Page 47 - JCBP-3-4

Journal of Clinical and
Basic Psychosomatics Psychosomatics, somatopsychics, and ADHD

methods employed in many studies these days, rather we I see ADHD as a psychosomatic disorder par excellence.
accept the statistics without understanding the methods It is a physically defined condition in terms of the motor
behind them, and thus their validity. I also think that hyperactivity (hyperactive subtype), restless fidgeting and
3,4
the reliance on group and cohort based studies which fiddling are frequent and the subjective sense of a busy or
cannot and deliberately do not take individual variation overcrowded brain are also common features. These and
into account is misguided. This is where genetic groupings the inability to concentrate are not dissimilar to pain,
would be helpful. and the literature on pain and its psychosomatic links is
voluminous. In addition, it is now part of my approach
Hence, after many years of practice, I started to
integrate my medical knowledge, my research experiences, to try to delineate the causative factors leading to this
distressing condition, not simply label it and treat with
and my psychiatric time into a whole. The idea that all medicines. In the end, all conditions are “psychosomatic”,
mental illness is either socially (environmentally) driven or biopsychosocial (as Prof. Crisp would have had it), or
or physically based (but in ways not understood) seemed multi-factorial as I would have it. Of course, there are
exclusive and unhelpful. My old Professor at St George”s some conditions that have more of one thing than another
with whom I worked for a number of years – Arthur Crisp – retinoblastoma is one such – but even there epigenetics
– was fond of the “biopsychosocial” model for years before might be argued to play a part.
it trended. However, I noted from early that much more
5
emphasis was laid on the first two and less on the social. The traditional view of psychosomatic illness would
I might now term that “environmental” and look for those only look at an evidently physical endpoint and ask how
factors in the genesis of the conditions I now see. mental phenomena were involved in creating or expressing
that condition. The more inclusive approach would ask
I no longer practice as a psychiatrist foregrounding how a problem that we label as an illness was related to
my dynamic or family (psycho) therapy skills. I was never constitution, experiences, and lifestyle and by implication
one who enjoyed the prospect of placing my (increasingly how the condition fed back into and influenced those
child) patients on psychoactive drugs but the tide has been to create perpetuation. That is what I do most days with
against me in the past 25 or so years. The usage of selective “ADHD”, autism spectrum, and all the other presentations
serotonin reuptake inhibitors (SSRIs) in children is now I see. I am not alone but we are still rather few. 9
common, and stimulants. We will come to those shortly.
6
Moreover I, along with colleagues, now use these daily. I have recently started to talk about how “ADHD” is
The previous abhorrence of the idea when I was training like bread. There are many types of “bread” and some
50 years ago that a child might take a medicine rather have ingredients that some people might query as falling
than have psychotherapy in Child Guidance Services, into the bread category. Polish potato bread is one. How
leading to prolonged therapy that often went nowhere, has do we decide if it is “bread”? We can set up a bread
evaporated. Or has it? The new orthodoxy is that children committee: they are expert bakers and manufacturers so
must have received cognitive behavior therapy (CBT) we will ask them to decide. The DSM committee (for it is
7
before medication, or with it. Dynamic psychotherapy has they) decide that this cluster of things is indeed (bread)
given way to CBT that also often goes nowhere, but at least ADHD and hey presto! there it is, defined and the eligible
is shorter. Medication is now legion. ingredients listed in a checklist. However, bread is
composed of many different things so it may make sense
Hence, how are these issues tied up with psychosomatics, to look at what got us here. Moreover, bread is pretty
an area of interest and the focus of my research over good with butter (or, as shall call it, methylphenidate).
the years? Well, diseases and trends come and go, and However, perhaps not all breads are good with butter;
currently, attention deficit hyperactivity disorder (ADHD) maybe olive oil is better?
and autism spectrum are having their moment. In my
world ten or even five years ago very few people turned Thus, I now spend my time trying to determine what
up with these as presenting questions of diagnosis. It was makes this person unable to concentrate for long enough,
emotional difficulties, anxiety, behavioral (oppositional) fidget, or unable to initiate organized tasks. That is,
disorders, occasionally, poor school attainment, or determine the physical or constitutional contributors to a
depression (covert). Now they come with little else. I see manifest condition that is currently listed in the Psychiatric
it as my role to help understand the complexity of such chapter of the DSM. Have you noticed how things get put
presentations and not give simplistic labels to complex in that category until a “real” cause is found and they then
disorders. This gets me into trouble, because the social become the province of physicians?
pressure and flow now is to get a diagnosis of ADHD and Perhaps that is why I continue to struggle with this.
medicate it. 8 I am not one or the other – not a (now ex) GP, or a pure

Volume 3 Issue 4 (2025) 41 doi: 10.36922/JCBP025090015