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ADHD Chatter PodcastADHD Chatter Podcast

Cambridge Educated Psychiatrist Shares New ADHD Treatment | Dr Judith Mohring

Dr Judith Mohring has over 25 years' experience of clinical and organisational practice having studied medicine at Cambridge and graduating as a gold medal finalist.

Dr. Judith MohringguestAlex Partridgehost
Apr 21, 202559mWatch on YouTube

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Transcript

  1. 0:00 – 1:52

    Trailer

    1. JM

      But ADHD impacts executive function, and one of the first elements of executive function is self awareness. So awareness of who you are in the world. And if you're not aware of who you are in the world, it's difficult to go through life because it's like you're kind of going through life naked going, "Am I wearing this outfit? Am I wearing that outfit?"

    2. AP

      Ooh.

    3. JM

      Um, who am I in the world? And whilst there is a really enjoyable adaptability because you can adapt, there is also a vulnerability because you don't have an exterior shell.

    4. AP

      Dr Judith Mohring is a Cambridge-educated psychiatrist- A medical professional and expert in all things ADHD-

    5. JM

      Specializing in women's mental health- Her mission is to help ADHD women understand themselves better And optimize their amazing unique brains So what I see amongst my ADHD coaching clients and me is a, a delightful lack of narcissism associated very often with a, a vulnerability because there's a sense of who am I in the world. With ADHD, there's an overactive default mode network, and the overactive default mode network means that we're very good at taking other people's points of view on, adapting to them. I call it pretzeling.

    6. AP

      [laughs]

    7. JM

      'Cause you twist yourself into the shape that's required of you.

    8. AP

      Yes. Yeah, fascinating. What do you think i- the, the toll of feeling lost, forgotten, misunderstood, what does that do to someone's mental health over time?

    9. JM

      Um, it-

    10. AP

      Loyal listeners and viewers, I can't thank you enough for tuning in. If you've ever felt broken or different, I hope this helps in your search for answers and community. And do you know what would really help me in return? By clicking the follow or subscribe button wherever you're listening. It might not seem like much, but at ADHD Chatter, it means a huge deal, and with this, I can book more incredible guests and keep the self-discovery fire alive for all of us, myself included. Just one click of a button goes really far. And remember, you have always been enough. [upbeat music]

  2. 1:52 – 2:45

    What is your mission within the ADHD community?

    1. AP

      What is your mission in terms of the ADHD community and, and mental health?

    2. JM

      Such a great question. Thank you so much, Alex, and thank you so much also for asking me on because, um, I'm really passionate about sharing high-quality information with people, and ADHD is both wonderfully complex and also wonderfully simple. So the science is complex. Sometimes the answers are quite simple, and I have a real passion for sharing that evidence-based science with people so they don't have to wait to have an assessment, they don't have to wait to see a doctor, and they don't have to just have medicines. They can also use skills to help themselves get better. So that's my real passion, is to see the light bulbs go on, see people inspired, and go, "Oh, that's what I can do. That will help."

    3. AP

      Mm.

    4. JM

      So that's, that's why I'm here, so thank you.

    5. AP

      Yeah. No, it's amazing. I, I s- see so many people in the community, particularly women, I'm sure you're familiar with it, they have that light bulb moment, and suddenly so much makes sense.

    6. JM

      Yes.

    7. AP

      I read on your website that your special interest is women's mental health.

  3. 2:45 – 8:09

    Trends with regards to what women with undiagnosed ADHD tend to struggle with

    1. JM

      Yep.

    2. AP

      So I suppose have you noticed any trends in your work in, in perhaps if, if you are a female with undiagnosed ADHD, what, what particular struggles there might be for that person?

    3. JM

      That's, again, that's really interesting because one of the things about ADHD that I think we're only just beginning to understand, and I'm, uh, really clear that ADHD is emerging, the science is new. It's emerging. Many of the papers that I quote have only come out in the last four or five years, um, is that ADHD is really tidal. And what I mean by tidal is that we know that noradrenaline and dopamine are dysregulated, not low, but dysregulated, which means that when the tide is out and we're zoned out, and we're not focused, and we're not concentrating, got low noradrenaline and dopamine. But then when the tide rushes in and you've got high dopamine, noradrenaline, you have hyperfocus. You've got hyperenergy. So you've got this real tidal variation in, uh, your energy levels and your focus, and it looks really confusing, both to the individual, to their friends, their colleagues, and also to doctors, 'cause doctors have a kind of thing called present mental state, which is how is the client now? And if you have ADHD, how you are now could be really different from how you are in half an hour or even an hour-

    4. AP

      Mm

    5. JM

      ... because the tide may be in, or it may be out. Does that analogy make sense to you?

    6. AP

      Oh, totally. I mean, how many people have had, you know, by bosses, by partners, "Why? You've got drastic mood swings." [laughs]

    7. JM

      Yeah, drastic mood swings, and so you get told you're moody, or you get told you're difficult because-

    8. AP

      Mm

    9. JM

      ... it's like, "But you were different yesterday. Who are, are you today?" And it's almost like your neuro, you know, your n- neuroscience is kind of quasi gaslighting you because of this variability. Now, I'm gonna caveat that with the fact that this is, um, there are a few papers that show this difference, and it's called the difference in tonic, which is resting, dopamine, and phasic, which is dopamine when we are rewarded or stimulated. So there's this, there are a few papers that reference this, um, and from talking to experts in the field, this is what we think is going on. It's very hard to evidence in live people, but we do have a few studies.

    10. AP

      Mm. Fast-forward a bit, someone gets a diagnosis, or they become aware that they might have ADHD. Do you notice that the struggles might shift a little bit from that ebbs and flow you were just talking about to perhaps a new territory, a new-

    11. JM

      Yep

    12. AP

      ... area of frustration? Why am I just finding out now? Do you see a new sort of type of struggle pop up after diagnosis?

    13. JM

      So there's a couple of things that happen after diagnosis, and I think the first thing to say is that neurodiversity, I tend to say this when I'm teaching doctors, neurodiversity is like the, the soil in which other conditions grow. So neurodiversity isn't, it's not a disease. It's, it's, you can be diagnosed neurodivergent with ADHD or autism. You can be diagnosed with it, but it's actually a way of being wired. It's who you are. Um, but within that n- way of being wired, other conditions can grow, so you might be neurodivergent and also have severe anxiety or OCD or an addiction problem or, um, any of these other issues. And so what we see is, first of all, we see that people say, "Well, my ADHD's a bit better under control now, but I'm still struggling with OCD symptoms," or, "I'm still struggling with an addiction problem or an eating disorder." Um, so we see that. So we see that shifting, and we also see the, you know, you and I talked earlier about coming out.

    14. AP

      Mm.

    15. JM

      That kind of, oh- Now it all makes sense. And I definitely had, you know, read your book and thought, "Yep, now it all makes sense." So for me, coming out with ADHD was like, "Oh, that's why my nickname for myself is Last Minute Lucy."

    16. AP

      [laughs]

    17. JM

      So you have this kind of-

    18. AP

      Mm

    19. JM

      ... mixture of shame and relief.

    20. AP

      Mm.

    21. JM

      And it takes time. It takes probably two or three years to really kind of come to terms with the fact that your life has been in a partic- uh, it has run in particular patterns-

    22. AP

      Mm

    23. JM

      ... because of who you are in the world.

    24. AP

      With coming out, do you think... What are the r- reasons somebody might not feel comfortable coming out? And I mean, in reference, perhaps in the workplace, or even within your family or friendship unit. Are there particular points of fear that might stop somebody from coming out?

    25. JM

      Um, yeah, I think it's difficult to explain to somebody that there's an invisible difference in your brain that means that you experience the world diff-

    26. AP

      Mm

    27. JM

      ... in a different way, and so there's a lot of dismissing, so people are like, "Don't be ridiculous." So I've had, uh, you know, really, you know, very clever, very well-off people saying, you know, "Neurodiversity is a fad. Neurodiversity's indulgent. Uh, this is a middle-class diagnosis. You want special treatment." So there's dismissal. Um, there's often a lot of shame within ADHD, the W- ADHD world anyway because of that whole kind of, "Why can't you be more normal?"

    28. AP

      Mm.

    29. JM

      "And why do you keep screwing up in this very particular way?" So there's the shame piece. There's the dismissing. Um, and then also, there's the power dynamics, that if you're a young person in a business, you know, you and I run our own businesses, so we are lucky that we can, uh, adapt the businesses around our neurodiversity. But if you are a junior in a business, saying, "Would you mind adapting to me?" is a big ask. So there's loads of, loads of reasons it's tricky to come out.

    30. AP

      Mm. A, a question I'm asked quite a lot is, is, "What are some of the biggest myths that are surrounding ADHD, and how could that impact someone's comfortability in wanting to come out?" And I think it's, like, you know, some, a lot of people still think that only boys can have ADHD, that ADHD is only physical hyperactivity, and it's quite easy to debunk those. But one of the biggest hurdles I find with speaking to people in the community, the biggest barrier stopping them from comfortably disclosing to their family or to their boss, is that they don't think that person thinks ADHD is real.

  4. 8:09 – 9:40

    How to respond when someone says ‘ADHD isn’t real’

    1. AP

      What, what would you say to someone who, who didn't think ADHD was real?

    2. JM

      Wow. Uh, that's a, it's a really good question, and I think, um, there's lots of evidence that we've known about the construct for over 200 years. So there's books written, like, in the late 18th century, uh, describing ADHD, ADHD constructs. So we know that it's been around for a very long time. We know that treatments have existed that help since probably the '50s. Uh, we know that the diagnostic constructs across, uh, countries are valid, uh, so we have different diagnostic construct- constructs ac- across different countries. Um, and I suppose in a way, it's about slowly, society slowly coming to terms with this, because nobody was talking ADHD. I only trained to diagnose ADHD about 10 years ago, and I'm a mental health professional. We weren't talking about it. So we're kind of on the sort of journey that other people might be about, um, you know, sexuality, that kind of... This is a very normal way of being, but it does have an impact, and we need to talk about it. So I think it's sort of slow and steady and find your allies.

    3. AP

      Mm.

    4. JM

      And I think certainly someone like me, I'm a middle-aged woman, so, uh, explaining to other middle-aged people who p- maybe don't believe in neurodiversity is kind of an important bit of allyship for other generations.

    5. AP

      Mm.

    6. JM

      So yeah.

    7. AP

      85%, in fact, I think it might be closer to 90% now, 90% of people that listen to this podcast or watch it are women.

    8. JM

      Yep.

    9. AP

      I think that they watch it and they tune in because they have felt lost, forgotten, misunderstood for, for years and years and years, and they, they're, they're seeking answers.

  5. 9:40 – 12:43

    How can ’feeling different’ be detrimental to a person's mental health?

    1. AP

      What do you think it, the, the toll of feeling lost, forgotten, misunderstood, what does that do to someone's mental health over time?

    2. JM

      Um, it, it's very interesting, because what you're naming is actually one of the, the core features of ADHD. It's not in the diagnostic, uh, constructs. But, um, ADHD impacts executive function, and one of the first elements of executive function is self-awareness, so awareness of who you are in the world. And if you're not aware of who you are in the world, it's difficult to go through life, because it's like you're kind of going through life naked, going, "Am I wearing this outfit?"

    3. AP

      Mm.

    4. JM

      "Am I wearing that outfit? Um, who am I in the world?" And whilst there is a really enjoyable adaptability because you can adapt, um, there is also a vulnerability, because you don't have an exterior shell. So what I see amongst my ADHD coaching clients and the, the people who come to my courses is a, a delightful lack of narcissism associated very often with, a, a vulnerability, because there's a sense of, "Who am I in the world?" Um, and so yeah. I think the other thing, and, uh, you mentioned this in your book, um, with ADHD, there's an overactive default mode network, and we come to that later on, 'cause we've touched a bit on neurotransmitters. But we need to talk about networks, too. And the overactive default mode network means that we're very good at taking other people's points of view on-

    5. AP

      Mm

    6. JM

      ... and adapting to them. I call it pretzeling.

    7. AP

      [laughs]

    8. JM

      'Cause you twist yourself into the shape that's required of you.

    9. AP

      Yes, yeah, fascinating. That's a new, new way to look at it, but yeah, fascinating.

    10. JM

      'Cause you talked about that in your book too, that kind of piece.

    11. AP

      Yes, yeah. I mean, new imagery with the pretzel, yeah.

    12. JM

      The pretzel. And I know myself, one of the reasons I was really good at, at being a psychiatrist was that I could see that different clients needed different things. So I would pretzel to what they needed, but it didn't leave any space for me. And so, um, my coming out has been to begin to emerge into the world and unpretzel and go, "Actually, I am a bit of a, y- you know, a bit different to who I-"

    13. AP

      Mm.

    14. JM

      And so, so it has a massive impact, and again, that's why we come back to coming out. 'Cause when you come out, you can explore, does this really feel authentic or not?

    15. AP

      Yeah, no, so true. I think people with ADHD, we're the world's best actors.

    16. JM

      Mm.

    17. AP

      Like, if there was an Academy Award for playing a character called normal, we'd be on stage accepting it. We're, we're experts at, we're, we're chameleons. We're so good at, you know, copying, masking, mirroring other behaviors, essentially putting everyone else's needs ahead of yours- And the, the, the knock-on effects of what that does to your self-esteem, I think can be really detrimental.

    18. JM

      Yes.

    19. AP

      It's so interesting, the self-awareness piece you mentioned, 'cause I, I truly... I haven't spoken to 300 amazing people on this podcast, thousands of people in the community, I truly don't believe ADHD is a deficit of attention. I think when we find something that captivates us and is a true alignment with our core, we have an abundance of attention, like, there's no stopping us. I think ADHD is more along the lines of a deficit of, of a self-awareness because of what you've mentioned, all of those years of, of changing, adapting, switching up your interests to, to please someone else other than yourself.

  6. 12:43 – 17:05

    Is ADHD is a deficit of self awareness

    1. AP

      Do you think that ADHD could be more of a deficit of self-awareness? And what steps could someone take to flex that muscle of self-awareness?

    2. JM

      Oh, yeah, so self-awareness is so, so, so key. So, and I agree with what you're saying as well, Alex, about it's not a deficit of s- attention. We now think it should be called attention dysregulation.

    3. AP

      Mm.

    4. JM

      Because, as I say, it's tidal. When the tide is out, no, you cannot remember where your car keys are. Um-

    5. AP

      [laughs]

    6. JM

      ... and you know, I'm quite proud of myself, I've never lost the children.

    7. AP

      Mm.

    8. JM

      But I have lost more or less everything else.

    9. AP

      [laughs]

    10. JM

      Um, including, at some points, my mind. You know?

    11. AP

      Yeah. Gosh.

    12. JM

      I've lo- I've lost many things.

    13. AP

      Mm.

    14. JM

      But, um, so there's this deficit of attention, um, at times, and then other times, so I, I, I really love a bit of hyperfocus-

    15. AP

      Mm

    16. JM

      ... and I'm never happier than when reading academic articles and digging deep into the default mode network, et cetera. So there's this dys- dysregulation. But then when we shift, um, to think about the, as I say, the networks, the brain networks, definitely in terms of identity, in terms of who we are, um, there is at times a difficulty in holding onto a solid self-construct. And so part of what I'd suggest to people is, you know, uh, Leanne Maskell says journal. Journaling's been really, really helpful for, for, for me. Um, breathwork, so simply coming back into the body. Uh, really simple mindfulness techniques that you can use. So I have a who am I, where am I, what am I doing, how long have I got? So that very simple, using kind of Russell Barkley's-

    17. AP

      Mm

    18. JM

      ... uh, executive function network model, but just reminding yourself, who am I in the world? So I'm Judith. Where am I? I'm in the, in the, um, studio with Alex.

    19. AP

      Mm.

    20. JM

      What are we doing? We're doing a podcast.

    21. AP

      Yes, so true. I think it's often hard to distinguish between what you and who you really are and what is the mask, and I think it's so important to pay attention to your knee-jerk emotional reactions. And what I mean by that is, say you're reading a newspaper and you see an advert for a musical theater role, and you think, "That's amazing," and you fill up with genuine, intrinsic excitement for auditioning for that character. That's your knee-jerk reaction. But then you remember, "Oh, my parents wanted me to be a doctor," and you suppress that excitement, and you go and you go back to medical school. Some people's whole career, some people's whole marriage, their whole... So much of their existence can be a mask, and they don't realize it. And yeah, I think it's those, those knee-jerk reactions to, to things in our life that can be your inner child screaming out, trying to remind you of what you actually care about and what you want to do.

    22. JM

      Mm. I love that example, firstly, 'cause my parents wanted me to be a doctor, and indeed, I became a doctor.

    23. AP

      [laughs]

    24. JM

      Um, and secondly, because I think it really underpins this, one of the ADHD experiences, which is, um, difficulty distinguishing between imagination and reality.

    25. AP

      Mm.

    26. JM

      Or it, it, not... And that makes it sound like a deficit, which it isn't, but it's more like I s- I have shower thoughts. I get in the shower every morning, and it's like, it's like this beautiful fruit tree has just come into fruit, and there's all these ideas just falling off the tree. And I'm like, I need to capture all these fruits that are falling off the tree, and I've now realized that it's okay to let some of them fall on the ground.

    27. AP

      Mm.

    28. JM

      But it would be wonderful. I always thought I wanted to be, like, a singer in a cabaret club. I- in another life, maybe, but not right now. That it, that sometimes the fruit is allowed to fall to the ground because the joy of ADHD is there'll always be more fruit.

    29. AP

      Mm.

    30. JM

      Always. It's like a tree which is forever in fruit, when you're in, particularly when you're in flow and when you've slept well.

  7. 17:05 – 18:20

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    1. AP

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  8. 18:20 – 27:07

    What is "positive psychology" and why can this be particularly beneficial for a woman with ADHD?

    1. AP

      I've heard you talk about positive psychology.

    2. JM

      Yes.

    3. AP

      What is positive psychology, and what are the benefits to ADHD women?

    4. JM

      So positive psychology, um, it was a term that arose in the 1990s. Martin Seligman, who I think was president of the American Psychological Association, really interesting guy, uh, he wanted to, um, research flourishing and kind of mental wellbeing. So if you think about it, before that, every gym was like a hospital for the mind. So, you know, if you went along to, to see a doctor, it would be assumed that you had a deficit. Um, and he was going, "Maybe you would go and see a psychologist 'cause you had a strength."

    5. AP

      Mm.

    6. JM

      A bit like ... Yeah, so shifting from a kind of there's everything wrong with people to there might be things right with people. Um, lots of research in the positive psychology movement on flourishing, and he has come up with, um, work on strengths and values, um, the 20 universal strengths, and you can go ... I think it's called VIA, um, Strengths Finder online. You can do a free strengths questionnaire. And that was later used by colleagues Jane Sedgwick Muller and, um, some other colleagues to do a piece of research on ADHD strengths, showing that successful ADHDers, and this was looking particularly at people who were, who were flourishing, but identifying their strengths within that network. And it's all the things we were talking about. It's courage, transcendence, curiosity, um, empathy, thinking outside the box, um, putting other people before yourself. Um, loads and loads of really interesting strengths there. And I think you've mentioned self-awareness, and we're gonna keep coming back to it because self-awareness is key, because if you know who you are and you begin to know what your strengths are, then it helps you overcome the ADHD shame, and you can go, "Yes, I'm not the person to organize a big project over six months, but I am the person to come in and do some really high-intensity work at various different points."

    7. AP

      Mm.

    8. JM

      So really understanding your strengths is so key.

    9. AP

      Yeah. Being great in a, you know, calm in a crisis. Often, everyone's running around panicking, but you're, like, switched on in that. You know, that adrenaline that, that ma- makes you see the solution, and you go for it. I think it's so interesting when ... I think, sadly, a lot of people get a ADHD diagnosis, and they go into, all right, problem-solving mode. How can I be, how can I become a neurotypical? That's what I feel like-

    10. JM

      Mm

    11. AP

      ... I need to do. How can I fix myself? Um, and I think that energy is, is misplaced. I think it could be better placed in, okay, how can I figure out who I actually am and do very basic self-awareness exercises, like the knee-jerk reaction exercises, like asking very basic questions, um, to yourself? You know, what did I do today that made me happy? What did I do today that made me sad? What did I do today that I found easy? What did I do today that I struggled with?

    12. JM

      Yeah.

    13. AP

      Really basic questions, but you have to be honest, you know-

    14. JM

      Yeah

    15. AP

      ... with those answers, 'cause if sometimes the mask is so entrenched, you can actually dishonestly answer those, and then, then, there- therefore, it's not a, a useful exercise. But if you're honest with those very basic questions, you can build up an arsenal of self-awareness that will, I truly believe, m- enable you to make better choices and say yes to things that are a better alignment with your core. And when you do that, you're gonna stick at that relationship. You're gonna become the world's best person at that new hobby.

    16. JM

      Yeah.

    17. AP

      You're gonna be amazing in that job. You're not gonna abandon. You're not gonna quit. You're not gonna break up. Therefore, you're not gonna have ... The shame associated with a history of abandonment will be massively reduced.

    18. JM

      And I think what's really interesting about what you're saying there, you, first of all, you mentioned that calm in a crisis.

    19. AP

      Mm.

    20. JM

      And that is a classic ADHD strength because of this tidal nature, that we're really good under stress very often, and we can talk about that in a minute 'cause there's some ni- very nice science around that. But that noradrenaline surge gets us into a sweet spot where we just sort of suddenly ... And I remember as a doctor, you know, being in A&E, somebody comes in, they're very unwell, I actually used to enjoy that kind of hot, hot breath of death on your neck. You're like, "Oh, this has got me in my sweet spot."

    21. AP

      Mm.

    22. JM

      Super focused, super sharp, really performing. Um, really, hopefully, helping this person out at this point. So there's a definite ADHD strength there. But what it leads to is a tendency to lean into rushing and to lean into stress because we know it helps us focus.

    23. AP

      Mm.

    24. JM

      And so you end up with a pattern of leaning into this tidal, kind of, I'm gonna jump into that tide, I'm gonna surf into it because I know it's gonna get me where I want to go. But then it's how do you get out of that? And what you've just described is actually just slowing down. So slowing down for long enough to go, where am I? What did I do today? What worked? Just slowing down, because the tides are very strong, and we get drawn into things that we shouldn't do.

    25. AP

      Mm.

    26. JM

      And it's learning to recognize when you're in those tides and to raise a hand to say, "Can you help me here? I seem to be in one of my patterns, and I don't know how to get out, or I could do with you just pausing me a bit. So what did I enjoy today? What was difficult? What triggered me? What was ..." So real self-awareness is so important.

    27. AP

      Mm. Do you think it helps to also ... I suppose this comes as a re- consequence of working on your self-awareness. You begin to recognize what your ... And they'll be very individual to everyone, but what your personal early signs of burnout are.

    28. JM

      Totally. [laughs]

    29. AP

      [laughs]

    30. JM

      Yes. Yes. Um, 'cause burnout can be worn by some people as a kind of badge of pride.

  9. 27:07 – 29:13

    What does the term "Natural Psychiatrist" mean compared to simply "Psychiatrist"?

    1. AP

      You describe yourself as a, a natural psychiatrist.

    2. JM

      Yeah.

    3. AP

      What's the difference between a natural psychiatrist and a psychiatrist?

    4. JM

      So I made up the term the natural psychiatrist 'cause it's really a reflection of who I was, o- of a developing sense of self-awareness of what I brought to the party. 'Cause I was a successful psychiatrist, but was also really unhappy.

    5. AP

      Mm.

    6. JM

      And, um, couldn't work out why, but it was this identity piece. I didn't see myself. Um, I didn't see other doctors who were like me. I didn't really know who I was, and it was a real, yeah, that real self-awareness piece. But the natural psychiatrist sort of emerged from, um, an understanding that there are three ways to treat any mental illness. You can use medicines, and many of those w- work really well, and you can definitely use therapy, and therapies can be very effective, particularly when there's a good rapport between therapist and client. Um, so there's medication, therapy. Those are the kind of two of the legs of the stool. But the third leg of the stool, which is the most important, the one that keeps it standing up, is everything else. And by everything else, I mean everything from group-based outdoor exercise, to mindfulness, to cold water swimming, to changing what you eat, to giving up alcohol, to joining a choir. Everything else, and everything else is massively powerful. And that's what the natural psychiatrist does.

    7. AP

      Mm.

    8. JM

      It's teaching that, to say to people, "If I can teach you to amend your mental health, then you might never have to see me again. You might take the doctor with you." It's like that teach a man to fish, you feed him for life.

    9. AP

      Mm.

    10. JM

      You teach people to improve their mental health, they don't need to see a psychiatrist, and you won't be surpri- surprised to know, Alex, there are not enough psychiatrists to go around. There's probably, I've calculated, about one psychiatrist doing primary care mental health for every 12 and a half thousand people who need one. So there's just not enough psychiatrists to go around. So if I can teach people to improve their mental health-

    11. AP

      Mm

    12. JM

      ... then actually that's a massively helpful thing to do, and that's what the natural psychiatrist is.

    13. AP

      I read on your website, Judith, that you said education can be as powerful as medication for treating a- um, ADHD in adults. Um, and I guess that's what you're talking about, is kind of un- understanding what are the natural ways you can get out, move, listen to music, raise certain chemicals, uh, rather than

  10. 29:13 – 30:21

    3 tips to increase mood and focus

    1. AP

      medication. But what would you say is, like, the, the, I don't know, the top five or three tips, things people could do that would boost their mood and focus?

    2. JM

      But the top two, let's go with mindfulness. Mindfulness, really well evidence-based in, uh, ADHD. Unbelievably hard to do if you have ADHD.

    3. AP

      Mm.

    4. JM

      Because basically we're saying let's, you know, we're trying to calm the chatter of the mind. Um, and so we have to adapt our mindfulness offering so it's something really simple. Like, you could mindfully run. You can mindfully dance. You can mindfully listen to music. But that, um, checking in with yourself, that who am I, where am I, what am I doing, how long do I have, that checking in is a form of mindfulness. And then exercise, massively helpful for ADHD.

    5. AP

      Exercise has been such a game changer for me. I mean, I get out e- e- every morning. I walk my dog. I try and get a run in. I t- the trajectory of my day if I skip that run, uh, is, is significant, and, you know, if I can't get outside, if I'm just feeling a bit crappy or the weather's rubbish, I just do like 20 star jumps in, [laughs] in the mirror. And even that, you know, I keep it going throughout the day, and the trajectory of how that impacts my focus throughout the day is, is significant.

  11. 30:21 – 32:14

    How to improve ADHD traits in 4 weeks

    1. AP

      Super interesting, I read on your website, just following on from that, you said, "Our training improved stress mindset immediately with greater improvements at four weeks." How can you measure this, and what techniques do you use that could help in the ADHD community?

    2. JM

      So that's, um, a quote from a piece of work I did for a business-

    3. AP

      Mm

    4. JM

      ... on stress management. So this is just after the pandemic, and a business asked me to go in and help managers manage stress better. So we used something called SPARKS Tools from Stanford, um, and that's been developed by Dr. Alia Crum, who you may have heard of. She's on the Huberman podcast.

    5. AP

      Mm.

    6. JM

      She talks a lot about stress mindset. So we were, um, using the stress is enhancing model, so explaining that stress is actually the way our body prepares us to overcome a challenge. And so it's not bad. We shouldn't be trying to live a stress-free life. And so we used the SPARKS tools in the morning and in the afternoon of that course and saw an improvement in stress mindset across the day, and then four weeks later, we saw a greater improvement. And what was really useful for me about that work is it helped me to understand the noradrenaline piece, uh, for ADHDers and the way that we use stress as a way of finding focus. So in my experience, people with ADHD will often, um, cope with a slightly higher amount of stress and find that sweet spot, that mental clarity that you and I have both described, in quite stressful situations. So we have a slightly different response to stress.

    7. AP

      Mm. So interesting. I've always suspected that I'm sort of massively driven by stress, and w- listening to you describe that, I think confirms it. But I always question whether my stress is almost like coming from a natural place or if it's coming from an internal feeling of, of not being good enough, and I wonder if that is of higher density within the ADHD community, this intrinsic feeling of, of not being enough sometimes. Do we therefore have a

  12. 32:14 – 37:54

    How ADHD people deal with stress

    1. AP

      higher level of stress, and is the way we deal with that stress unique?

    2. JM

      So there's some interesting research that came out a couple of years ago looking at anxiety and ADHD, and that, um, we overcome the h- the lack of focus through our tendency to worry and our tendency to apply stress. So we're sort of turning up the stress dial, um, in a way that then m- makes us successful 'cause we find focus. Um, and so I think there's an interesting link there, and I suspect it's probably intrinsic. It's sort of how many of us are wired.

    3. AP

      Mm.

    4. JM

      And it... You know, you're very successful, Alex, so your stress has served you well. It may not be easy to live with.

    5. AP

      I'm also an alcoholic. [laughs]

    6. JM

      [laughs] Yes.

    7. AP

      I've, I've got that under control, but-

    8. JM

      But you're an alcoholic in recovery.

    9. AP

      Yes.

    10. JM

      So-

    11. AP

      Exactly, yeah

    12. JM

      ... and that requires courage. It requires resilience. It requires self-awareness, so that's not a small thing.

    13. AP

      Mm.

    14. JM

      That's successful, too.

    15. AP

      Yeah. No, true. Good way of reframing it. I've, I mean, it... Yeah, very mu- When I'm, when I find something, again, that has connected with my core, like this podcast, before it was social media, and it still very much is. And this, you could argue this podcast, well, it is built on social media, but when that got taken away from me, um, in my previous career, it triggered a big court case. Like, my obsession got stolen from me, and my knee jerk was alcohol. I think having that awareness... And that nearly killed me, you know? I went to hospital. And that's, I've t- told this story. So I think it's so important for... And it's als- Do you think it's quite risky territory when someone with ADHD kind of finds their thing, that thing that they're just going full steam towards, being really good at, but if they have that taken away, pulled away, and then they're sort of left in this void, directionless.

    16. JM

      Mm.

    17. AP

      Do you think that's a very vulnerable position for someone with ADHD to be in?

    18. JM

      It can be. It can be, I think. Yeah. I mean, and your story's really, you know, it's really compelling, and it's really inspiring as well because it's a story of losing so much and yet also finding the courage to recover, which is, is amazing, and that you've found your, you know, love again, which is podcasts, social media, and the, the interest, the, the interest in ADHD and sharing this for the benefit of other people, which is very altruistic. So it's, um, it's a really inspiring story, and I think one of the advantages of ADHD is there is a creativity 'cause I also lost my passion. I lost the thing that I was good at. I wasn't able to continue with psychiatry-

    19. AP

      Mm

    20. JM

      ... after a while. And we can talk about that bit more in a minute. But, um, and so I had a very strong sense that I was lost for a while, and actually, that wasn't a bad place to be. There's nothing wrong with being lost if it means that it's a chance to find yourself. If, if it's a, if it's a chance to, to, to reflect, to journal, to become more self-aware, to go, "Well, that was a screw-up. What am I gonna do differently now?"

    21. AP

      [laughs]

    22. JM

      [laughs] What did you learn from that screw-up, you know?

    23. AP

      Yeah. Trust your intuition massively for-

    24. JM

      Yeah

    25. AP

      ... I remember that day I signed that bit of paper. My intuition, which I now know is so strong with ADHD people, was screaming at me. I, I sensed that they were not on my side, but I didn't listen to it, and it, you know, nearly cost me my life through getting screwed over in business.

    26. JM

      Do you s- Talk about intuition screaming at you. My, my inner self sometimes has screamed at me, "Not that way.

    27. AP

      Mm.

    28. JM

      Not that way. Don't go there." And you do it, and then you're like, "Why did I do that?"

    29. AP

      Mm.

    30. JM

      But it's because, you know, logically it all looks good, but I think that there is often a very strong... You know, people talk about the sixth sense, and they talk about sensit- sensory sensitivities in neurodiversity. The ability to intuit others' mental states is a si- is a sixth sense, and it can be hypersensitive in us, those of us who are neurodivergent.

  13. 37:54 – 45:21

    ADHD in the workplace

    1. AP

      s- the ADHD, neurodivergent conditions, as well as the intuition, do you see it showing up in the workplace? I wanna talk about the positives, but, uh, at first, do you see, like... What struggles do you see it creating in the workplace?

    2. JM

      Well, I think when you're... when you have a neurodivergent colleague and they've got particular strengths, very often the workplace goes, "Oh, that's amazing. We'll give them all this particular sort of work to do." So I remember working with a, um, a partner in a firm who was incredibly good at certain very highly technical things, and so everybody's like, "Well, just give him all this highly technical stuff to do." But they also expected him to be good at everything else. And then I was thinking, but how can you expect this man to be a technical genius in this area, which requires immense, immense hyperfocus? Like, the cognitive effort that went into doing what he was doing was vast, and at the same time, people are saying, "Well, you need to run your own diary. You need to send your own emails. You need to do your own time sheets." It's like, you just don't get it, do you?

    3. AP

      [laughs]

    4. JM

      This is not how people's brains work. You don't get the genius. You don't get the kind of amazing hyperfocus, the ability to deliver all this stuff, and also the person who's gonna turn up on time with all their notes beautifully highlighted-

    5. AP

      Mm

    6. JM

      ... not having forgotten their own shoes. I mean, yeah, sorry.

    7. AP

      Yeah.

    8. JM

      Speaking personally. [laughs]

    9. AP

      [laughs] Uh, no, so, so interesting, and it's so true. Um, we have amazing s- positives, but you know, we also struggle with certain things, and I think it's a lot of the, the shame that comes with those struggles that can stop someone asking for help.

    10. JM

      Mm.

    11. AP

      Like, if someone's listening, and they are... they have ADHD or another neurodivergent condition, and they know that their anxiety, the bits that they struggle with, are stopping them from being able to do the job that they're being paid to do, they're able to do, but there's something, there's something in the work environment that's blocking them. How would you advise that person to ask for help? Like, how can they ask for help? Because when I speak in companies, the question I get a lot is, "I wanna ask for help, but I'm scared that it's gonna be met with stigma, bullying, discrimination," being worked out of the company, you know, in, in, in the worst-case scenario, and, and I've spoken to people who have taken that claims to court, and all that's another conversation. But in that moment where you need to ask for help-

    12. JM

      Mm-hmm

    13. AP

      ... but you don't know how to approach your boss or your line manager, like, how, how do you approach that? How do you even start that conversation?

    14. JM

      So i-i-it's a really good question because I also work with companies and often see them struggling with this, which is this sort of, "Oh, well, people just need to disclose, and then it will all be fine. You know, just say you've got ADHD." Not actually that helpful, A, because, um, it's a condition recognized under the Disability Discrimination Act, so you, y-you don't have to disclose the condition, um, and you may be stigmatized if you do. So I talk with people about the idea of saying, "I am the kind of person who..." So I'm the kind of person who really needs some quiet to, to give you my best work, and focus on the company's needs. Like, if you want the best out of me, it would be really helpful if we could look at some coaching at work, if we could look at a color-coded diary, if we could look at a quiet room to work in, if we could look at flexible working. So, um, a- and the difficulty with that, Alex, if I'm honest, is that, um, it puts a lot of emphasis on the individual to be self-aware enough and also to know what they can ask for, and that is a lot of emphasis on the individual. Unfortunately, though, because neurodiversity is diverse, every individual's needs are gonna be different.

    15. AP

      Mm.

    16. JM

      So we can't expect a company to go blanket everybody gets this. What we can expect a business is to say we have a universal design approach. You've heard of universal design?

    17. AP

      Mm.

    18. JM

      Yeah, so Nancy Doyle, um, talks... Professor Nancy Doyle talks a lot about this, and, um, the team at Birkbeck, who've done lots of work in neurodiversity at work, uh, talk about this. And it's basically designing an environment where anybody can ask for the adjustments they need. So if you're deaf, you can say, "It'd be really helpful if the, um, business is... you know, if we can link teams to my hearing aids." It's all the basic stuff.

    19. AP

      Mm.

    20. JM

      And it... Neurodiversity inclusion is, would be fit within that, but it requires the neurodivergent to be able to say, "What really helps me is flexible working," or, um, really explicit instructions. This is a big issue, is when companies are vague. Or, oh, God, my bugbear, somebody asks me to do something, and I, and they don't give me a deadline. It's like, it will not happen-

    21. AP

      Yes. [laughs]

    22. JM

      ... unless there is a deadline.

    23. AP

      Yeah.

    24. JM

      I need to know when, otherwise it's literally not gonna happen, unless it's something I'm really interested in doing, in which case I'm probably already doing it.

    25. AP

      Mm. Yeah. [laughs]

    26. JM

      So...

    27. AP

      It's so true. I think it is, like, everyone has different needs, so like you said, I hear people quite often on LinkedIn or something just, just put out quite blanket a list of adjustments that might be beneficial for some, but are quite sort of stereotypical. Like, y- well, we'll just normalize the use of fidget toys, and it's, you know, that might... I, I have one in my hand all the time. It helps me, but for many, it, they'll need different needs. So I think it's about creating a s- a, an environment of psychological safety, and you need to put signals out to make it clear that ... the environment is safe for someone to ask for help-

    28. JM

      Mm-hmm

    29. AP

      ... and it's not gonna be met with discrimination.

    30. JM

      Mm-hmm.

  14. 45:21 – 49:32

    What is "vicarious trauma" and how can that affect a person?

    1. AP

      What is vicarious trauma, and how can that affect someone?

    2. JM

      So vicarious trauma, it links to this idea, um... So I'll descri- I'll define it first, sorry. Um, vicarious trauma is essentially being traumatized by, um, traumatic material you're exposed to. It's not your traumatic material, it's other peoples. So an example might be, say, lawyers working in family law or in, um, in, um, a lawyer on a homicide case, they might be exposed to lots of traumatic material, traumatic, um, videos, traumatic depositions. Now, in my career as a psychiatrist, I'm a woman, as you recognize, and I saw an awful lot of women who'd experienced sexual assault, and I saw a lot of women who were very traumatized, and over the years listened to many, many stories of trauma. And I think, um, for neurodivergent people who can be very emotionally attuned, we've talked about that sixth sense, um, you begin to mirror other people's trauma responses. You begin to actually develop symptoms of trauma yourself. So, um, I ended up with things like nightmares of being murdered.

    3. AP

      Mm.

    4. JM

      Um, all sorts of unpleasant symptoms, um, which was to some extent that, that vicarious trauma.

    5. AP

      Do you think someone with ADHD, therefore, could potentially be more susceptible to experiencing this type of trauma? And w- I suppose where would that be coming from?

    6. JM

      So it's a really interesting question. I don't know that we have the evidence to support that, but theoretically we could argue that they could, because, um, of this default mode network piece-

    7. AP

      Mm

    8. JM

      ... where if you are using your default mode network to mirror, and we know the default mode network has many, many functions, one of which is to mirror other people's internal states. So you're mirroring and empathizing with others, and you're perhaps less aware of yourself and your own needs, which is something else we've talked about. So that kind of ability to empathize whilst you're so, the, the difficulty prioritizing your own needs, means that you can end up... I- in my experience, I see lots of people with ADHD who do this, who, who, who experience trauma. And I'm gonna say something a little bit controversial here as well, which is I see lots of people with ADHD becoming coaches. Now, this exactly mirrors my experience nearly 20 years ago. I went off and trained to be a coach. Actually, I needed coaching. But because I was so curious and I loved learning, I was like, "I know, I'll go and be a coach." So I went off and learned to be a coach, loved it, and then thought, as I went through the process thought, "Ah, I don't need to be a coach, I need to have coaching." And I think there can be difficulty sometimes distinguishing between meeting our own needs and meeting others' needs, and it takes practice to balance those. 'Cause you can do both.

    9. AP

      Mm.

    10. JM

      You can be a really good ADHD coach and meet your own needs, and probably through the process of learning to be a coach, you learn to meet your own needs. So it's a v- very fluid thing.

    11. AP

      Mm. Do you think that's related to the fact that the, the wellness industry and the, and the, sort of the, the self-help industry is in such a boom at the moment? What do you think that says about society, that there is this deep huge demand for finding inner peace?

    12. JM

      Mm. Yeah, it's really interesting, isn't it? Um, so wellbeing is massive. It's, you know, very valuable. We globally as a society are wealthier than we were. Although that wealth isn't very well distributed, we are wealthier. And if you're very wealthy, um, you're gonna be looking to maximize other things.

    13. AP

      Mm.

    14. JM

      And what are you gonna maximize? You want to maximize your health. You want to get the most joy out of life. 'Cause money doesn't bring you happiness. So once you've solved the money equation, it's like, "What do I do now? Ah, I turn to wellbeing." And it, you know, we're a less spiritual, less religious society than we used to be, so wellbeing is beginning to answer that, which is why you can get caught up. You know, there are some people in the wellbeing world, you know, selling quasi-religious experiences.

    15. AP

      Mm.

    16. JM

      Um, so it's, it's kind of the opium of the masses at the moment, is wellbeing. That's what I would say. It's, it's what we're all looking for is in this world where there- Things are difficult. Where do I find peace and contentment?

    17. AP

      Hmm, yes. Huge, isn't it? I think people with ADHD, again, that intuition can probably protect you in spotting the grifter, [laughs] or the, the, the person who might not be truly as righteous as they're portraying and, and selling something maybe for their own financial gain, rather than actually wanting to help the community.

    18. JM

      You hope so.

    19. AP

      Hope so. [laughs]

    20. JM

      I do hope so, yeah. Yeah, that would be nice to think, wouldn't it?

  15. 49:32 – 51:59

    Ned Hallowell Brain Health Advert

    1. AP

      Sorry to interrupt with an ad read. I know it can ignite rage, but a brief word from our sponsor. You'll hate slow talkers like I do, so I'll keep this snappy. If you've ever wanted the specialized support of a highly qualified, world-renowned, Harvard educated ADHD psychiatrist right there with you at all times, now's your chance. The one and only Dr. Ned Hallowell, ADHD specialist and bestselling author, has worked with some of the brightest minds in the ADHD world to develop an app that makes his knowledge on how to manage ADHD and stress accessible to all. Features include customized and tailored daily exercises to stimulate the cerebellum, and proven to help manage those trickier aspects of ADHD, four sessions of virtual ADHD individual coaching tailored to your needs, a self EMDR program, a cutting edge treatment for ADHD to help target that unwanted stress and anxiety with two personal coaching sessions. Lastly, if you've not officially been diagnosed yet, the app offers several reliable self-administered diagnostic assessments of ADHD that can help you see if you actually have ADHD. And the app includes daily coaching tips written by Dr. Ned Hallowell for how to best utilize each day on the program. All of this and more is just a thumb swipe away with the Hallowell Brain Health app. The app is available for the tablet or smartphone. 10% off if you use the link in the bio. Back to the episode. Just finally, Judith, this has been truly, truly fascinating. Um, or penultimately, what moves you the most when helping ADHD women and, and guiding them through their struggles?

    2. JM

      Um, seeing people validated. That moment where somebody goes, "Oh, it wasn't just me?" "Nope, it wasn't just you." Because the big fear when you go and see a psychiatrist is you're frightened that you're going mad, and actually the power of education is to say, "No, no, no, this is a normal response to a, a really difficult situation. You're not going mad. You're going sane. It's a really sane response to what's happening in your life." And I, you know, I'm always flattered when people... or when I was running my clinical practice, when people would cry because it's like, well, this is a good place to weep. This is a place to, to let go of that masking. So I think validation and people being heard and listened to and believed is hugely moving because very often they've experienced not being believed for a long, long time.

    3. AP

      Absolutely. Wow. You know, I think you've really just really so accurately summarized the, the experience of so many of our, of our listeners, so thank you so, so much.

    4. JM

      You're welcome.

  16. 51:59 – 54:09

    The ADHD item segment

    1. AP

      I wanna talk about your ADHD item finally, Judith.

    2. JM

      Oh, yes.

    3. AP

      Uh, it's been patiently waiting underneath that cloth for our [laughs] entire conversation.

    4. JM

      [laughs]

    5. AP

      I ask every, all, all my guests to, to bring in an item that most represents ADHD. It ends up on the shelves behind us, but for now, yours is underneath this cloth. I'm gonna reveal it before the explanation.

    6. JM

      Fabulous. Oh, he's fallen over.

    7. AP

      Oh, the dog. It's a puppy. Is it a puppy? It's a dog.

    8. JM

      He's a puppy. Um, yeah, he's a puppy. And, um, so he links to a metaphor that I use. So, um, I, I run various courses for ADHD, which use kind of an, an awareness and regulation coaching model, and one of the things we talk about is we talk about neurotransmitters, and we talk about that tidal nature of neurotransmissions. We also talk about networks. We haven't talked so much about networks today, but, but maybe another time, because the puppy is the default mode network. And so, the default mode network of the brain is the part of the brain that struggles to switch off with ADHD, and we only discovered it maybe 20, 25 years ago, so it's new and it's complex, scientifically complex. It does all sorts of things. Um, but the default mode network is the part of our brain that is curious. It, it wanders. It doesn't wanna stay on the path like the central executive network. Like a puppy, it wants to wander off the path, and it's looking for new ways of doing things, and it's playful, and it's creative, just like a puppy. And just like a puppy, it needs looking after. It needs exercise. It needs sleep. It needs rest, and it does not need to be beaten. And that's why I use the metaphor of the puppy and the path when we teach the networks of ADHD because when we understand our, our networks and we begin to get a, a feeling for what they might be and a feeling for what's going on, we know instinctively what that puppy needs. And that's my, that's my puppy.

    9. AP

      It's, it's so fascinating, and I'm gonna remember that [laughs] because I have a dog. I'm gonna... firstly, dog, D, default network, but my dog went off the path two days ago and came back covered in, um, horse poo. [laughs]

    10. JM

      [laughs]

    11. AP

      So I will very much remember that. I don't know how-

    12. JM

      That's great

    13. AP

      [laughs] Um, Judith, truly fascinating. Thank you so

  17. 54:09 – 59:01

    The ADHD agony aunt segment

    1. AP

      much. I wanna finally do the ADHD agony aunt section-

    2. JM

      Great

    3. AP

      ... which is called The Washing Machine of Woes, because my ADHD item is this washing machine.

    4. JM

      That's fabulous. Is it a toy?

    5. AP

      It is. I think it actually works. I think you... it, it's got the wi- it's got the plumbing if you actually wanna connect it to a s- water source. You can put in the detergent or whatever the, the powder in here.

    6. JM

      Oh.

    7. AP

      And they claimed it worked. I don't believe them. It doesn't look like it works. [laughs]

    8. JM

      Wow.

    9. AP

      It looks like it'll definitely leak.

    10. JM

      [laughs] Well, that reminds me of what I used to say about rumination, that rumination is like a washing machine. It's the same worry sock goes round and round and round.

    11. AP

      Right. Yeah.

    12. JM

      You know when you have a worry, it just keeps going round. So I love that-

    13. AP

      Yeah

    14. JM

      ... you're using it, the worry, the washing machine of woe.

    15. AP

      That is a really good connection, actually. My connection is a lot more basic than that, and that's only because I just always leave my clothes in the machine after every cycle.

    16. JM

      But no, I love it. Washing machine of woe.

    17. AP

      Yeah.

    18. JM

      It's great.

    19. AP

      Well, I'm using the Tiimo app now, which is the sponsor.

    20. JM

      Okay.

    21. AP

      And I'm getting better.

    22. JM

      Okay.

    23. AP

      How, how are you at your laundry re- memory, getting it out of the machine?

    24. JM

      Okay, so We have someone who helps us with our laundry [laughs]

    25. AP

      Okay. [laughs]

    26. JM

      Which is, I'm really embarrassed to say. But she said to me, the other day, she said, um, "Don't forget to bring the laundry in." What did I do? I forgot to bring the laundry in.

    27. AP

      Mm.

    28. JM

      So yeah, it's, uh, yeah, I'm not great at doing laundry, to be fair.

    29. AP

      Yeah.

    30. JM

      Shrunk things, lost things, forget things.

Episode duration: 59:02

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