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A Psychologist's Thoughts on Clinical Practice, Behavior, and Life

A Nonsense Mental Health Diagnosis That Many Believe In

A February 25, 2023 article in The Wall Street Journal ("Administration Moves to Put Limits On Some Telehealth Drug Prescriptions") describes new government restrictions to rein in the COVID regulations permitting the online prescription of controlled substances including Adderall which is widely dispensed for the so-called Attention Deficit Hyperactivity Disorder or ADHD. ADHD is a popularly believed though unsophisticated notion with symptoms identical to anxiety and depression which are present in almost all medical and psychological disorders. It has a 200-year-old history from 18th century England onwards ("mental restlessness") to the Minimal Brain Dysfunction (MBD) of early 1900s America (of which a Harvard psychiatrist then remarked that only a doctor suffering from a minimal brain dysfunction would use this diagnosis), to its latest ADHD incarnation. Widespread ignorance of child psychological development and developmental psychopathology maintain belief in such nonsensical notions and treatments, fostered of course by businesses that profitably hustle these wares.

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The ADHD Epidemic

ADHD is an unsophisticated, nonsensical notion though with a long history, it being termed "mental restlessness" in 1700s England, Minimal Brain Dysfunction (MBD) in early 1900s USA (of which a Harvard psychiatrist said that any doctor using this diagnosis had a minimal brain dysfunction), with Attention Deficit Hyperactivity Disorder (ADHD) being its newest incarnation. It has symptoms identical to anxiety and depression which can be associated with every psychological and physical disturbance. Though a large profitable industry has grown up around it. Its belief largely reflects public ignorance of early life psychological development, and the attempt to "neurologize" psychological symptoms and life issues. And check online for the prescribed drugs' potential side effects, which are far from small.

To explain what is termed ADHD further: some children with school learning issues and adults with concentration difficulty do have psychological problems, reflecting what has since the 1960s been understood as Elements of A Borderline Psychotic Psychostructural Organization. Which does not mean "psychotic" or "borderline psychotic" but rather weakness of those basic ego capacities which develop in early childhood and include control of thinking and behavior, mood modulation, development of a sense of self, and others. This requires psychotherapy to heal, to replace the deficient ego capacities with more mature one. These weaknesses are not a present or absent diagnosis but a continuam of strengths and weaknesses which must be assessed through interview.

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Why the Unsophisticated Diagnosis of ADHD Persists:

The Attention Deficit Hyperactivity Disorder (ADHD) diagnosis persists despite it possibly being the most unsophisticated notion in mental health for the past two-hundred years. In the late 1700s an English physician described the symptoms as "mental restlessness." In early 20th century America it was described as Minimal Brain Dysfunction (MBD) of which a Harvard psychiatrist remarked that any doctor who uses this diagnosis has a minimal brain dysfunction (a cute remark, I think). ADHD is merely its latest incarnation and makes no sense with more diagnoses on the East Coast than the West Coast and more boys than girls, apart from its symptoms being identical to anxiety and depression.


In both children and adults, when these symptoms are present and not related to real worry or unconscious conflict, they reflect Elements of a Borderline Psychotic Psychostructural Organization. Which does not mean Psychotic or Borderline Psychotic but rather a weakness of basic ego capacities because of faulty early developmental experience which occur during the first three years of life and affect the development of reality testing, mood regulation, sense of self, and control of behavior and thinking.


The ADHD diagnosis has persisted, I believe, for a number of reasons:
1. Large, profitable mental health and pharmaceutical industries have grown up around it.
2. Ego psychology has grown out of favor with a consequent dearth of education of clinicians on sophisticated early life ego and child development. My (long deceased but still mourned) doctoral advisor once said that to understand human behavior one must go to psychoanalytic concepts, that there is simply no where else to go, and I agree.
3. Sixty years ago most psychiatrists provided therapy but today few do, apart from those who have had psychoanalytic training and these are not many. Thus, apart from reasons 1 and 2, they prescribe drugs. Which, alas, some parents demand and doctors comply. As a mother once said to me, she would rather that her child had a brain tumor than an emotional problem since a tumor could be cut out. Most new patients don't know what therapy is and must be educated.

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Is Adult ADHD a Childhood-Based Hypersensitivity to Impending Anxiety, a Paralyzing Fear of Fear?

There may be no more unsophisticated, longer-lasting diagnosis than ADHD which was described two-hundred-years ago as "mental restlessness, later as Minimal Brain Dysfunction (MBD), and most recently as Attention Deficit Hyperactivity Disorder (ADHD). This, despite its diagnostic symptoms of anxiety, depression, and concentration difficulty being present in nearly all serious medical and psychological disorders.

Unsurprisingly, adult ADHD has now  become a popular diagnosis, often resulting in treatment with a stimulant medication having potential side effects of seizure, stroke, abnormal heartbeat, mood changes, and more.

But concentration difficulty that has existed since childhood may also reflect a paralyzing fear of fear, a heightened sensitivity to anxiety against which normal ego defense mechanisms had never developed due to the early faulty interaction between parent and child. During thoughtful work, an individual is experiencing their sense of self, an ego capacity that can be deficient due to childhood deficits.


Relieving this deficit's crippling effect in an adult, in the absence of lengthy individual psychotherapy to replace their deficient ego capacities with more mature ones, may possibly be gained with the same technique which is used for battling many fears: by providing psychodynamic understanding, and engaging in the feared activity under a controlled circumstance.


Thus, one who has difficulty concentrating should practice concentrated work for a short time each day. As the fear of impending anxiety is reduced, their ability to concentrate may improve. Being cost-free and lacking dangerous side-effects, this technique is certainly worth a try.

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ADHD and ADD Explained Briefly

Attention-Deficit/Hyperactivity Disorder (ADHD) and Attention Deficit Disorder (ADD) symptoms are identical to those of anxiety and depression and have a long history, having been asserted to "mental restlessness" in the eighteenth century and Minimal Brain Dysfunction (MBD) in the early twentieth century. These terms are descriptions of behavior, and to believe that they  Read More 
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