ADHD and Psychoanalysis.

I’m writing this piece about ADHD and how it is viewed from a psychoanalytic perspective in response to the considerable increase in people contacting me about it in the past couple of years. In fact, in my fifteen years of clinical work I have never been contacted more frequently by people looking to be assessed for an ADHD diagnosis than in the past 24 months. Over the last decade in particular there has been an increasing de-stigmatisation of mental health issues in general, with so much first-hand testimony of personal struggle discussed in all forms of mass media. Where once discussion of such things was met with silence or ridicule, there's an increasing appreciation of the need to discuss such things and support one another in combating poor mental health.

I think that the specific increase in interest in ADHD is linked to people sharing their own experiences on social media such as TikTok., and it clearly resonates with many people viewing it. It must also be part of the internet age that we now live in that finding detailed information about psychiatric diagnoses such as ADHD is the result of a one-line Google search. All of this is leading to massive increases in people seeking assessment for ADHD, with a concomitant rise in people being diagnosed as having ADHD.

I would argue that it shouldn't be concluded from the increase in diagnoses that there is a startling epidemic of ADHD, but that more people have learned about it, identified with the symptoms, and sought a diagnosis with a psychiatrist. I rather argue that the symptoms grouped within the ADHD diagnosis have afflicted humans for a very long time, but are only being viewed as one discrete pathological illness or state since the diagnosis became crystallised in psychiatric diagnostic manuals in the 1960's, 70's and 80's. There are observations made of symptoms that could fall within the current classification of ADHD from the late eighteenth century – so that while the diagnosis is relatively recent, the symptoms have been recorded for at least two hundred years.

The causes for ADHD cited in psychiatry are genetic factors or an acquired brain injury – through physically reductive explanations. You're either born with it or acquire it through injury. You may choose to take deication to treat your symptoms and/or enagae in some form of psychological treatment to address your difficulties, but if you’re diagnosed as having ADHD, from a psychiatric perspective it’s like finding out your blood type - this is a permanent part of who you are. Psychiatric treatment therefore only treats the symptoms without seeking to treat and alter the generative causes of those symptoms. It does this through stimulant medications to increase focus and attention, and through possible psychological treatments to manage symptoms. In contrast, psychoanalysis offers a way to tackle the causes of symptoms.

I find the conception and psychiatric classification of ADHD as controversial and unsatisfactory from the perspective of Psychoanalysis. What is specific and fundamental to Psychoanalysis is the idea of the unconscious – that every human has a portion of their mind that exists beyond conscious thought, and that is often where we find answers to questions about ourselves when we don't understand why we do what we do. Engaging in psychoanalytic treatment offers someone experiencing the symptoms of ADHD more insight into their specific, individual thoughts and behaviours than a psychiatric approach – because it pays attention to the unconscious mind, which is not valued or researched within psychiatric approaches. From a psychoanalytic perspective, the symptoms of ADHD are a response to unconscious conflict, and figuring out what is provoking them can massively reduce them.

The core symptoms of ADHD – a low attention span, poor concentration, bursts of energy or impulsiveness, procrastinating, intrusive thoughts or outbursts – are the fundamental symptoms of a person under stress, and symptoms that everyone can identify with in times of stress. The hyper fixation is understandable from the perspective of an overloaded psyche looking for release of pressure by finding a new, exciting forcus that may give a bounce in one’s mood. I think it's helpful to look at ADHD as a spectrum of severity, just as there is a spectrum of intensity for feelings of depressed mood. For someone who identifies with ADHD symptoms, or who is diagnosed with it by a psychiatrist, these symptoms are much more intense – so from a psychoanalytic perspective such a person has more going on for them at an unconscious level that is intensifying their symptoms on the surface of their mind. Someone else may experience the same symptoms but more infrequently and less intensely, and their symptoms may never rise to a level that leads them to seek external help. It’s important to point out that, unlike psychiatry, there is very little conceptualisation of a generalised ‘good mental health’ in psychoanalysis across the whole of society. There aren’t ‘healthy’ people and ‘unhealthy’ people. There are just people, living complicated lives, and we all have symptoms. It’s when they become so intense that we can’t resolve them ourselves that someone may reach out for outside help, but no one is immune from such a situation.

In conclusion, I want to make something absolutely clear in how I'm speaking about ADHD. A lot of people who seek and get a diagnosis of ADHD feel like it gives them room to breathe - once they are able to put a name to what they have been suffering with they get a huge sense of relief. The diagnosis is very important to them, because it finally stops the endless questioning and judgement that they have been bombarding themselves with previously. This is the experience for many people who receive a diagnosis that helps them to make sense of whatever suffering or ill-health they have been dealing with.

The position I'm putting forward in this piece in no way challenges the veracity of such a person's account of their symptoms and experiences – it rather suggests that there is a more substantial way of understanding such symptoms within psychoanalytic treatment as opposed to pursuing solely psychiatric treatment. Even if someone is taking medication to treat their symptoms they can still engage in psychoanalytic treatment – just as someone taking anti-depressants may still wish to have somewhere to speak and better understand their experiences.

If it is something you want to engage in you can make contact and we can begin.