No.1 ADHD Psychologist Shares 2 Proven Ways to STOP Overthinking + People Pleasing - Dr Mark Rackley

Dr. Mark Rackley 0:00 If people don't like you, that doesn't mean you're unlikable. The person gets a negative experience, then they personalize that, and they think, "Well, that means I'm unlikable." No, you just didn't click with that person.

Alex Partridge 0:09 Dr. Mark Rackley. A psychologist. Helping you cope with major mental health issues. What is the cost of repressed emotion?

Dr. Mark Rackley 0:17 It's terrible. That essentially will poison your body. But if repressed emotion is held in the brain, then the brain has to do something with that energy. What you'll find is it will come out in the physical symptoms. So the person might be struggling with, say, migraines or, uh, dermatological problems or a very common one is gut. They have emotion trapped in the body, which is actually causing problems.

Alex Partridge 0:38 Out of all the traits of ADHD, what do you think the three ones are that, if unmanaged, can cause the most problems?

Dr. Mark Rackley 0:45 So the emotional dysregulation, the... And

Alex Partridge 0:50 Is there a way us ADHDers, can we control our overthinking?

Dr. Mark Rackley 0:55 Yes.

Alex Partridge 0:55 [gentle music] This episode is dedicated to anyone who over-shares at parties, but then stays up all night worrying that everyone thought they were too much. I know you've probably heard this a million times on other podcasts, but following or subscribing really helps the show. And the more followers we get, the more likely it is that I'm able to book new, exciting, and insightful guests for the show. So, if you subscribe, I will continue to keep to my word and promise to never let this podcast be sponsored by

Alex Partridge 1:26 Huel. Dr. Mark, thank you so much for joining us.

Dr. Mark Rackley 1:29 Thank you for having me, Alex. It's an absolute pleasure.

Alex Partridge 1:33 Let's jump straight in. If a new patient were to come into your surgery-

Dr. Mark Rackley 1:37 Mm-hmm

Alex Partridge 1:38 ... where would you begin to start unpicking if they had ADHD, and what effect it might be having on their lives that they don't even know about?

Dr. Mark Rackley 1:47 Oh, it's a very big question. [laughs] To break it down, some of my patients would be coming in already with a diagnosis. So they've come through, um, either, uh, via a psychiatrist that specializes in ADHD, so I've already got the diagnosis in front of me. So I know exactly, um, what I'm working with. With others, um, when I get a new patient, I'll do a full assessment with them. So we go into their childhood history, we go into what's going on now, and we kind of draw, try and draw a picture of their life, but also to draw a picture of their, their life, their mental health life. And w- when, when you're talking to them in terms of what's happening now, you're lo- you're listening, okay, well, well, is there some depression here, some anxiety? But you're also listening as well to, is there anything developmental here that might be kind of underpinning what I'm seeing? So if I'm hearing a story of, um, difficulty at school, problems with, um, um, dealing with their lives, kind of constantly having kind of chaotic moments, um, challenges at home in relationships, or challenges with o- kind of organizing their life, then, um, I'm listening to that and I kind of... I think when you, when you work with ADHD, you kind of have spidey senses, I often call them-

Alex Partridge 3:11 Mm

Dr. Mark Rackley 3:11 ... where you're kind of like, "Oh, I think that might be something."

Alex Partridge 3:12 [laughs]

Dr. Mark Rackley 3:13 And you kind of just dig a bit deeper. And if it's a young person, I always have the parents or a parent in the room. So I'll often say to the parent, like, "Can you tell me a bit more about that?" And the parent... Like, the parent will tell you everything.

Alex Partridge 3:26 Mm.

Dr. Mark Rackley 3:27 Like, you'll get a whole load of history. And, and if you're still seeing similar patterns kind of running through the life of the, the person, and the pattern is still live by the time they come in to see me, Alex, then you're pretty kind of like sure, "Right, I think I know what this is." And then you'll gently present to the patient, um, "I think we might have undiagnosed ADHD here." But I'll only ever say that if I'm 95% sure that what I'm hearing and what the patient's life story is telling me is giving me those markers that this is, this is, this is a, this is a story that's running along

Dr. Mark Rackley 4:14 with their life.

Alex Partridge 4:15 One thing I've noticed with people with ADHD is that they can be filled with, they can be filled with shame.

Dr. Mark Rackley 4:21 Yeah.

Alex Partridge 4:21 And that quite often can stop them wanting to share their inadequacies with their parents or their peers. So what is the cost of repressed emotion?

Dr. Mark Rackley 4:34 Oh, it's terrible, is the simple answer to that. Repressed emotion, um, like, that essentially will poison your body because emotion is not meant to be repressed. It's meant to be processed. And by processing it, then it works through the brain, it works through the body. It doesn't get held in the body. But if repressed emotion is held in the brain, then the brain has to do something with that energy, so it compromises how the brain works. But then it has to go somewhere within the body. So what you'll find is it will come out in the physical symptoms. So the person might be struggling with, say, migraines or, uh, dermatological problems or a very common one is gut. It hits the gut. And it's, it's not got an organic source, so the person doesn't have a bug. They have emotion trapped in the body, which is actually causing problems. The tricky thing with shame, and shame is a very common emotion when you're com- like you said, when it comes to dealing with, uh, ADHD. Shame is, is awful because shame is all-encompassing, um, negative emotion. It's how the person sees themselves. So those chronic feelings of worthlessness, not feeling good enough, um, not feeling that they're, they're worthwhile. And, and unfortunately, like, shame, shame can lead to people feeling suicidal because, uh, they just get so hopeless. But also, if they're dealing with all that repressed emotion, then, um- The, the narrative in shame is, "I'm not worth listening to. Nobody's interested. I'll be judged. Um, I won't be treated kindly." And because you've got the rejection sensitivity anyway in ADHD, if you've got somebody who has shame with the rejection sensitivity, then it's a massive thing for them to then say, "Hey, I'm not doing so well here." So it's, for somebody with ADHD with shame, I know it's certainly for me, I, I, I tread really carefully with those patients. Really, really carefully. Because you don't want them to in any way be triggered or feel a sense of, "He's not listening to me." Yeah. So you've got to be real-

Alex Partridge 6:57 Mm

Dr. Mark Rackley 6:57 ... almost like you've got to hold them really gently and just reassure them, "You're safe here." Because of course, the, the, the, the primary feeling that they have, Alex, is, "This isn't safe." And so, like all of us, if something doesn't feel safe, then we, we back away to protect ourselves.

Alex Partridge 7:17 You mentioned RSD

Alex Partridge 7:19 there, rejection sensitivity.

Dr. Mark Rackley 7:20 Yeah.

Alex Partridge 7:20 What's happening in our brains when we experience RSD?

Dr. Mark Rackley 7:24 So RSD, a- again, in, in, in the, the A- ADHD sphere, um, it's a chronic sense of feeling different, and that the difference is negative. So therefore then, what you expect or your, your, your prediction is, "I'm going to be treated badly here. I, this, the, the person's going to reject me." So with RSD, the person wants to protect themselves from the rejection, so they overcompensate. And when they overcompensate, then that can go lots of different ways, where, um, they are very careful, uh, at what they say and what they do. Or they'll be the opposite, where they'll be, um, the Jack the Lad. They'll be the person to make everybody love them so that there's no, um, sense of them being rejected. But essentially what you have there is it's, and it's linked to the shame, is it's an, uh, an, an overactive sense of, "I'm different. The difference is negative, and I don't want to experience either shame or rejection from my, my peers or my family." So therefore, um, then it plays out then in those interpersonal relationships. Yeah.

Alex Partridge 8:45 I mean, I think-

Dr. Mark Rackley 8:45 Mm

Alex Partridge 8:45 ... it echoes a lot, a lot what I hear from my community, and that's that the reaction to shame, the reaction to rejection can be so intense, it actually stops them from leaving the house sometimes.

Dr. Mark Rackley 8:56 Yeah.

Alex Partridge 8:56 They're so scared of encountering a rejection, they don't put themselves forward for that promotion. Or even as extreme as they won't go to the shop in case they say something to someone, 'cause it can really throw them off course for the whole day. It's that visceral.

Dr. Mark Rackley 9:11 Yeah.

Alex Partridge 9:11 It's that intense.

Dr. Mark Rackley 9:12 Yeah.

Alex Partridge 9:12 Is there a difference between how men and women deal with feeling inadequate through the school years?

Dr. Mark Rackley 9:18 Yeah. There is, actually. That's a very good question. Um, so, and, and by the way, I, I'm generalizing here, so obviously, you know, there's variables and individual difference. So anything I'm about to say, if for the listeners, it's like, "That's not me," I totally get that that might not be your story. So I am kinda going on more the, what the research tells us on how we kinda understand kinda more general populations as opposed to individuals. Um, so yes. What you tend to see with, with, with, um, with boys is, um, the, the, the boys will be more externalized. So you'll see that in the behavioral problems. So boys tend to be a bit more disruptive. They can be the, uh, talk back more. They can, um, be more, um, difficult in terms of what they're saying and doing in the, in the, in, in the s- in the school. And for girls, you might see it more internalized, where you're not necessarily going to see the behavioral problems, uh, that you get with the boys. But the, the girl will internalize it more. So that might come out in, in, in anxiety, where they become quite anxious. But the anxiety is linked, is linked to their ADHD.

Alex Partridge 10:31 Mm.

Dr. Mark Rackley 10:31 But that's how it manifests itself, um, in, in, in, in a, in, in a symptom. So there are differences there, yes, in terms of, um, how girls and boys, um, deal with

Dr. Mark Rackley 10:44 school. Yeah.

Alex Partridge 10:45 The emotional dysregulation, how can that manifest itself in someone who's undiagnosed?

Dr. Mark Rackley 10:53 Yeah. So I had this conversation today, interesting, uh, in my clinic. Um, so think about emotional dys- be careful with the mic here. I, I use my hands a lot. [laughs]

Alex Partridge 11:03 [laughs]

Dr. Mark Rackley 11:04 Uh, so, um, your body will naturally sit in a place ca- it's called homeostasis. So homeostasis is where, um, it's a place where everything's just working perfectly. So your heartbeat's fine, your blood pressure's fine. Everything's just kinda sitting really, really nicely. And, and ideally what the brain wants to do is keep the body in a homeostatic state. So even with the emotional surges, it will always want to pull you back here, which is why we can't stay in an emotion state all the time. We'll always drop, 'cause the body will bring it back to that, the homeostatic state. So what you get in the emotional dysregulation with ADHD is it can go either way, and it, and it can, and it, and it can seem quite strange in terms of how that manifests itself. So for, for some of my patients with ADHD, it would be the big meltdowns. So massive overreactions. If you look at the context and how the person is then, uh, reacting emotionally, it, it, it's, it's completely, uh, larger than, than what you imagine it is. So, so that kind of re- dysregulation, which is a massive overreaction, the person's struggling to bring things back down. It can go the other way as well, where the person doesn't show that, that, that, that kind of outburst, where they internalize it. So with some of my patients, what they do is they disconnect. So they shut down. So you don't... They go very quiet, and they, they're not sh- they're not saying how they're feeling because, again, the dysregulation, how they feel safe in regulating the, the dysregulation is to just contain it all or repress it, like what you said. But what you also get with the emotional dysregulation, Alex, is, um, it goes not just negative but positive. So, um, it can be where if the person is enjoying themselves and it's super fun, then they take it to the next level. So when it goes to that and, and the person's having a really good time, th- they can emotion dysregulate in a positive way as well, which would be, that's the person that the party never stops. They're the last person to leave a night out. They want to keep the party going because they don't want the feeling to stop, and that's another form of, of emotion dysregulation, too. So there's no, there's no cutoff, and the cutoff only, only happens when the person sort of is, the night's over or they're wrecked-

Alex Partridge 13:26 Mm

Dr. Mark Rackley 13:26 ... and then it drops. So it goes both ways, actually. [laughs] Yeah. And it's interesting, when I'm li- I listen to my patients, they're like, they're, they don't often think that they're, they s- they can see that as a positive, that piece, of, "Well, I'm having a good time." But if we're kinda like, "Well, like, when would it end?" And of course, i- in the mind of an ADHD patient, it just doesn't end. It just keeps going. Yeah.

Alex Partridge 13:50 With the emotional dysregulation, I suppose having an awareness of oneself is the first step, but are there ways to manage your emot- emotional dysregulation?

Dr. Mark Rackley 13:59 Yes. So the, the, one of the key point, parts that, i- is, is, yeah, the understanding, but also understanding the environments that maybe trigger you. So I know certainly for lots of my adolescent patients, we do huge amounts of work around school, and even down to the specifics of teachers. So some teachers are wonderful, and some teachers are the, the pe- the petrol on the flames. They're, they're, the- there's a personality clash. So learning the triggers, learning the w- the, the areas where you're more likely to, to dysregulate, but also big parts of the work I do at the moment is listening to themselves. So noticing the changes. Now, obviously, it can happen quite rapidly, but noticing the changes if they're starting to dysregulate. So that's being aware of their heartbeat, being aware of their breathing. If they're noticing they're losing focus quite quickly, or they're becoming kinda heated, then it's listening to the physiological signs to show, actually, something's happening here. So using their body as a cue to help them identify what's happening. And then we, then w- w- once we, um, kind of do all that work, then we look at, okay, what do we do to intervene? And certainly with my young people in school, that might be where, again, we, we, we put all these things in place, where the young person, they get five minutes out of the room, they breathe, they calm down. Some of my patients, we have them, they're allowed to wear their headphones. So they go out, piece of music on that we know works, gets them, gets them calm again, and then they go back in.

Alex Partridge 15:26 What do you think the most common triggers are for emotional dysregulation?

Dr. Mark Rackley 15:31 Um, [sighs] I suppose anecdotally, Alex, um, I think a lot of, a lot of the triggers are interpersonal. So with the rejection sensitivity, um, and again, I'm generalizing here, because you have to generalize with ADHD. And again, caveats, peop- this doesn't land with people. But a real kind of sen- sensitivity to injustice and wrongdoing and being on the receiving end of wrongdoing-

Alex Partridge 16:01 Mm

Dr. Mark Rackley 16:01 ... that, that can be a huge trigger point for people. I think the other piece as well is, um, not being listened to, so f- feeling like this person isn't listening to me, and then that, that feeling of I'm being, um, I'm being treated differently or being treated badly. And suppose the other thing as well is if there's any, um, it's heartbreaking, but if there's any kind of bullying that's happening in school, or there's any kind of bullying that's happening in, uh, say, the workplace, then, of course, they're massive triggers as well.

Dr. Mark Rackley 16:34 Yeah.

Alex Partridge 16:35 A girl with undiagnosed ADHD, what might her struggles be in pre-pubescence versus adolescence and then young adulthood?

Dr. Mark Rackley 16:45 So with an adolescent brain, adolescent brain is a brain in development, regardless of whether it has ADHD or not. Um, it's, it's maturing, and it's growing. Now, what we know about an ADHD brain is it matures at the same rate as any other brain. However, part of the brain that's responsible for executive functioning, your prefrontal cortex, develops slower. And we're looking roughly at a three-year gap in terms of the development of the prefrontal cortex, which of course is why people with ADHD can struggle with executive functioning and management, uh, during the teenagers. So, so some of the struggles that you might see with a, a girl in spec- in, in particular, she may struggle with the, the, the thing like disorganization. Um, she may struggle with, um, being able to plan and manage her life. She might also struggle with interpersonal relationships because, again, if you've got the rejection sensitivity, at that stage of life, um, you're moving from kinda childhood to adulthood, so you're creating your own independent, um, identity, and the family become less important. Your friends become way more important. So there can be a lot of issues around the friendship groups and integrating into the friendship groups, feeling wanted, sort of, and feeling accepted, uh, by the friendship group. [lips smack] So you c- you can see that, that, that, that, those kind of issues. Now, you wouldn't necessarily see it as an adult patient because, of course, an adult patient has now, they've got an adult brain, and also we tend to care le- not everybody, but- We can tend to care less about popularity [laughs] when we're kind of adults. But when you're a teenager, it's massive. It's absolutely massive. And also, it's, it's just, it's being accepted. That's a massive thing. And that's, by the way, that's a non-ADHD and an ADHD thing. It's just the, the, the, the group becomes all-important, and being accepted by the group is vital. What you can also sometimes see with girls as well is, um, they can sometimes struggle with perfectionism, so it's the compensating for the, um, the struggles ADHD can cause. So you can see kind of fear of failure. They become very, um, obsessed about, um, doing the academics perfectly. But also, that can create identity issues, too, where it can lead to body image issues if they feel that, um, their body isn't the way that, um, other people, uh, think it should be. But again, you don't tend to see that so much. I mean, you can do, but certainly, uh, in a, a more adult females, um, you tend to see less of the interpersonal problems and maybe more to do with, um, managing their professions-

Alex Partridge 19:36 Mm

Dr. Mark Rackley 19:36 ... managing the stress of their jobs, managing the stress of life, uh, dating, all that kind of stuff. So, so different challenges, but still you'll see the ADHD at

Dr. Mark Rackley 19:46 play there.

Alex Partridge 19:47 And if we looked at boys-

Dr. Mark Rackley 19:48 Yeah

Alex Partridge 19:48 ... are there any differences in that transitional period?

Dr. Mark Rackley 19:52 Yeah, there are. So with boys, uh, again, because the group becomes hugely important, boys can do terrible things to try [laughs] and get the group to like them. So again, that more of a kind of behavioral stuff that, that, that they might be doing things that you really shouldn't be doing or, or, um, their, their ability to, to, to think consequentially is a problem. So you, you can see a lot of behavioral difficulties with boys. Um, what you can also see with, uh, with boys as well is, again, they can get very competitive. So they can become quite fixated on, if they're in team sports, being the best because, again, they don't want to experience any kind of rejection or feeling different. And, um, you can see the opposite with boys as well, where, um, it's very sad. They can actually develop other disorders. Girls can, too. But, um, they can have things like depression as teenagers, um, because they're just hugely struggling with coping with their life. Um, or they can have very bad anxiety because they struggle with academic performance, uh, family expectation, and, uh, managing their life, especially if they're in a, a high-performing school.

Dr. Mark Rackley 21:06 Yeah.

Alex Partridge 21:07 Do you think it's beneficial for somebody who is displaying ADHD characteristics to get a diagnosis of ADHD?

Dr. Mark Rackley 21:13 Definitely. I can't say that strongly enough. Yeah. I understand it's personal, and I understand there's loads of things around getting this done because the waiting lists are horrendous. I get that. In CAMHS, and the waiting lists privately are horrendous, too. But how I, how I see it, Alex, is, um, it gives you a framework to understand what's happening to this person, and that framework is hugely helpful in terms of just the understanding that it brings with it, that this, your brain is wired differently. This is why we're seeing your life happen like this. This is why these... So it gives us the causality. And I think that that's hugely important because without that, then the person can really feel misunderstood, and they can feel, "Well, what's wrong with me?" But when we explain, "Listen, like, you've got a n-", and I don't sometimes don't even use the diagnosis of ADHD when I'm talking to my patients. Uh, and I think in the future, we won't. I think, you know, psychology, psychiatry, it's constantly evolving. We're constantly understanding and learning. So, you know, things that we talked about years ago, we don't talk about anymore because they're redundant. And I think in the future, that's the road we're going down. So I just label it as neurodiversity.

Alex Partridge 22:27 Mm.

Dr. Mark Rackley 22:28 And I think even in the future, we won't even use that word. So neurodiversity, and your brain's a bit different, and it's wired a bit different. And because you have a different brain, these are the things that we know can happen in your brain because of the, the, the way it's wired. And so it just normalizes it, but it also, it allows the person to understand and hopefully start on that road to acceptance of, "Oh, yeah, this is okay." And it, it just brings down, what you hope anyway, is it brings down that sense of, "Well, I'm, I'm different," but that, that, but them thinking that that difference is, is a negative.

Alex Partridge 23:06 Aside from acceptance, you must see a range of emotions and reactions after someone gets a diagnosis later in life.

Dr. Mark Rackley 23:13 Yeah.

Alex Partridge 23:13 What are some of the reactions that you see?

Dr. Mark Rackley 23:16 The main one's anger. [laughs]

Dr. Mark Rackley 23:18 Yeah, I see a lot of anger. [laughs] Uh, yeah, so anger is a massive one. And, and it's understandable because, like, uh, this might be a patient who's like, they've gone through uni, and they've had a battle through uni. They've battled to get into their career. They're still battling. Like, things are still problematic. And, um, and when you do the history, like, the thing about ADHD is it doesn't just appear at some random point in your life. Like, from what we know about it, you're, you're born with it. Like, this is with you from the get-go. And the anger is justified because it's, it's, it's, "Well, why, why did nobody pick this up?" And, and, and the, the, the patient in question may have seen the school nurses, been in front of the GP multiple times. There might have even been child psychologists or whatever involved, and, and it wasn't diagnosed [laughs] or it wasn't picked up. And so when you kind of... And I have, I'm always very gentle when I say this 'cause I, I, I know kind of how it goes down. Like, uh- I think there might be some ADHD here, and I say why. And, um, then we send them off for assessment, and then the assessment comes back, yeah. Then we start the whole treatment plan for them. And it's anger. It's anger, yeah. Because, um, and sadness as well, that, well, it could've been different for me, or I could've had less of a challenging life. Um, so in, in, in some cases w- when, when, when you're dealing with an adult patient who's diagnosed later in life, you, you have to help them process all the anger, and you have to also help them process all that sadness because, um, lots of their memories, their core memories are at those stages in their life when, in an ideal world, they'd be full of happy memories that you can reflect on. They're really negative. And if we look back, it's, it's, it's, it's ADHD. Yeah.

Alex Partridge 25:31 A lot of sadness and anger-

Dr. Mark Rackley 25:32 Mm

Alex Partridge 25:32 ... looking back at the life that could've been.

Dr. Mark Rackley 25:34 Yeah.

Alex Partridge 25:35 Really, the life that should've been-

Dr. Mark Rackley 25:36 Yeah

Alex Partridge 25:36 ... if they had just known sooner. You know, perhaps-

Dr. Mark Rackley 25:38 Yeah

Alex Partridge 25:38 ... that relationship would've lasted. Perhaps they wouldn't have left that job.

Dr. Mark Rackley 25:41 I wouldn't have got fired. Yeah. Oh, totally. Ah.

Alex Partridge 25:43 Maybe they wouldn't-

Dr. Mark Rackley 25:44 Mm

Alex Partridge 25:44 ... go into that relationship-

Dr. Mark Rackley 25:45 Yeah

Alex Partridge 25:45 ... if they had just known.

Dr. Mark Rackley 25:46 Absolutely. Yeah, yeah.

Dr. Mark Rackley 25:47 Yeah.

Alex Partridge 25:48 Do you think there's an evolutionary advantage as to why us ADHDers overthink?

Dr. Mark Rackley 25:54 Oh, um [sighs] yes and no. So a- overthinking is... You gotta be careful about overthinking, 'cause you gotta use it wisely. [laughs] So we're overthinking. Y- if you overthink about everything, then essentially that's a precursor to anxiety, so, and, and possibly excessive worry and panic, so you gotta be careful with that. Um, but where I think the overthinking can be a positive, Alex, is that it can help you to see the world differently or think through different scenarios or, um, w- work with a problem in a more holistic way. And I think that's where it can be a huge advantage, 'cause again, without sounding too generalist, but, like, lots of my, like, ADAD patients, their, their creative mind is insane. Like, the stuff they talk to me about or the, the, the, the, the things that they're thinking about doing, like, it's amazing because it's a whole different way of seeing the world. And so I think certainly in terms of, like, just creating different things or, um, art or culture and all of these things, even in business and working with people, then absolutely, yeah.

Alex Partridge 27:12 Mm-hmm.

Dr. Mark Rackley 27:12 But I often say to my ADHD, like, with any of these kind of superpowers that you have, like, you got, you gotta, you gotta use them wisely, 'cause if [laughs] you don't, they can, they

Dr. Mark Rackley 27:22 can bite you. Yeah.

Alex Partridge 27:23 This is interesting. Do you think there's a benefit to overthinking that no longer exists in the modern world, and actually that might suggest that overthinking is actually just the hangover of human nature?

Dr. Mark Rackley 27:36 Yeah. We tend to associate overthinking with, um... So, 'cause obviously we're born with the ability to think, and, um, overthinking is a way for us to really ana- analyze something or so- when something important. So it, it is a, it is a huge gift. But I think where, where we're at, we're overthinking now is unfortunately, um, we're overthinking about the wrong things. Like, people are overthinking about, um, why hasn't that person texted me back, and, um, why aren't my followers on social media growing, and why hasn't that person, uh, why have they left me on read? So it's all of that stuff, and that's just not healthy. It really isn't healthy because that doesn't kind of bring humanity along.

Alex Partridge 28:27 Mm.

Dr. Mark Rackley 28:27 It just generates anxiety. So I think there's a, a big part to that which is influenced by where we're at currently in life, but also I think, um, like, technology and just the way we relate to the world is very different now, which is not healthy for overthinking. Yeah.

Alex Partridge 28:45 Is there a way us ADHDers, can we control our overthinking?

Dr. Mark Rackley 28:50 Yes. Co- probably not control, but manage. Yeah. So I always say to my patients, "Right. If you're overthinking, then look at the context in terms of what am I overthinking about?" So is this about a scenario where I am being influenced by my sen- my rejection sensitivity? So where they're replaying a scenario where there's been a party or a social interaction, and now in the aftermath, they're replaying it and replaying it and replaying it. But what they're doing there is they're just adding stories that don't exist, which of course inevitably generates the anxiety and the worry. So I always try and help my patients get the context. Like, l- l- look at the story of what's in the overthinking, and if it's something where you're predicting or you're overanalyzing without evidence, so we don't have any evidence to suggest, listen, this needs extra thought, then we do a piece of containment. And the piece of containment is, right, I know what I'm doing. I know this is gonna bring me down a rabbit hole if I stay with this, so I'm gonna use a distraction technique. And that's the beauty of ADHD, because it naturally aligns itself to distraction. It's like, oh, look over here. And so we use a distraction technique which we know will reengage the brain and will pull it away from the overthinking. So that's where it's a real gift with people with ADHD, is it's easy to distract the brain away. [laughs]

Alex Partridge 30:24 It's the classic story of the ADHD community. You go to a party, you overshare, and then you come back, and you almost can't sleep-

Dr. Mark Rackley 30:30 Yeah. Oh, why did you... Yeah

Alex Partridge 30:31 ... because you've, you're worried everyone thought you were too much. But then-

Dr. Mark Rackley 30:34 Yeah

Alex Partridge 30:34 ... you look at the evidence, and no one's texted you-

Dr. Mark Rackley 30:36 Exactly

Alex Partridge 30:36 ... saying, "Why did you say that? You were outrageous last night." There's no evidence to back up the, the thought of being too much. Super interesting. Onto sleep a tiny

Alex Partridge 30:47 bit. Um, when I'm trying to get to sleep, my brain feels like it suddenly needs to switch on.

Dr. Mark Rackley 30:53 Mm.

Alex Partridge 30:53 And I overthink like crazy.

Dr. Mark Rackley 30:55 Mm-hmm.

Alex Partridge 30:55 Do you have three tips that might help that brain unwind?

Dr. Mark Rackley 30:59 Yeah. So first of all, with ADHD, especially if you know that that's... Uh, and again, I wanna, I wanna just kinda normalize that. So it's not a gi- a given if you have ADHD you're gonna have problems with your sleep. Like, lots of people with ADHD sleep perfectly. Uh, it's just certain types of people will, um, the, the lack of stimulation at nighttime, the quiet space, uh, unfortunately the brain can wake up in that space looking for stimulation. So but that's not everybody, but that's obviously what we, what you, my struggle with, Alex. Um, and so if you know that, then it's really important to prepare that that is a time in the evening where you might struggle with trying to wind down. So three things I would recommend is, um, in the kind of hour before sleep, that you really try and create an environment where it's calm and you get off your devices. Yeah. So nothing that is going to remotely stimulate the brain. So you take all that away, and you create a calm space. In your bedroom, then your bedroom should be a place where it's an environment where it relaxes you, and it's not chaotic. So that being, uh, that the light is right, that you, your bed is comfortable, that you're looking forward to getting into your bed because that's a place of comfort. But also it's a, it's a, um, it's, it's a place that, uh, you want to spend time in. And the third one, uh, would be white noise. So white noise doesn't stimulate the brain. It does the opposite. It relaxes it. So it's any particular kind of white noise, like it could be static, crashing waves, um, wind through the trees. That you're creating n- noise in the environment. And where that c- can really benefit people with ADHD is the brain will obviously listen to the noise, but it won't stimulate the brain. But it gives the brain distraction, and that can help it sleep.

Alex Partridge 33:04 Oxytocin, that's the chemical that we release when we experience human connection?

Dr. Mark Rackley 33:10 Yes.

Alex Partridge 33:11 Does that help with sleep?

Dr. Mark Rackley 33:13 Hmm. I don't know is the answer to that, 'cause the main one with sleep is melatonin, which is your sleep hormone. It would help, I suppose, in terms of... 'Cause oxytocin, um, it's, it's the bonding chemical. So it makes like some- if we need a hug, and somebody gives us a hug, it's like, oh, that feels nice. So it does, it does relax the nervous system, and it does make us, make us calm down. So yeah, I would think on just on a scientific level, in terms of its effect in the body, that, um, if you had a, a dump of oxytocin in the evening, be it a, a, a somebody you're cuddling in bed or even they've done studies on oxytocin where, um, if you spend 20 minutes stroking a dog, then it increases the oxytocin levels in the human and the dog. So, um, so I'm not recommending pets in bedrooms or whatever. But i- if it helps, then absolutely, yeah. Yeah. I'm a big believer in kind of being creative with these things. Like, you know, it's never one size fits all, and if you can get something that works for one particular patient, then great. Yeah.

Alex Partridge 34:32 What do you think are the biggest mistakes people are making in the lead up to bed?

Dr. Mark Rackley 34:37 Devices. Getting off the devices, yeah.

Alex Partridge 34:41 Social media use?

Dr. Mark Rackley 34:42 Totally, totally, totally. Because that's what they're designed to do. They're designed to keep you on, and they're designed to keep you engaged. And so, um, and especially for people with ADHD, where the brain is constantly craving stimulation, it's looking for different interesting things, then it's one of the worst things, Alex, to kinda help the brain to wind down. So I think the biggest one is devices. Yeah, for sure. Like, and so like certainly w- w- with some of my patients we're literally like the devices are not to be in the bedroom. They cannot be... They can't even be in the room, let alone arm's reach, because it's too tempting. But also what some people can do is they, they, if they're struggling to sleep, they think, "Oh, they'll pick up the phone." That's the worst thing you can do literally, 'cause that's not gonna relax you. It's gonna wake your brain up. [laughs] So I would think at this stage, definitely devices. Yeah.

Alex Partridge 35:36 I've spoken to people in the community, and they say sometimes they're quite tired. They go to bed, and as soon as their, their head hits the pillow-

Dr. Mark Rackley 35:42 Mm

Alex Partridge 35:42 ... it gets filled with intrusive thoughts.

Dr. Mark Rackley 35:44 Yeah.

Alex Partridge 35:44 And it's those that keep them awake.

Dr. Mark Rackley 35:46 Yeah.

Alex Partridge 35:47 What advice would you have for

Alex Partridge 35:48 that type of person?

Dr. Mark Rackley 35:49 So intrusive thoughts are a normal thing. So we can't control intrusive thoughts 'cause they come from your unconscious mind. And so, um, we can't stop those. So first thing is accepting that they're, they're, they're just a natural part of it is to, to, to be conscious. Um, but what can help with intrusive thoughts is mindfulness. So intrusive thoughts are exactly that. They, they intrude. They come in, but they move. But where we can get stuck on intrusive thoughts, we pay attention to them. And when we pay attention to an intrusive thought, then the brain has no choice but to focus on it 'cause it thinks, "Oh, this is important." And if we focus too much on intrusive thought, then the intrusive thought, instead of moving along and the person's like, "There's nothing to see here. Let the next thought come along," the brain then, uh, starts to attend to the intrusive thought. And if we start building other thoughts and feelings around the intrusive thought, then it, it, it empowers it, and it wakes the brain up. So first of all, there's understanding intrusive thoughts, understanding how they work, and then mindfulness is great for that 'cause mindfulness teaches you just to let your thoughts pass and to not give them attention, to not, to not, uh, uh, focus in on them, but to literally see them as thought proc- as just brain processes. So the brain isn't always generating thoughts because you need to think about this. It's just doing what it does

Alex Partridge 37:19 Hmm. What are the most common types of intrusive thoughts?

Dr. Mark Rackley 37:25 Um, [sighs] I suppose the, the ones, I suppose, that I tend to deal with in m- my clinic, um, would be more the serious side of intrusive thoughts, I suppose, around suicide, um, self-harming, um, hurting yourself. So those kinds of intrusive thoughts would be the ones I suppose that I... They're the, probably the most serious, but they're the ones that I suppose can cause people real distress, 'cause obviously they're not very nice things to be thinking of. But you can literally have intrusive thoughts about anything, yeah. So we can have intrusive thoughts about our friends, our family, our boss, so they can be any number of things, yeah.

Alex Partridge 38:09 And aside from essentially acknowledging them and de-powering them-

Dr. Mark Rackley 38:14 Mm-hmm

Alex Partridge 38:14 ... is there anything else someone could do to combat or manage intrusive thoughts?

Dr. Mark Rackley 38:19 Get professional help if you need it. Like, if you're really struggling with them in terms of if they're becoming too frequent, if they're distressing you, then it might be a good idea to get some professional help with managing those intrusive thoughts. But I suppose the thing with an, an intrusive thought is what you don't want to take is a passive approach. 'Cause if you take a passive approach, then like I was saying a minute ago, it's not necessarily gonna move that through your mind. You need to do something active. So whether that be you, you talk to somebody else then and that person knows about your intrusive thoughts and just help you to, um, think about something else, or you do some mindfulness, or you use some distraction. But what's very important with intrusive thoughts is that just because we think something doesn't mean it's real. You know, where we can get into trouble with intrusive thoughts if we can start to believe that could happen, and then that can become a real problem.

Alex Partridge 39:18 What's an example of one that you think could happen?

Dr. Mark Rackley 39:21 The most serious ones where, um, if I'm treating a patient and the intrusive thought is, um, oh, I could be, um, I could throw myself in front of a, the, a train. Terrible thought. That's frightening to think like that, and it's scary to think like that, but that doesn't mean that the patient is going to throw themselves in front of a train or they'd even want to do that. But because that intrusive thought lands in the conscious mind, then that can cause real distress for that person if they're not able to manage

Dr. Mark Rackley 39:57 it. Yeah.

Alex Partridge 39:58 I wanna do the Washing machine of woes.

Dr. Mark Rackley 40:00 [laughs] Great name.

Alex Partridge 40:05 Every week, I ask my Instagram community to share their ADHD woes with me, and I put it in a washing machine because-

Dr. Mark Rackley 40:10 Fantastic

Alex Partridge 40:11 ... to me, the washing machine represents my biggest worry, which is memory loss. I always forget my laundry-

Dr. Mark Rackley 40:15 Right

Alex Partridge 40:15 ... in the machine. [laughs]

Dr. Mark Rackley 40:16 [laughs]

Alex Partridge 40:16 I'll say this every episode. It will stick. Do you forget your laundry in the machine ever?

Dr. Mark Rackley 40:20 [laughs] I, oh, I have done many times.

Alex Partridge 40:22 Yeah.

Dr. Mark Rackley 40:22 Many times.

Alex Partridge 40:23 Good.

Dr. Mark Rackley 40:23 Yeah, yeah, yeah.

Alex Partridge 40:23 Very reassuring to many people listening, I'm sure.

Dr. Mark Rackley 40:26 [laughs]

Alex Partridge 40:26 Right. This week in the washing machine, [clears throat] I would like this to be read out anonymously.

Dr. Mark Rackley 40:32 Okay.

Alex Partridge 40:32 "I'm 17 years old, and I'm gay, but I can't come out because I'm so terrified of what my friends and family might think. I suffer from severe RSD, and even though I'm sure they will accept me, I'm terrified of them not accepting me. What can I do?"

Dr. Mark Rackley 40:47 Oh. Okay. I think this person's already in a really positive place because it sounds like they've already accepted their sexuality with the fact that they're actually, they're recognizing that they're gay. This, a big part of if this person can, can, can hold this, unfortunately, what RSD does is it fills your mind with negative consequences and negative outcomes, and it gets stuck in the details. It's all about what could go wrong and what, um, what would be negative outcomes for, for you. But it doesn't look at the bigger concepts that are at play as well. So what I would encourage this young person to do is think about, do they trust their family? Is there a high degree of trust within this family? Is there a high degree of love and kindness and respect within this family? And if the answer to those is yes, then that's safe. That's a safe space. What RSD will convince you of is this isn't safe. But just because it feels like it's not safe, that doesn't mean that it isn't safe, because what we're not focusing on is all the other evidence to tell us otherwise. So I would just think about the bigger picture of your family, and if there's enough there to you think, "Yes, this is all, all good," then maybe identify one person in the family. Like, I often think with these things, like it's never one size fits all. Like, if there's one person in the family that you think, "You know what? I think they're the safest person in the family to kinda just g- get the words out and to, to get somebody to support me," then identify that one person and then decide what you want to do next. So if you wanna tell everybody, go for it. But have that person working alongside you so that you don't feel so alone in doing it as well.

Alex Partridge 42:58 Amazing advice. Thank you so much on behalf of the person who-

Dr. Mark Rackley 43:01 I just made it up [laughs]

Alex Partridge 43:04 [laughs] Really useful. So thank you very much.

Dr. Mark Rackley 43:06 Pleasure.

Alex Partridge 43:07 We touched on perfectionism earlier. I wanted

Alex Partridge 43:09 to explore that a tad more. Um, a lot of us with ADHD, we are perfectionists, so much to the point that we don't even try to execute the idea out of fear that it might go wrong.

Dr. Mark Rackley 43:21 Yeah.

Alex Partridge 43:21 Why do you think that is?

Dr. Mark Rackley 43:23 Fear of failure. Yeah. It's fear of failure. So fear of failure is a very real thing in terms of, if you think j- just, the, the problem with fear, we were talking about this earlier when we were talking about inside out. So, um, we were talking about inside out earlier. Uh, that fear is one of the emotions that's hardwired. We're born with fear 'cause it's essential for survival. And but the problem with fear is it's very sensitive to being triggered. So it's triggered when we're in actual life-and-death situations because we need to take action to protect ourselves. But it can also get triggered when it's not life and death, there's no active threats, there's nothing awful happening, but we trigger it because of fear of consequence and fe- and wanting to avoid those consequences. So when fear gets triggered, we get three responses, which is fight, flight, or freeze. And with fear of failure, what you get is flight. So you get avoidance. And the avoidance is because the person doesn't want to potentially experience failure. So I see this all the time, unfortunately, Alex, that when it comes to taking exams, when it comes to, uh, the study, it's all avoidance. And this person isn't dropping out of school or that they don't care. They care too much. And they care so much, they trigger fear that they're not going to achieve, and they're going to fail. And then the fear then creates an avoidant response.

Alex Partridge 44:58 Yeah.

Dr. Mark Rackley 44:59 It's awful. I-

Alex Partridge 44:59 Mm

Dr. Mark Rackley 44:59 ... it breaks my heart when I see this, and I see this, sadly, all the time.

Alex Partridge 45:04 Do you have any tips on how somebody might rein in their perfectionism?

Dr. Mark Rackley 45:08 Yeah. So first of all, perfect people don't exist. So you're, you're, you're, you're holding yourself up to an ideal, which is, is not realistic. And also, the other thing is, well, nobody expects that of you. And if people do expect that of you, then they really need to rethink, "Why am I putting all this pressure on this person?" I think as well it's important to identify everybody has different strengths and weaknesses, so nobody has all the gifts. So work with your strengths, work with your weaknesses, but don't try and have everything working at the same level because that's not realistic. And I think the other thing too is being really mindful of this is not, perfectionism is not a positive thing. It puts too much pressure on you. It can actually... A- and instead of it actually enhancing your abilities, uh, it will do the opposite. It will actually curtail them, and in some cases, it will stop you from achieving what you want to achieve. So really kinda looking at it in perspective because unfortunately, what can happen with perfectionism is it can be held up as a positive thing, and it's not.

Alex Partridge 46:17 People pleasing. That's a big topic as well. And I think-

Dr. Mark Rackley 46:20 Yeah

Alex Partridge 46:20 ... there's a clear correlation between the people I speak to and people pleasing.

Dr. Mark Rackley 46:25 Yeah.

Alex Partridge 46:26 I think RSD can mean the thought of being rejected is overwhelming, and therefore we want to please everyone.

Dr. Mark Rackley 46:32 Yeah.

Alex Partridge 46:32 So do you have any tips on how to put up boundaries without offending people?

Dr. Mark Rackley 46:38 Yeah. So first of all [laughs] with that one, [laughs] um, you're gonna have to get used to the idea people aren't gonna like you. That's just, that's just reality. Like, not everybody's going to gel with you. And if people don't like you, that doesn't mean you're unlikable. What can happen with the RSD is that, um, if the person gets a negative experience where somebody maybe doesn't gel with them, then they personalize that and they think, "Well, that means I'm unlikable." No. You just didn't click with that person. So it's creating those healthy boundaries in terms of they're the, the, the natural boundaries within interpersonal relationships. But also, there's this idea as well in psychology, we call it finding your tribe. So finding your tribe is like finding your people, and your people who you kinda really, they're your, they're your, they're your crew. They're your people that get you, and you get them, and it's all kinda easy and nice. So it might take you a while to kind of find your tribe and to find the people that really get you. But if while you're on your way and navigating all of this, it's, it's about understanding that, uh, just because, again, you feel that this person isn't maybe gelling with me, that doesn't mean then that you're being rejected or that other people won't connect with you.

Alex Partridge 48:01 For me, I've always, it's always been a source of attack on my self-esteem-

Dr. Mark Rackley 48:06 Yeah

Alex Partridge 48:06 ... because I end up saying yes to everything-

Dr. Mark Rackley 48:08 [laughs]

Alex Partridge 48:08 ... 'cause I'm so scared of letting someone down.

Dr. Mark Rackley 48:11 Yeah.

Alex Partridge 48:11 So you, you have no integrity. You have no self-respect. And as soon as you start putting those boundaries in place and you say yes, or you be more decisive on what tasks or what projects you say yes to or no to, you, you take back some of that control. What do you think some of the other costs are of being a people pleaser?

Dr. Mark Rackley 48:26 Oh, it's awful. Yeah. I mean, I know that that can seem like, again, it can be positioned as, as a positive, but it's not, it's not. 'Cause it's exhausting, and it doesn't create healthy boundaries. So you might be saying yes to something that's right for everybody else, but it's wrong for you. So with, with people pleasing, again, it's to understand, well, what, what am I doing here? Like, uh, when we pe- when we get into people pleasing, um, [lips smack] behaviors, we're basically losing agency because we're allowing the, the other people to dictate to us what we say yes and no to. And- Saying no is really important because saying no creates a healthy boundary that you can get to stand on the right side of, as opposed to saying yes to something that's maybe more, more dangerous for you. So I often say to my patients, like, we... It's very important to be assertive, and being assertive is being able to say no, and being able to say no and be okay with the no because the no works for you. And if other people don't like the no, well, that's unfortunate, but that's not your problem because you've not done something wrong here. But if other people don't respect your no or respect your boundary, then it doesn't mean that what you've done is wrong for you, but it might be wrong for other people. And that's okay because the people who respect you and the people who understand what you're doing, they won't question that.

Alex Partridge 50:06 Are there any other ways someone with ADHD could get better at putting boundaries in place?

Dr. Mark Rackley 50:12 Yeah. So I think, again, it's, it's im- it's important to, to, you know, understand how the ADHD is playing out in, in your own life. So if you're finding that you are kind of prone to people pleasing, that you're taking risks that you shouldn't be taking, that you're maybe making decisions based off of the more impulsive nature of ADHD, or if you're... One of, one of the things I talk to my patients about all the time, Alex, is if they're bored. Like, just the general state of being bored isn't great, actually, because then they might go looking for stimulation or say... If somebody say, "Hey, do you wanna do this?" "Oh, well, I'm bored, so I'll just, I'll say yes," when actually it's probably not the right thing to be doing. So again, it's understanding the context, but also it's understanding as well, well, if I'm, if I'm not using the word no enough, then why am I not doing that? And then re- re- reasserting the no in a healthy place. But there needs to be that recognition that this isn't working for me, and so therefore, then change needs to happen.

Alex Partridge 51:18 Out of all the traits of ADHD, what do you think the three ones are that if unmanaged, uncontrolled, can cause the most problems in someone's life?

Dr. Mark Rackley 51:27 So the emotional dysregulation, um, the, uh, impulsivity control. And, um, I wanna pick, uh, the right one here. Just I'm trying to... I'm thinking in my head around the ones I hear the most. Um, it would be, um, probably sleep. Yeah. Because sleep is like, if your sleep is pro- They use sleep deprivation to torture people for a reason.

Alex Partridge 51:58 Mm.

Dr. Mark Rackley 51:58 Because it just wrecks the person.

Alex Partridge 52:01 And starting really early, how do you think someone who feels inadequate at school, what effect can that have on that person later on in their life?

Dr. Mark Rackley 52:10 Oh, again, it, it's tragic because it can create a sense of not being good enough, low self-esteem, um, not feeling able to take risks. So it can have massive knock-on effect on their confidence. So they're less likely to apply for jobs they should be applying for or to, you know, ask that person out on a date or to, um, go and do things that are going to be more challenging. So they, they can... It can shrink their world. And instead of them exploring potential, it does the opposite. It can massively limit the, uh, opportunities that that person can have.

Alex Partridge 52:54 We spoke previously, and you said some schools are really well-versed in understanding, managing ADHD, and others aren't. The ones that aren't, what are they doing wrong?

Dr. Mark Rackley 53:05 So I could do a whole podcast on this [laughs] and probably ruin my career. [laughs] I wouldn't name schools, by the way.

Alex Partridge 53:15 Thank God.

Dr. Mark Rackley 53:16 But I'm sure if someone's watching, they'll know who I am. Um, the problems with some schools is they don't want to put the work in to manage neurodiversity because that takes resources, and it takes money, and it takes effort. So some schools will put that in, and it's am- they're amazing. They will absolutely have the best services available for, for, for young people with, um, with ADHD. And the teachers are well-versed. Everybody's really up on what this young person needs, and so it's really tailored to ensure that that's a safe space, that that's a supportive space, and that the young person feels very, very welcomed, but also they're able to thrive in that space. It's, it... So, some are brilliant with that. But others, they're, they're, they, they don't, they don't want the naughty kids, 'cause that's how they, these kids are, are, um, are labeled because, um, they're disruptive. They're the kids that hand in their homework late. They're late for school. Their uniforms, inevitably there's a piece of the uniform missing. Or, um, they will, um, talk over the teacher, or they'll interrupt. And so instead of understanding, okay, what is that, and, like, what's go- Then that young person is, is, um, they're, they're seen as a problem. And then if the school is not interested in addressing that problem or, um, they don't want those kind of kids- ... in this school because they're, um, disrupting the experience for other people, or they bring bad PR to the school, then, um, my experience is that those schools want to move those kids along.

Alex Partridge 55:24 W- what can teachers do to better equip themselves to spot undiagnosed ADHD or other neurodivergent conditions?

Dr. Mark Rackley 55:32 I think it really depends, Alex, on the, the, the services in the school. So some of the schools have proper dedicated learning support centers. And in those learning support centers, you have the SENs, which is special needs assistants, uh, but then you also have other members of staff that are really well versed and trained in neurodiversity. So those centers essentially are the, um, they're the, the, the place in the school that takes care of all of this stuff. So they disseminate all the information. They, they liaise with all the teachers. They're amazing with the parents. They liaise with me. So I have direct contact with these particular, uh, um, uh, services within school. I mean, it's amazing what, what, what they do. And so what you get is just a really brilliant space that works, and it really works. It works. I've seen this multiple times. It works very, very well. But if you don't have that, then it's all a bit kinda like, like it's me writing in a letter to the school saying, "Hey, can you do this?" Or th- this young person has this diagnosis, and I need to... So you have a doctor writing into the school saying, "Can you do all of this, please?" [laughs] "And implement all of this?" Which we will do, of course, we will. But you're kinda like hoping the school will take the letter seriously because, of course, we have no power to, to c- to, to make the school implement that. And, um, the, the school might not have the resources to implement what you're saying. So it really, like, it, it, uh... My experience of kinda what works best is if there's a service embedded in the culture of the school, and it's visible, that is working with not only, like, the internal environment but the external agencies as well to ensure that these young people... Um, and it works. We, you know, we get them through. We absolutely get them through, yeah.

Alex Partridge 57:34 Do you think the traditional school setup is designed to make a child with ADHD feel broken?

Dr. Mark Rackley 57:39 Yeah. Totally. Yeah.

Alex Partridge 57:43 And what could they do to change that?

Dr. Mark Rackley 57:44 [laughs] Oh, goodness. Again, there's a whole podcast on that one. I think... First of all, it's recognizing that school doesn't work for everybody. It just doesn't. Like, the, the, the traditional methods of learning, the curriculum, the, um, the way, the way information is taught, that only works for people who can, um, align themselves with that environment but also that their brain is good with learning by, say, verb- verb- being verbally taught. But for, for... Not everybody learns that way. You know, we all learn, learn... I'm a very visual guy. Like, if you, if you, if you tell me something, I might struggle to kinda, like, hold that. But if you show me something, I'll get it 'cause that's how my brain, uh, that's how my brain works. Um, so, so it's understanding that. It's not just neurodiversity. It's different modes of learning. But also that, um, especially with young people with ADHD, is they thrive on praise. Like, lead with praise. Lead with reward. We know this stuff works really, really well. But if you have a system that's designed to punish and to, um, to, to make the young person feel worthless, then it, it can't work.

Alex Partridge 59:18 And it feeds into the anger, right?

Dr. Mark Rackley 59:20 Oh, absolutely.

Alex Partridge 59:20 Because that kid's gonna get a d- a diagnosis later in life. They're gonna think back to their experience with school, and that's probably gonna fill them with resentment and anger at how it wasn't spotted, how they were treated.

Dr. Mark Rackley 59:29 Yeah, very much so. I hear that all the time. Yeah. And it's too late. It's too late. Like, you're not gonna go back and resit your GCSEs or A levels. Like, it's too late. But it is, and it's, it... And a lot, like I was saying earlier, a lot of those memories are, they're deeply unpleasant. And also, like, it's, it's, it's a real kinda sadness of, well, I, I, I coulda, I coulda had it a bit easier, actually. Yeah, just coulda been a bit more, bit, bit more born nicer for me, yeah.

Alex Partridge 1:00:02 Lots of people who listen to this podcast are late-diagnosed ADHDers-

Dr. Mark Rackley 1:00:06 Yeah

Alex Partridge 1:00:06 ... filled with that shame, the anger that you're discussing. Do you have any closing advice, any closing words for that person listening who has gone their whole life feeling different? They've just got a diagnosis. They're now in the pits of that anger.

Dr. Mark Rackley 1:00:20 Yeah.

Alex Partridge 1:00:20 Do you have any advice for that person right now?

Dr. Mark Rackley 1:00:21 Just be careful with the anger 'cause anger, um, is, uh, again, it's one of those ones that's hardwired into the brain, so we're born with that. And anger is not necessarily a negative emotion because it can be hugely helpful in understanding when something's gone wrong or we've been the victim of injustice or something like that. So it's kind of that idea of righteous anger. But the difficulty with anger is w- whether it, it, it's, it's, it's anger because something's gone wrong or, um, if it's, if it's justified anger, um, it holds a lot of energy, and it hyperarouses the body, and it pumps very powerful chemicals of adrenaline and cortisol through your body. And when that anger is, um- Present, as in the energy is, is present, then that can become destructive and that can become a problem for that person then to be able to manage their anger. So if you're struggling with the anger, first of all, your anger is justified. It's valid. It absolutely is valid. But you need to be very careful what you're gonna do with your anger now, and make sure you're dealing with your anger in healthy ways. So healthy ways being exercise, um, sports, um, go to therapy if you have to. But just that the anger's not going to actually cause additional harm, because the pers- the person's gone through enough harm already, and we don't want the anger causing unnecessary additional harm to that person.

Alex Partridge 1:01:54 Mm-hmm. Yeah, it's great. Um, I'm just thinking of the, some of the people I know who have gone their whole life, they get their diagnosis and they experience that, that feeling of anger, that, that's... It's grief, sadness, and anger bottled into one.

Dr. Mark Rackley 1:02:10 Mm.

Alex Partridge 1:02:10 And it's a process. They go through the stages.

Dr. Mark Rackley 1:02:13 Yeah.

Alex Partridge 1:02:13 They get, they hear the, the words, "You have ADHD", and for a moment they might be thinking, "Well, I knew I had that." It's, it's not a surprise. But then it kind of sets in-

Dr. Mark Rackley 1:02:22 Mm-hmm

Alex Partridge 1:02:22 ... over weeks or months or even years, and then they suddenly have flashbacks to that time at school or that relationship, that argument they had at, at, with their boss, and the rage real- really boils up.

Dr. Mark Rackley 1:02:33 Yeah. Anger, it, it, it's, it can be a primary or secondary emotion. So sometimes what we think is anger, because it feels like anger, isn't anger. It can be a secondary emotion, but the primary emotion we're feeling is disappointment, frustration, agitation, guilt, shame, sadness, grief, any number of things. So that's the true feeling. That's the primary emotion. But what we think we're feeling is anger, but it's not always anger.

Alex Partridge 1:03:08 So can it imitate other emotions, or are you confusing it with them?

Dr. Mark Rackley 1:03:11 It's the, you're confusing it, 'cause it's the feeling. So it's the physiological feeling where it's, "I'm angry." Well, but are you angry? Let's break it down. Like, are, are, are you, are you disappointed? Are you, are you frustrated? Do you feel like somebody's let you down? Are you sad? So people confuse the feeling of thinking, "Well, that feels like anger," because they feel hyper-aroused, but actually what they're, what they're really feeling is a different feeling, which is why when people get very angry, they can start crying, because you wouldn't expect an angry person to suddenly burst into tears. But actually, it's not anger. It's probably sadness.

Alex Partridge 1:03:52 And is there, is it possible to identify the different emotions?

Dr. Mark Rackley 1:03:55 Yeah, so that's the work you'd do with me. Yeah. We would help you work on all of that to understand what's actually happening. Yeah. Yeah.

Alex Partridge 1:04:05 If someone wants to identify a particular emotion, what's the first step?

Dr. Mark Rackley 1:04:10 Um, so you've really got to be reflective with this one, Alex. So it's about like, um, generating that self-awareness of your life story, the triggers, the things that, um, are happening in the moment, maybe the, the thoughts or the, the memories that were, were around. And then, um, identifying then the, the fe- subsequent feeling that came about as a result of that. So, um, you gotta generate the awareness first before you can start to understand, okay, what's happening here? Yeah. So that, I suppose you can do that yourself, but I suppose to really kind of do that piece, um, go to therapy.

Alex Partridge 1:05:05 Amazing advice.

Dr. Mark Rackley 1:05:06 Mm.

Alex Partridge 1:05:06 Thank you, Dr. Mark, for your time today. Thanks for answering the washing machine of woes so gracefully.

Dr. Mark Rackley 1:05:10 [laughs] Pleasure.

Alex Partridge 1:05:11 Um, thank you for your time.

Dr. Mark Rackley 1:05:13 Pleasure. Thank you for having me. I really enjoyed it. [outro music]