings and countless other homicides committed by mentally ill people who are now able to elude the federal law. This is a solution America needs to act, now.

December 12, 2006

Alen J. Salerian, MD quoted

By Holly VanScoy, PhD

It’s the quintessential human emotion, says New Brunswick, N.J., psychologist Michael Lewis, Ph.D., in his writings.

All extravagant behaviors are reactions to it, says Philadelphia psychiatrist Donald I. Nathanson, M.D.

It’s the root of dysfunctions in families, says Montpelier, Vt.-based Jane Middelton-Moz, author of “Shame & Guilt: Masters of Disguise.”

After decades of obscurity — spent, Middelton-Moz says, confused with and overshadowed by guilt — shame is increasingly recognized as a powerful, painful and potentially dangerous emotion,- especially for those who don’t understand its origins or know how to manage it.
A Complex Response

According to Alen J. Salerian, M.D., psychiatrist and medical director of the Washington, D.C., Psychiatric Center Outpatient Clinic, shame is a complex emotional response that all humans acquire during early development. “It’s a normal feeling about ourselves and our behavior,” he said, “not necessarily a symptom of an illness or pathology. In many situations, it’s abnormal if we don’t experience it.”

Embarrassment and shyness, for example, are two forms of shame that seldom cause trouble — unless they’re extreme or long lasting. And humility, another of the forms shame can take, is generally considered socially desirable.

But there’s mounting evidence that problems occur when shame or humiliation becomes an integral part of a person’s self-image or sense of self-worth. Over the past two decades, psychologists, psychiatrists and other mental health professionals have reported that abnormal styles of handling shame play an important role in social phobias, eating disorders, domestic violence, substance abuse, road rage, schoolyard and workplace rampages, sexual offenses and a host of other personal and social problems.

The Importance of Feeling Adequate

Marilyn J. Sorensen, Ph.D., author of “Breaking the Chain of Low Self-Esteem” and clinical psychologist in Portland, Ore., explains how such disorders originate.

“Early in life, individuals develop an internalized view of themselves as adequate or inadequate within the world,” she said. “Children who are continually criticized, severely punished, neglected, abandoned, or in other ways abused or mistreated get the message that they do not ‘fit’ in the world — that they are inadequate, inferior or unworthy.”

These feelings of inferiority are the genesis of low self-esteem, Sorenson says.

“Individuals with low self-esteem become overly sensitive and fearful in many situations,” she said. “They are afraid they won’t know the rules or that they’ve blundered, misspoken or acted in ways others might consider inappropriate. Or they might perceive that others reject or are critical of them.”

Once low self-esteem is formed, the person becomes hypersensitive — they experience “self-esteem attacks” that take the form of embarrassment or shame, Sorenson adds.

“Unlike guilt, which is the feeling of doing something wrong,” she said, “shame is the feeling of being something wrong. When a person experiences shame, they feel ‘there is something basically wrong with me.’”

Middelton-Moz says this is a common emotional response in adult children of alcoholic parents, as well as those who grew up with depressed parents, abuse, religious fanaticism, war, cultural oppression, or adult or sibling death. All of these experiences cause an individual to feel vulnerable, helpless and shamed.

A Deep, Unproductive Well

Aaron Kipnis, Ph.D., author of “Angry Young Men: How Parents, Teachers and Counselors Can Help Bad Boys Become Good Men” and a clinical psychologist in private practice in Santa Barbara, Calif., agrees. He says that shame’s effects are more damaging than those of guilt.

“Guilt is positive,” he said. “It’s a response of psychologically healthy individuals who realize they have done something wrong. It helps them act more positively, more responsibly, often to correct what they’ve done.”

But shame is not productive, Kipnis says. “Shame tends to direct individuals into destructive behaviors. When we focus on what we did wrong, we can correct it; but when we’re convinced that we are wrong as a result of shame, our whole sense of self is eroded.”

That’s why guilt doesn’t produce the anger, rage or other irrational behaviors shame does, Kipnis adds. “Many violent behaviors lead back to a deep well of shame,” he said.

He’s Shamed, She’s Shamed

Do men and women respond similarly when shamed?

“It has been common in shame-based conditions to say that men ‘act out’ and women ‘act in,’” Kipnis said.

In his book, “Shame: The Exposed Self,” Lewis says that not only do women feel more shame than men, they tend to express it differently. Typically, females have dealt with shame through introversion and self-hate while males have been more likely to exhibit extreme anger and violence.

Lewis found the major causes of shame in women are feelings of unattractiveness or perceived failures in personal relationships. In contrast, he reported, the leading cause of shame in men is feelings of sexual inadequacy.

In a 1997 article in the Electronic Journal of Sociology, Thomas J. Scheff, Ph.D., professor emeritus at the University of California-Santa Barbara, and Suzanne M. Retzinger, family relations mediator in the Superior Court of Ventura, Calif., provide an explanation for the difference in how men and women manage the shame associated with sexuality — described as “quite prevalent” in modern society.

Scheff and Retzinger found that women typically experience shame-shame feedback loops, while males experience shame-anger feedback loops. In shame-shame loops, individuals are ashamed of being ashamed, which makes them more ashamed of being ashamed, which leads to more shame, and so on. This circular process often results in withdrawal or depression.

In shame-anger loops, individuals are angry that they are ashamed, and ashamed that they are angry, and so on. This creates another emotional loop that feeds on itself and often culminates in antisocial acts.

“Shame about sexuality helps to explain the direction sexuality often takes with women: lack of sexual interest, withdrawal, passivity or late-blooming interest,” Scheff and Retzinger say in the journal article. “But the same shame leads men in a different direction — to boldness, anger and aggression. When a man feels ashamed of his sexuality and rejected by or inadequate with women and does not acknowledge these feelings even to himself, a likely outcome is sexual assault.”

Nathanson uses an even broader stroke in characterizing the potential effects of shame: “There’s no record of a violent action other than as a reaction to shame or humiliation,” he said.
Compass of Shame: Pointing a Way to Treatment and Recovery

Nathanson, author of “The Many Faces of Shame” and “Shame and Pride: Affect, Sex, and the Birth of the Self,” has focused much of his attention on how to help both patients and their therapists deal with the emotion more effectively. After extensive study, he concluded nearly two decades ago that psychoanalytic therapy had treated almost everything but shame-based conditions — despite mounting evidence that not only was shame a prominent feature of many psychological disorders, but that many treatment approaches often created or exacerbated painful shame reactions.

“Conventional psychoanalysis had viewed silence as anxiety, which was interpreted as resistance to treatment,” he said. “But, more often, silence in therapy is actually a sign that the patient is ashamed to say what he’s thinking. The therapist’s silence only makes the shame worse, it doesn’t make it go away.”

Nathanson devised the Compass of Shame to provide a framework for better understanding of the dynamics of shame and humiliation, as well as for supporting more effective approaches to shame-based responses in treatment situations. In this compass, each of the four cardinal directions is represented by a reaction to an experience during which a shame trigger has occurred, a physiological effect has been experienced and a cognitive response has taken place.

“Imagine the points with ‘Withdrawal’ at the north pole, ‘Attack Self’ due east, ‘Avoidance’ at the south pole and ‘Attack Other’ due west,” he said. “Each of these is a library in which individuals store a huge number of scripts they use to respond to experiences of being shamed. These scripts are activated by the sequence of events that involves the trigger, the physiological effect and the cognitive response.”

This means there is not a single entity that can be called “shame,” but four separate entities, four patterns of response in reaction to life events, he says.

Nathanson adds that making patients aware that feelings of shame are a normal part of the treatment process is an important first step toward resolving the core psychological problems at all four points of the compass.
Medications for Shame

Nathanson, Salerian and other therapists agree the role of biology is increasingly evident in the development of shame. Low levels of serotonin, for example, are believed to contribute to an innate vulnerability to feeling shamed or humiliated.

Both experts say the class of medications known as selective serotonin reuptake inhibitors, or SSRIs, including Prozac, Zoloft, Luvox and Paxil, have been effective in shame treatment.

But not all authorities agree on the appropriateness of prescribing SSRIs or other drugs. Middelton-Moz, for instance, says that biology is unlikely to hold the key to the cause or the cure of shame. “Medications send yet another message that the individual is helpless; that they are not the one making the change,” she said. “The hope that we can achieve a better self through chemistry is inevitably a false one in shame-based conditions.”

OK, I admit. I blew it. I — like most forensic experts quoted in the media — thought the phantom sniper, who terrorized millions of people in the Washington area was insane, and if not insane, overpowered by brutal urges to murder. We all focused on someone like Son of Sam or Jeffrey Dahmer — the infamous cannibal.

Now I believe John Allen Muhammad and John Lee Malvo are not crazy. In my opinion, Muhammad is a brutal con artist, a master manipulator and a serial killer. In my opinion, Malvo is a brainwashed mental slave and a serial killer. Jointly, they are more in the category of pairs with warped minds such as Kenneth Bianchi and Angelo Buono, the Hillside murderers, or the two female nursing-home workers, Gwendolyn Gail Graham and Catherine Wood, who hideously made murder an extension of their lesbian sexual pleasures.

There is no evidence that Muhammad and Malvo are delusional killers or insane. As far as we know now, they never heard voices, never communicated with invisible forces and seemed to understand what they were doing.

They were not insanely driven to kill and totally controlled by obsessive urges such as experienced by Thomas Dillon, the solitary sniper who experienced overpowering urges to hunt hunters in southern Ohio in the early 1990s. Nor is there any evidence that Muhammad and Malvo are Jeffrey Dahmer types — not insane yet mentally troubled enough to find comfort and joy in cannibalism and in incapacitating their victims into helpless zombies. Interestingly, Dahmer knew he was evil and often wished that somebody would stop him. He met his poetic justice in prison when he was bludgeoned to death.

Let us explore Muhammad and Malvo’s past. There is nothing particularly surprising about their chaotic parentless childhoods except that emotionally and physically abandoned children are more likely to become unhappy adults. Muhammad never knew his father and at the age of 3, lost his mother to cancer. No father existed in Malvo’s life until Muhammad appeared in his life, telling great tales of power, hope and adventure.

It’s an easy speculation that 17-year-old Malvo was mesmerized by the deceptively grandiose yet comforting stories of an Army veteran. To many, Muhammad and Malvo might have looked like father and son and introduced themselves as such, but the nature of their relationship is a mystery.

The short answer is we just don’t know, and of course it would be wrong to jump to any premature conclusions — there is no evidence of any sexual bond.

But there have been serial killers like Graham and Wood, who mercilessly killed elderly women and immediately after the slayings, rushed to a private corner for sex and exhilaration. So, a sick possibility like this should at least be entertained.

Muhammed and Malvo have different yet warped brains. They share one thing. They have no sense of pain or emotion for others: In shrink-speak, this is called empathy. They are accused of murders that cannot be explained by the hollowness of their childhoods or the neglect they suffered as infants, children or teenagers. After all, there are millions of kids who grow up in much more deprived and hostile environments and never become mass murderers.

Mental illnesses are common in any society, but mental illness does not explain or justify — and must not be used as an excuse by — people who are willingly and consciously being wicked when they have a reasonable chance of being in control over their behavior.

It is important to differentiate Muhammad from Malvo and vice versa.

First, a few words about Muhammad. To hell with psychiatry, psychology and forensic sciences. I fully realize that I may find myself in deep trouble with my colleagues for saying this, but Muhammad is just a wicked deadly virus dressed as a human who manipulated a teenager.

He knew exactly what he was doing. Even his letter to the authorities appears to have contained an attempt to create the false impression that he was a delusional killer. Why else would he sign the letter “Call me God”? He knew he was not God. He never acted like an obsessive killer. After all, no obsessive killer even in public discussed his future plans of violence and killings as Muhammad reportedly did at a bar in Seattle, Wash., in the spring of 2002.

Muhammad is the prototype of people with damaged brains and hollow souls, destined to fail, not insane, not brilliant, yet smart enough to know that he would never quite make it.

How about Malvo? What happened to Malvo was similar to what happened to Patty Hearst, the young California heiress, who was kidnapped by the self-proclaimed liberators/bank robbers of the SLA in the early 1970s. Soon, she was robbing banks and acting with apparent recklessness in imitating her captors’ philosophy and behavior.

Patty Hearst was an example of the Stockholm syndrome: identification with the aggressor after imprisonment and adoption of the aggressive and hostile methods of your captors.

Yes, it is speculation, but perhaps a reliable one, to think that that is exactly what happened to Malvo once he met Mohammad. He was hypnotized by Mohammad’s powers and soon became his mental slave, lost his identity and became an obedient and loyal servant.

And what are the lessons for us?

The lesson may be a simple one: There are many sane people with warped minds and hollow childhoods, abandoned and forgotten by society, who have the potential to be infinitely destructive.

Sadly and frighteningly the signs of their destructive potential are not obvious until it is too late.

On the positive side, it is possible that if we ever find a way of recognizing these early signs of trouble, particularly for youngsters like Malvo, it will be possible to rescue them from the grasp of predators before they become prey.

The Nevada State Athletic Commission delivered a stinging blow that hurt Mike Tyson badly when it denied him a boxing license Jan. 29.

Yet no one seems willing to extend a helping hand to rescue the powerful fighter from the demons of the mind that pound him with greater force than any opponent.

For years, people have called Tyson crazy, out of control, a wild man, even an animal. He’s been fined, imprisoned, barred from the ring and shunned. Yet in all of his glorious years of ear biting, brawling, lawbreaking and serving time in prison, Tyson has never once been forced to seek and finish psychiatric treatment. Tyson needs mandatory psychiatric care. And as a psychiatrist who for 25 years has worked with terribly troubled people, I have patiently waited for some sporting or legal authority to force Tyson to get the help he so desperately needs.

It seems, however, that there’s a stigma attached to mental health disorders that prevents the authorities from treating them like any other health issue.

I’m sure if Tyson were suffering from a concussion, the boxing authorities would allow him to fight only after a medical expert deemed him healthy. Why isn’t the same help given to those with mental health disorders?

Maybe Tyson’s race and educational background have influenced why he hasn’t been given help. How long would it take us to commit Andre Agassi if he jumped across the net and bit the ear or thigh of competitors like Pete Sampras or Lleyton Hewitt? Probably faster than a three-minute round in the ring.

I find it interesting that the same people who vilify Tyson for his actions could not find enough praise for the courage and spirit of Professor John Nash for his triumph over his psychological demons, as chronicled in the film and book “A Beautiful Mind.” Nash was violent and dangerous like Tyson, and got better only after treatment was forced on him.

It’s sad that the United States is one of the few civilized countries that consistently does not require treatment for severely handicapped people.

Our recent history is filled with brutally painful lessons of the dark consequences of unrecognized psychiatric disorders. There’s evidence that President Franklin Delano Roosevelt was psychologically impaired by depression in 1944 when he let Stalin steal Eastern Europe at Yalta, and that President Ronald Reagan’s Alzheimer’s disease began while he was still at the White House.

And what about the FBI’s top counterintelligence officer, Robert Hanssen, who sold our nuclear secrets to Russia? For 20 years, Hanssen confessed his spying and his deep psychological problems to his Catholic priest, but all he received was advice to pray.

What kind of advice are we giving Tyson? I wonder how many people have said to him: “Don’t worry about the Nevada boxing license–there are so many other states we haven’t tried yet,” instead of just having him committed.

It was less than four years ago that the Nevada commissioners rejected another of Tyson’s licensing bids, naming lack of continued treatment for his erratic behavior as their main reason.

It doesn’t particularly matter to me whether Tyson ever fights in the ring again. But as a psychiatrist–and someone who wants to feel safe with people like Tyson roaming the streets–it does matter to me that he receives help, even if we have to force it on him.

We don’t have to accept Tyson’s outrageous acts. For society’s sake, and for Tyson’s own sake, we must open our eyes to the perils of untreated mental disorders. Instead of continuing to attack this sick man, we need to help him get well.