Mind over body: the trouble with treating chronic conditions
While I agree with viewing health holistically and treating the person, not the disease, I felt uncomfortable with some of the conclusions that Suzanne O'Sullivan draws from the cases presented (Are we less healthy than we used to be – or overdiagnosing illness?, 1 March). Implying that we are overdiagnosing certain conditions only reinforces the stigma associated with them, and will prevent people in need from being taken seriously and receiving appropriate support and treatment. The scepticism, however well-meaning, can be damaging for patient outcomes and public health in general. Treatments and support available for conditions such as ADHD and autism are already lacking and underresearched.
The rise of diagnostic levels of most of these conditions comes from increased awareness, and also from the environmental changes in our society that place ever-increasing pressure on individuals to perform at a certain standard. Neurodiversity conditions have become a lot more debilitating for those experiencing them. Increased population density exposes individuals to more stimuli than their nervous system can handle. Technological progress, particularly the advent of smartphones, has led to an expectation of being always available and a pressure to react and respond in real time that did not exist 20 years ago.
The solutions to the problematic rise of diagnoses, then, must also be societal. Individual adjustments, as seen in the case of Anna in the article, can only help to a degree, and for some it may not be enough to allow them to be fully functioning in society. There needs to be a recognition that some of the narratives shaping our society today are actively preventing a significant part of the population from being able to fully contribute. Placing the onus on the struggling individual is unhelpful.Diana AnisimovaLondon
Suzanne O'Sullivan's 2015 book, It's All in Your Head, made a huge impact. We psychotherapists felt this doctor was singing our song – the power of the mind over the body. Her powerful case studies demonstrated the psychological underpinnings of medically unexplained diagnoses. Nine years later, O'Sullivan writes of the startling rise in the diagnosis of mental health disorders: 'We are not getting sicker – we are attributing more to sickness.'
I wonder if we need to think in broader terms about what is needed now for our sickness. If our bodies are screaming in distress, what is not being heard? Psychotherapy offers an environment in which people can and do heal and change. Through understanding and care, our most basic human needs are met. This transformational process is very different from diagnosis. It offers an exploration that tries to understand why we are the way we are, and not rush to conclusions.
I can understand why taking the diagnostic route is tempting. But I have always believed that psychotherapy is, in the words of Stephen M Johnson, 'the hard work miracle'. Hard work in the sense that facing pain is not for the faint-hearted: opening up our vulnerability, being honest about our inner conflicts and entrusting ourselves to someone else are acts of bravery. And a miracle in that, with patience and time, the good stuff starts to make an impact.
When we feel understood and accepted, and start to apply this to ourselves with compassion, the painful parts of the self settle down in peace and coherence. We can relax and feel safe in the world. These are the qualities, so much in short supply, that could be a salve for our current sickness.Philippa SmethurstDuns Tew, Oxfordshire
The extract from Suzanne O'Sullivan's new book, The Age of Diagnosis: Sickness, Health and Why Medicine Has Gone Too Far, that you published lays bare a patronising attitude that many healthcare professionals take towards neurodivergent people. She has spoken to scores of people diagnosed with autism or ADHD – all of whom have said their lives were better for it. Yet she wants to discourage diagnosis.
Why? Because she worries about their future, noting that many left jobs, dropped out of education, or lost friends. It seemingly never occurs to her that these changes might be deliberate, even positive. As an autistic person, my diagnosis empowered me to leave a high‑stress career in London and start a fulfilling online business, where I can work alone, from home. It also helped me cut out unhealthy friendships and build a life that genuinely suits me. Others have done the same, not out of helplessness but choice. O'Sullivan and her colleagues should try listening to their patients. And when neurodivergent people say they're happier, they should believe them.Name and address supplied
I feel Suzanne O'Sullivan overlooks the anxiety and distress people who are neurodivergent have in trying to function in a world that often makes little sense to them. This can lead to profound feelings of isolation, which in turn can lead to problematic behaviours for society. And for an individual struggling like this, even suicide. I feel this is being largely sidelined here.
If there is no diagnosis, there is a missed opportunity for helpful therapy and a better understanding of their struggle, both for themselves and those around them. People need to feel seen and heard, and when this is absent there can be profound implications for us all. So 'pathologising', with its implication of overdiagnosing symptoms, would not be the goal but perhaps the way the health and education systems work – without a diagnosis, no help is available.
From a neurodivergent person's point of view, a great deal of relief may come from a recognition that they are facing real difficulties. I agree that to see mental health problems as a person's response to a threat to themselves can be a useful and compassionate approach. But if their struggles are profound and enduring over a lifetime, it still needs to be recognised, and we have a duty to offer treatment where possible.Anne SanachanEdzell, Angus
I was disappointed by this edited extract from Suzanne O'Sullivan's book. As a disabled specialist psychotherapist working with neurodivergent and chronically ill clients, I feel that her representations need challenging. While I agree with the importance of hope and dangers of pathologising common experiences, she ignores the role inequality and social context play in health. She minimises the disabling impact that chronic conditions can have in the absence of mainstream understanding of their complexity; the medical gaslighting she scorns is all too common, and her simplification of the potential for improvement shows a striking ignorance of average experiences.
These misrepresentations can, ironically, contribute to the lack of hope and disabling impacts she mentions. With a failing NHS and lack of specialist support, the validation of a diagnosis can be all a person has, if they can get one at all.Elizabeth TurpLiverpool
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The misuse of ADHD drugs – and what they really do to your body and brain
Be more alert; improve your focus; do better at work: these are the reasons why high-flyers, from surgeons to lawyers and bankers, take 'brain-doping' ADHD drugs despite not having the condition. Now, increasing numbers of elite athletes are joining them, looking for something extra to give them the competitive edge. But taking ADHD drugs when you don't need them will certainly do more harm than good, with many takers becoming more irritable, experiencing sleep disruption and, in the most serious cases, causing heart problems, anxiety and depression. Sportspeople are barred by the World Anti-Doping Agency from taking ADHD medications such as Ritalin and Adderall before competing, but those who have been diagnosed with ADHD are exempt, on the grounds that they need the drugs to function. Such exemptions have tripled in the last five years, so suspicion has turned to the 'subjective assessments' by doctors to diagnose athletes with ADHD in adulthood, John Brewer, a former UK Anti Doping board member told The Telegraph last month. There has been a known black market for ADHD drugs ever since they became available to buy online, with packets of Ritalin, the drug most commonly prescribed to people with ADHD in Britain, selling for less than £20 on the websites of unscrupulous online pharmacies. It's more common, however, for stressed students and professionals alike to acquire spare pills from friends and family. In fact parents, who believe they have ADHD but have never been diagnosed, have been known 'to take stimulants that have been prescribed for their children because they think it helps them to perform better', says Katya Rubia, professor of cognitive neuroscience at King's College London. What are the main ADHD drugs and how do they affect your brain? In Britain, the drug most commonly prescribed for ADHD is Ritalin, the brand name for the drug methylphenidate – a type of stimulant drug. Adderall, another stimulant drug, is typically prescribed in America, and sometimes finds its way into the hands of British students (or professionals) illegally. There is an important distinction between 'misuse' of ADHD drugs – taking them in their prescribed doses when you don't have ADHD – and 'abuse', which means taking large amounts of Adderall or Ritalin for a high, says Prof Rubia. ADHD drugs are considered to be 'very safe' in the small doses prescribed to treat the condition, adds Prof Rubia, but abusing the drugs can cause heart palpitations, stomach aches and can be 'neurotoxic'. 'They actually change your brain's dopamine system, producing effects like anxiety and depression, as well as inattention and difficulties with memory,' she adds. In other words, abusing ADHD drugs can leave you with a set of symptoms that look a lot like ADHD. Prof Rubia also strongly advises against misusing ADHD drugs because 'you shouldn't take ADHD drugs at all if you don't have ADHD; you're a healthy person and the side effects are unnecessary'. You might believe that taking ADHD drugs when you don't have ADHD would make you think more sharply, but that's far from the truth. ADHD drugs 'work on your brain's dopamine system, to increase the amount that your brain has available to use,' says Prof Rubia. People with ADHD 'don't have enough dopamine, so struggle with motivation, concentration and focus, as well as keeping time and controlling their own behaviour, especially in children'. Taken by people without ADHD, the drugs might improve alertness, but they have a negative impact on other functioning, due to the 'U-shaped' impact of the levels of dopamine in your brain: past a certain point, your attention, focus and motivation will suffer. 'If you don't have ADHD, you already have an optimal amount of dopamine in your system, so increasing it will make you perform worse,' Prof Rubia says. One study, published in 2023, gave three groups a common 'smart drug' (Adderall, Ritalin or Modafinil, which is prescribed for narcolepsy in Britain) and observed how it affected their performance in a problem-solving task. 'When taking any of the drugs, the participants tried harder, but performed less well,' says Peter Bossaerts, professor of neuroeconomics at the University of Cambridge, who led the study. Those who performed best without the drugs 'performed below the mean when they were on them,' he adds. 'So they aren't really smart drugs. They make you dumber, but more busy and more motivated.' Another study, using a similar task to assess cognitive performance, found again that 'people who took 'smart drugs' performed worse despite trying harder,' Prof Bossaerts says. Here, worsened memory seemed to be behind the decline in ability. 'Dopamine doesn't only affect motivation, but also your memory, and drugs like Ritalin work on the dopamine receptors in your prefrontal cortex' – the part of your brain that manages your working memory and lets you retrieve memories from the past, Prof Bossaerts points out. The effects of taking so-called 'smart drugs' (also known as 'study drugs') are also short-lived. 'Students who take them might feel a bit down and sluggish for a few days after their exams, but they'll quickly pick up again in most cases,' says Prof Bossaerts. Abuse, or taking large amounts of Adderall or Ritalin for a high, is another matter. This means that the drugs have a 'high potential for abuse', even if you start out taking them occasionally to pull an all-nighter or meet an important deadline, Prof Rubia believes. 'As your body gets used to them, you need more and more to feel the same effects.' 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A Taekwondo black belt or football star probably has a higher likelihood of having the condition than the average person, Prof Rubia believes. 'People with ADHD are very often good at sports,' she explains. 'They have more energy than the average person, and where academics might have been a struggle at school, they might have realised their talent for sports and pursued that instead.' Intense sports practice can also be an effective tool for managing ADHD symptoms. Prof Rubia recalls meeting an Olympic karate fighter who had 'managed to overcome his ADHD without medication by training in a very focused way'. A sportsperson who takes ADHD drugs without having ADHD, however, might be in for a shock. Though the drugs might improve performance in the short term by making athletes 'feel less tired and more alert, as if they've had a lot of coffee,' Prof Rubia says people misusing the drugs over weeks or months might find themselves feeling less motivated and alert than they were before. 'Even within a day, they'll feel more low by the evening than they otherwise would.' Whether you're an athlete or not, taking stimulant ADHD drugs when you don't have the condition 'will affect your body in very similar ways these drugs affect the bodies of people with ADHD who take them,' says Prof Rubia. Stimulants increase your heart rate and blood pressure and can also reduce your appetite, while making you feel more awake and alert. People who take Ritalin also report some personality changes, like being more irritable and on edge, as well as worsened sleep, but both can also be symptoms of ADHD itself. Some research has indicated, however, that long-term use of ADHD medications (in people with and without the condition) may lead to an increased risk of cardiovascular disease. Weight loss and headaches are common, as are gut problems, though side effects like these are usually mild. 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Scottish Sun
a day ago
- Scottish Sun
I'm a psychologist and there are 5 things your kids must NEVER do if they have ADHD – or they risk making symptoms worse
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The Sun
a day ago
- The Sun
I'm a psychologist and there are 5 things your kids must NEVER do if they have ADHD – or they risk making symptoms worse
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As of 2024, 2.6 million people in the UK were estimated to have ADHD, approximately 708,000 children and 1.9 million adults. Prescriptions for ADHD increased significantly from around 25 items per 1,000 people in 2019-20 to 41.55 items in 2023-24. But this increase isn't necessarily due to a true surge in cases. It reflects a number of factors, such as increased awareness and recognition of the condition, updates in diagnostic guidelines, and sociocultural pressures such as overstimulating digital environments. While the rise partly reflects these factors, it also raises important questions about overdiagnosis, the medicalisation of typical behaviour, and the need for individualised care. Do you or your child have ADHD- Here's the NHS test as Brits waiting two years for diagnosis To better understand the condition, chartered counselling psychologist Dr Sheena Kumar shared everything you need to know - from telltale signs to what to avoid. Signs you might have ADHD ADHD isn't just about being hyper or distracted or struggling under a heavy workload, says Dr Kumar. Instead, it's a neurodevelopmental condition that affects how you focus, organise, and manage impulses. Dr Kumar explains: "While everyone struggles with attention sometimes, ADHD symptoms are persistent; they do not come and go. "They show up in different parts of life like work, school, and relationships, and make things feel harder than they should be." According to Dr Kumar, the following symptoms always start in childhood, even if they weren't recognised: Losing focus, even in conversations or reading Misplacing things, forgetting tasks, or missing deadlines Struggling to start or finish tasks that need mental effort Feeling restless, talking a lot, or interrupting without meaning, which impacts your relationships Having trouble managing time, emotions, or priorities For adults, it might look less like physical hyperactivity and more like feeling mentally scattered or overwhelmed all the time, says Dr Kumar. What NOT to do if you have ADHD For people with ADHD, their brain works differently to neurotypical people, especially in areas like attention, impulse control, and executive functioning. Because of this, some habits and choices can make symptoms worse or lead to burnout - especially for kids. Dr Kumar says: "You want to find ways to support your brain rather than to add extra demand to it." ADHD in children and young people Symptoms of ADHD usually start before the age of 12. A child or young person may show signs of being inattentive, such as: being easily distracted finding it hard to listen to what people are saying or to follow instructions forgetting everyday tasks, like brushing their teeth or putting on socks They may show signs of being hyperactive and impulsive, including: having high energy levels fidgeting or tapping their hands and feet talking noisily feeling restless, or getting up and moving around when they're supposed to sit still finding it hard to wait their turn, or interrupting conversations Most children and young people with ADHD have symptoms of both the inattentive and hyperactive-impulsive type. Some only show signs of one type. ADHD is thought to be recognised less often in girls than boys. This may be because girls with ADHD more commonly have inattentive symptoms and these can be harder to recognise. If you're worried that ADHD may be affecting your child, talk to one of their teachers. The teacher will usually make a referral to the school's special educational needs co-ordinator (SENCO), who can discuss support in the classroom or with homework, or help with building confidence and friendships. If you're still worried or you think your child needs additional support, you may want to make an appointment with a GP. Source: NHS Here are five things she recommends to avoid: 1. Prioritise sleep People with ADHD tend to have a higher rate of sleep disorders. Studies indicate that 50 to 80 per cent of people with ADHD experience sleep difficulties, including a higher likelihood of insomnia, sleep apnoea, periodic limb movement disorder, and restless leg syndrome. For children, ADHD can lead to trouble falling asleep, staying asleep, and getting up in the morning. And sleep deprivation amplifies ADHD symptoms. It hinders the brain's ability to concentrate, making it more challenging for individuals with ADHD to stay focused and attentive. Dr Kumar advises: "Prioritise sleep, and if you struggle, research and try different ways to help sleep." 2. Don't overcommit The impulsivity and difficulty with time management associated with ADHD can contribute to taking on more tasks than one can realistically manage. Kids in particular may also struggle to say 'no'. This could be related to schoolwork, exams, or social situations such as hanging out with their friends. But overcommitment can be particularly problematic for individuals with ADHD, often leading to stress, burnout, and difficulty following through on commitments. Dr Kumar says: "Learning to say 'no' doesn't make you rude, it makes you honest." 3. 'Just try harder' The belief that someone with ADHD must exert extra effort to perform tasks can negatively impact self-esteem, warns Dr Kumar. This can be due to a combination of factors, including the feeling of being constantly behind, the internalisation of external criticism, and the challenges associated with emotional regulation. Telling a child with ADHD to 'just try harder' is ineffective and can be harmful because ADHD is a neurological condition, not a lack of effort or motivation. Instead of focusing on the perceived need to exert more effort, people with ADHD should adopt strategies to improve focus, organisation, and overall functioning. These strategies should be tailored to individual needs and preferences, and may include using tools to manage time and tasks, incorporating physical activity, and seeking professional guidance. 4. Ignore your emotions People with ADHD shouldn't ignore their emotions because neglecting them can lead to a number of difficulties. Children with ADHD may especially have difficulty regulating and managing their emotions. This can potentially result in intense outbursts and difficulty managing everyday situations. "Working on regulation skills helps," says Dr Kumar. 5. Never self-diagnose or self-medicate While parents are key to recognising potential ADHD symptoms and initiating the process of seeking a diagnosis from a doctor, they should never diagnose their child with the condition themselves. Self-diagnosing and self-medicating ADHD is strongly discouraged because it can lead to inaccurate diagnoses, ineffective treatment, and potential harm. A formal diagnosis requires a thorough evaluation by a qualified healthcare professional, and treatment plans should be tailored to individual needs under the supervision of a medical professional. You risk the danger of making symptoms worse, says Dr Kumar. The best way to get diagnosed To go down the NHS route, visit your GP and ask for a referral to an ADHD specialist (only certain professionals are qualified to diagnose, such as psychiatrists and psychologists). Dr Kumar advises: "You'll usually be asked to bring examples of how your symptoms affect your daily life. "But note - while the NHS pathway is free, unfortunately waiting times can be up to three years. "If a private assessment is an option for you, diagnosis tends to be a lot quicker. "In my clinic I also do online ADHD assessment and diagnosis with adults." What happens if ADHD is never diagnosed? ADHD that is never diagnosed can hide under layers of frustration, burnout, or health issues. A diagnosis can be the first step toward understanding yourself, finding effective strategies, and feeling less alone. Dr Kumar adds: "Many people experience underachievement, feeling capable but consistently falling short due to disorganisation, missed deadlines, or procrastination. "This often leads to low self-esteem, with individuals internalising harmful beliefs like 'I'm lazy' which can increase the risk of anxiety and depression. "Without understanding the root cause, people may turn to coping mechanisms like excessive caffeine, or other substances to self-regulate. "Relationships may also suffer due to impulsivity, forgetfulness, or emotional reactivity, all of which can create unnecessary conflict. "Getting a diagnosis can bring clarity, relief, and a starting point for meaningful support." How ADHD is treated For some people, just knowing their diagnosis brings relief as it helps them to make sense of themselves and they do not want formalised treatment. For those that want treatment, that can look like a combination of medication, psychological support, and lifestyle adjustments, says Dr Kumar. She explains: "Psychological therapies, such as cognitive-behavioural therapy (CBT), support managing time, emotions, and daily challenges, often alongside coaching and family education. "Lifestyle changes like establishing routines, using organisational tools, exercising, and prioritising good sleep also play an important role. " Schools may provide additional support through formal plans, and regular follow-ups with healthcare professionals ensure the treatment is effective and adjusted as needed. "Overall, treatment is personalised to help improve daily functioning and quality of life."
