One Syndrome To Rule Them All

Enter The Kenneth Blumiverse

don’t worry, i have no idea wtf this means either

The other day, I was reading a post on Burnt Toast, journalist Virginia Sole-Smith’s newsletter, challenging the idea that sugar is physically addictive. I like Sole-Smith’s work and have learned a lot from her about diet culture, so this is by no means an indictment, but I stumbled across something she missed.

It got me thinking about how ubiquitous certain ideas are, and how the people who craft and sell those ideas show up all over the place, but we rarely pull the curtain back on them and look at all the cheap props backstage.

I don’t blame anyone for missing these things, by the way — you wouldn’t know unless you read neuroscience papers about dopamine and behavior late at night when you could not sleep and then obsessively looked up all the lead authors in order to understand who is asking such reductive questions of brain science.

For some reason, I cannot stop doing this, so consider it my very niche and entirely unprompted service to the world, I guess?

Sole-Smith’s post was an answer to a question from a concerned parent about their child with ADHD:

I’m trying not to put limits on food for my kids but I’m really struggling with the question of sugar-filled foods, which my son craves and tends to OD on if he has the chance. He has ADHD so he’s more inclined to seek out sugar/carbs because of the dopamine surge they provide. What do we do when the notion of “no food is off limits” clashes with what’s indicated for other conditions our kids might have?

She responds that metaphors which liken sugar to a drug are inaccurate and it’s likely that restriction contributes more to these cravings. We want what we can’t have, basically. She says that what we perceive as a “sugar high” in kids overlooks the combined influence of a high-excitement event where more sugar is often consumed, like a birthday party, and a culture of food restriction that makes the opportunity to eat sugar more exciting than it should be.

I appreciate that Sole-Smith’s arguments are based in an understanding of how deeply our social environment affects us (and honestly, I would make a similar argument about drug prohibition), but here’s the part of her response that gave me pause:

..there is some evidence that people with ADHD eat more sugar than neurotypical folks, and as you mentioned, that may stem from their heightened dopamine cravings.

Oh god. There it is, the dopamine deficiency discourse, once again! I clicked the link (you know I clicked the link) and it’s a paper called Attention-deficit-hyperactivity disorder and reward deficiency syndrome. The first author on this study was a guy named Kenneth Blum, and immediately I was like, where have I seen that name before?

OH, right, he invented Reward Deficiency Syndrome. He also invented a genetic test for Reward Deficiency Syndrome, “nutrigenomic” treatments for Reward Deficiency Syndrome, and he’s editor-in-chief of the Journal of Reward Deficiency Syndrome & Addictive Sciences.

What is this Reward Deficiency Syndrome, you ask? It’s Blum’s answer to everything from ADHD to addiction to “the obesity epidemic” — a concept widely denounced by fat activists (which Sole-Smith has also done much great work to debunk).

RDS is “a term that connects addictive, obsessive, compulsive, and impulsive behavioral disorders” and attributes these behaviors to “a reduction in dopamine signaling within the reward pathway.”

Never mind that all of these behaviors are deeply affected by the social and political environment we live in, or that human behavior in general cannot be reduced to a simple chemical reaction in the brain.

Blum has built a career on the premise that you can, actually, attribute something as complex as alcoholism to one variation of the DRD2 gene that codes for dopamine receptors. If you have the DRD2 A1 variant, according to Blum, you have less dopamine receptors, thus, more “dopamine cravings” and addictions.

His ORCID bio proudly notes that he has been called “The Father of Psychiatric Genetics”, but I’m not sure who is calling him that, or if it’s just something he also invented. It looks like he’s been busy over the last few years filing all kinds of “genetic risk analysis” patents for things like PTSD and ADHD, and “Anti-RDS compounds” that can “induce anti-stress states”.

This work very clearly individualizes systemic social problems, and it frustrates me that I often see people who make progressive social critiques in other areas suddenly pull up short at psychiatry. A DSM diagnosis comes up and then all of a sudden, we are back to reducing human behavior to a chemical, making drug-based metaphors about our neurotransmitters, and accepting reductive arguments that would be totally unacceptable in other contexts.

Reducing body size down to a brain deficiency is an offensive argument that stems from a long history of racism and ableism — all the way back to Adolph Quetelet’s body mass index. But Quetelet did not just propose the BMI.

His work opened up all sorts of ways to apply the cold rationale of statistics to society, including the construction of normalcy that led to the development of the DSM. Disability scholar Lennard Davis wrote that Quetelet’s concept of “the average” idealized the middle, or the norm, as something good and beautiful:

…one must observe that Quetelet meant this hegemony of the middle to apply not only to moral qualities but to the body as well. He wrote: ‘deviations more or less great from the mean have constituted [for artists] ugliness in body as well as vice in morals and a state of sickness with regard to the constitution.’

ADHD, addiction, and body size, once upon a time moralized, have now been refashioned as brain diseases, all coming together under Blum’s Grand Theory of Reward Deficiency.

In a 2014 paper, he argued:

“Recently a number of theories backed by a plethora of scientifically sound neurochemical and genetic studies provide strong evidence that food addiction is similar to psychoactive drug addiction.”

Two years later he gave a presentation on RDS that included this slide:

Along with addiction, ADHD, Tourette’s, and basically all the personality disorders, Blum thinks your S&M kinks are caused by “a dysfunction of the reward genes,” too! His argument for RDS is based on the idea that dopamine controls us, as if we are but robots piloted by our neurochemicals:

Dopamine, a very powerful neurotransmitter, controls feelings of well-being.

“Feelings of well-being” is frustratingly vague, and the popular idea that dopamine equals pleasure is not true. I have critiqued this before, writing that people talk about dopamine like it’s “a kind of heroin that your brain makes when you enjoy things,” and then they turn around and slap old US drug war narratives about being “powerless to drugs” on top of it.

Blum’s theory seems nicely buoyed by narratives like these, so it’s maybe not surprising that his research also plays into racist tropes about drug addiction in the US that go back to the beginning of the 20th century.

In the video, he jokes about “the controversy” that he encountered when doing this research, controversy that is rightly deserved, considering the implications of his claims. Remember the DRD2 A1 variant is supposed to mean a person has less dopamine receptors and thus is more susceptible to addiction? When this slide came up, I choked on my coffee:

Curiously missing here are any stats for white Americans, who, according to SAMSHA’s 2017 data, report drug addictions at very similar rates to Black and Hispanic populations.

Addiction is not a genetic disease, it’s a compulsive habit that results from motivated repetition, according to neuroscientist Marc Lewis. What motivates a person to do something over and over again until they become unable to stop regardless of the harm it’s causing them is usually isolation, trauma, poverty, oppression, or some other kind of major hardship in their lives. But Blum’s work strips all that social context away and presents simple solutions he can patent.

In a 2012 paper, he writes:

“Since [dopamine] has been established as the “pleasure molecule” and the “anti-stress molecule,” any reduction in function could lead to reward deficiency and resultant aberrant substance-seeking behavior and a lack of wellness”

What does “a lack of wellness” mean?! Do I have a “wellness” meter somewhere that you can read? Will I gain more “wellness” if I take Synaptalean RX?

Yes, this is also a Kenneth Blum creation, and I can hear a shady late-night infomercial playing in my head when I look at it. It contains a combination of vitamins and minerals called “Synaptamine” that is supposed to treat all manner of “cravings” without pesky side effects.

Synaptamine and its successor, SynaptaGenX, come from a substance called KB220z. Here’s how the blogger Neuroskeptic described it:

"KB220z" is presumably named after Kenneth Blum. Which brings us back to the new Journal of Reward Deficiency Syndrome. One of the papers there is about KB220z. This paper is a) authored by Blum b) published in a journal edited by Blum c) about a product named after Blum and d) hosted on a URL starting with "blum". What kind of academic publisher would host an outfit like this? Well, JRDS is published by United Scientific Group (USG), which is on Beall's List of 'predatory' open access publishers. Who's the founding president of USG? Inevitably, it's none other than Kenneth Blum. In summary, this is the most extreme example of academic editorial self-publication I've ever seen.

He’s done studies that administer KB220Z intravenously in drug rehab centers, in hopes of solving a problem that other pharmacological treatments for things like addiction and ADHD run into — drugs that initially stimulate the dopamine system also cause unwanted down-regulation of dopamine receptors over time.

This is because the body is always seeking homeostasis and will compensate for the substances you put into it accordingly (and is, similarly, why calories in/calories out diets do not work long-term).

In a 2012 study, he writes:

The challenge is to find a safe, nonaddicting natural substance that would activate the “brain reward site,” causing up-regulation of [dopamine] receptors (D2 in particular) without side effects but having therapeutic value.

They want a good drug that only does good things (which, I’m sorry Kenneth, doesn’t exist! All drugs have both benefits and risks). While Blum began by targeting drug users, his ultimate goal is to use this treatment for all the “RDS behaviors” — the wider the tent, the bigger the product market. I even found this image from a 2018 case study on a woman who took KB220Z and suddenly... cleaned her room, I guess?

It would be nice if being a human was as simple as Kenneth Blum seems to believe it is. If just finding the right lever to pull in the brain with the right chemical formula would magically fix an entire spreadsheet full of human problems. But we are thankfully, beautifully, painfully far more complicated than that, and true fixes for our distress are not going to be something you can patent and sell on Amazon.

Back to the little citation that opened this rabbit hole — it’s clear how much of a financial stake Blum has in convincing everyone that kids diagnosed with ADHD eat more sugar than other kids, because he’s built an entire universe where every deviant human behavior is genetic, and all cravings are caused by a dopamine deficiency in the brain that can only be fixed by his special patented formulas.

“Dopamine deficiency” as an explainer for social problems has become such an omnipresent discourse that we don’t even really notice it anymore. It’s becoming a common sense sort of truth, like the now-debunked “serotonin imbalance” before it. We assume that a study published in an academic journal counts as scientific evidence, but science is a process — a production of knowledge — and the truly scientific thing to do is question its products.

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