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

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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