The Doctor With 23 Years ADHD Experience: We Let Women Down! | Dr Martin Brunet

Alex Partridge 0:00 If I think about ADHD, so many mental health conditions are called disorders. Many people quite rightly say, "Look, I don't like being described as disordered." And the other D, deficits, I suspect for you doesn't feel like a deficit at all. You've got an excess of attention. It's just trying to focus it that's the challenge. Dr Martin Brunet.

Dr. Martin Brunet 0:18 A leading NHS GP. With over 23 years of experience in assessing and diagnosing ADHD. He's an expert on how you can break free from your harmful cycles. And simple strategies to help you master your ADHD. I'm sort of ashamed to say, in many ways, how it was viewed when I first qualified. So it was very definitely the naughty boy stereotype. The idea of girls with ADHD, barely a concept. But I remember being taught that autism was a childhood form of schizophrenia.

Alex Partridge 0:45 Really? What's the consequences of unmanaged anxiety, unmanaged stress?

Dr. Martin Brunet 0:51 I think the consequences for children are really saddest in many ways because parental anxiety about the label that stops them helping their child understand. Yeah.

Alex Partridge 1:00 If someone asked you today to describe what is ADHD, what would you say?

Dr. Martin Brunet 1:04 I'd say it's-

Alex Partridge 1:08 This episode is dedicated to anyone who is so hyperfocused right now that they haven't eaten all day. Martin, thank you so much for joining us.

Dr. Martin Brunet 1:19 Thank you for inviting me.

Alex Partridge 1:20 You've been a, a GP, Martin, for around 23 years?

Dr. Martin Brunet 1:23 Yes. Yeah.

Alex Partridge 1:25 Out of the patients that do come to you with anxiety, do you have a inclination t- towards how many of those are undiagnosed ADHD?

Dr. Martin Brunet 1:35 Many more than we think. Um, and it's very easy to, to miss, I think, um, and very easy to sort of gloss over. W- One of the problems with anxiety when you're coming to see a GP is often there's so much you could deal with. You come with anxiety, but often you're coming with other physical symptoms of anxiety or things you're worried about, and, and both doctor and patient can get sidetracked in checking out the chest pain that's part of your anxiety.

Alex Partridge 2:04 Mm.

Dr. Martin Brunet 2:04 And they never really come to the anxiety. Or you've gotta deal with the anxiety in itself and check that things like thoughts of self-harm, and have they got OCD? Have they got an eating disorder? Are they gambling? Are they... You know, what's their social situation? So there's so much to cover that it's easy to never quite get to saying, "Do you think you might have ADHD?" Um, so I can understand why it's been, why it often gets missed. And then we've also got the fact that when I started in GP, adult ADHD in the UK was not felt to be a thing.

Alex Partridge 2:44 Mm.

Dr. Martin Brunet 2:45 We'd get the odd American patient come over with a diagnosis of adult ADHD and, and in a, an arrogant way would sort of go, "Duh, they overdiagnose ADHD in America, don't they?" And, you know, we've had to learn a lot. Um-

Alex Partridge 2:58 Mm.

Dr. Martin Brunet 2:58 So I think there's still a lot of undiagnosed ADHD, and sometimes patients are coming and saying, "I think I might have it," which is really helpful. Um, but sometimes neither patient nor doctor has even-

Alex Partridge 3:10 Mm

Dr. Martin Brunet 3:10 ... thought about it. Um, you know, I can think of some of my patients that I've known quite a while, and only in recent years become so much more aware of ADHD that actually thought, "Goodness, why didn't we spot this years ago?" Um, particularly women.

Alex Partridge 3:25 Mm.

Dr. Martin Brunet 3:26 Um, and you know, now it just seems so obvious that you've got ADHD.

Alex Partridge 3:30 Mm.

Dr. Martin Brunet 3:30 And yet neither of us even considered it five, 10 years ago. And it- So we, we need to do better. We are doing better, but we need to do better still.

Alex Partridge 3:38 Mm. I mean, yeah, you've hit the nail on the head. You know, women and girls have been missed-

Dr. Martin Brunet 3:41 Mm

Alex Partridge 3:41 ... for so long.

Dr. Martin Brunet 3:43 Yeah.

Alex Partridge 3:43 And so many are now finally realizing-

Dr. Martin Brunet 3:46 Mm

Alex Partridge 3:46 ... that there's a reason for-

Dr. Martin Brunet 3:48 Yeah

Alex Partridge 3:48 ... their overwhelm and their burnout, and why so many people that they know are just gliding po- gliding through life and, and, and progressing, and yet-

Dr. Martin Brunet 3:57 Yeah

Alex Partridge 3:58 ... they seem to, to struggle.

Dr. Martin Brunet 4:00 Yes.

Alex Partridge 4:00 Do you remember

Alex Partridge 4:02 when you started as a GP, what, what you thought of ADHD, and how does that compare to what you think of it now?

Dr. Martin Brunet 4:11 Yeah, I do, and I'm, I'm sort of ashamed to say, in many ways, how, how it was viewed when I first qualified, and some of my own prejudices. So it was very definitely the naughty boy stereotype. And if I'm going to be really honest about my own prejudices, it sometimes seemed like... It sounds awful to say this, but I have to be honest how it seemed, how I sometimes felt at the time, like there were parents who just couldn't really parent their children, who wanted them labeled ADHD.

Alex Partridge 4:44 Mm.

Dr. Martin Brunet 4:44 Give them a drug, and then that will perhaps calm their behavior. The idea of girls with ADHD, barely a concept. Um, and the idea of, um, adults with ADHD was, was just, it was felt to be something that you grow out of.

Alex Partridge 4:59 Mm.

Dr. Martin Brunet 5:00 That was certainly the impression I... That's what I was taught. I mean, it's fascinating. With, with autism, I remember as a medical student, and I only... This didn't last long, but I remember being taught that autism was a childhood form of schizophrenia.

Alex Partridge 5:14 Really? Wow.

Dr. Martin Brunet 5:15 Which is extraordinary. I mean, thankfully, that's long, long gone. I think ADHD only, I mean, even in the last five, 10 years, it's changed massively, and even, even in the last five years, it's, it's changed massively how both patients and doctors are seeing it. And it's fascinating how that's come about 'cause I think a lot of it is a, a ground up movement, the sort of thing you're doing. Getting the word out there that ADHD does exist. It is a thing. That it can, you know, as your book says, make sense.

Alex Partridge 5:48 Yeah. [laughs]

Dr. Martin Brunet 5:49 Um, and, and a key thing with w- if, if someone comes to me and says, "I'm, I'm wondering if I might have ADHD or autism," a really key question is to go back and say, "Okay- Looking back, how long do you think this has been an issue? 'Cause if someone says, "Well, the last two or three years," well, you know, it's probably not either of those then. It's probably burnout and anxiety and something else.

Alex Partridge 6:12 Mm.

Dr. Martin Brunet 6:12 Whereas when someone goes, "You know what? I look back, and, and it might explain this, and it might explain that, and, you know, all these different steps." It's an interesting time because there are a lot of conditions in medicine that can be both under-diagnosed and over-diagnosed. So I, you know, I think of the menopause as something that's changed a lot recently, and that's something that can be both under-diagnosed and ignored, and women not being given the treatment they need. But potentially, you could over-diagnose it. You could ascribe everything to any woman who's age 50, it must be the menopause-

Alex Partridge 6:45 Mm

Dr. Martin Brunet 6:45 ... when, you know, actually you are allowed to have other things happen to you when you're 50.

Alex Partridge 6:48 [laughs]

Dr. Martin Brunet 6:49 Um, so we've gotta try and get it right, and I think with ADHD, it's important to help people get a diagnosis if that's what it is. But obviously, it's a clinical diagnosis. There's no definable single test. So labels can be very helpful if, if they're the right label, but obviously there's the danger that you might apply the wrong label.

Alex Partridge 7:11 Mm.

Dr. Martin Brunet 7:12 Um, and yet I certainly don't subscribe to the idea that, ooh, it's become fashionable. Everyone's got ADHD. I- I think that's a nonsense. There's a, an obvious undiagnosed hump, um, of people who need to be able to get themselves diagnosed-

Alex Partridge 7:27 Mm

Dr. Martin Brunet 7:27 ... when they should've been many, many years ago.

Alex Partridge 7:31 85% of people who listen to this podcast are, are women-

Dr. Martin Brunet 7:34 Mm

Alex Partridge 7:34 ... and in their 30s, 40s, 50s, 60s, all coming to terms that they've gone f- for so many years-

Dr. Martin Brunet 7:41 Yeah

Alex Partridge 7:41 ... with, with probable ADHD or ADHD, um-

Dr. Martin Brunet 7:45 Yeah

Alex Partridge 7:45 ... and they're looking back through this li- their life with this-

Dr. Martin Brunet 7:48 Yeah

Alex Partridge 7:48 ... new lens that they have and trying to make sense of, of past decisions and, and past-

Dr. Martin Brunet 7:54 Mm

Alex Partridge 7:54 ... versions of themselves and trying to add color and context-

Dr. Martin Brunet 8:00 Yeah

Alex Partridge 8:00 ... to that relationship they had when they were, you know, in their 20s that went wrong-

Dr. Martin Brunet 8:04 Yeah

Alex Partridge 8:04 ... or that new job they maybe shouldn't have taken or that hobby they started and a- abandoned.

Dr. Martin Brunet 8:08 Mm.

Alex Partridge 8:09 And, and RSD is, is the one that comes up, you know, time and time again.

Dr. Martin Brunet 8:12 Yeah.

Alex Partridge 8:12 It's the Achilles heel often, um, in so many people's story, the debilitating consequence of, of a rejection or a perceived criticism. It's like a dagger, right?

Dr. Martin Brunet 8:23 Mm.

Alex Partridge 8:24 You, you ... It can ... The tiniest comment.

Dr. Martin Brunet 8:26 Yeah.

Alex Partridge 8:26 And it's like a dagger, and, and someone twists it. Um, if, if people are looking back through their life, and they've been missed for so long-

Dr. Martin Brunet 8:37 Mm

Alex Partridge 8:38 ... and they're trying to work out what the actual consequences are of going years and years and years without an awareness-

Dr. Martin Brunet 8:47 Mm

Alex Partridge 8:48 ... what do you think the, the effect is on particularly women and girls of-

Dr. Martin Brunet 8:53 Mm

Alex Partridge 8:53 ... years and years and years of being misdiagnosed, not diagnosed, misunderstood?

Dr. Martin Brunet 9:00 I think, I mean, particularly for women, I, I think often it has had a huge effect on relationships, um, and certainly I've ... If I think about patients of mine who've been diagnosed later, um, broken relationships is, is a theme, and n- you know, not because they're not great people who you could imagine being able to form good relationships, but because they didn't recognize they had ADHD, and neither did their partner, and then they haven't really known how to-

Alex Partridge 9:33 Mm

Dr. Martin Brunet 9:34 ... how to handle the relationship or, and their partner hasn't understood either, and it's, it's broken, so I think broken relationship's a big thing, and, and, and like you say, with, with work as well. I think it's really interesting as to what might be the barriers, and I'd quite like to talk about the language that doctors use because I'm always ... When I use language in the consultation, I, I like it to pass two tests. So one is that the words should make sense and should mean the same to the patient as they do to me. Um, and the other is that they should feel how I hope they would feel as a result of the language. So if I think about ADHD, I think I s- I, the two Ds bother me. So disorder, so many mental health conditions are called disorders in a way that we don't do with physical disease, and many people quite rightly say, "Look, I don't like being described as disordered." And I know what you feel, and sometimes it feels a bit disordered, but to be labeled with a disorder, um, is not really how I'd want someone to feel about themselves with, with this understanding, this new understanding that might come with a diagnosis. Um, and the other D, deficit, I think that one's fascinating because doctors generally have come up with these terms, and if you've got ADHD, and I'm trying to assess you, and you're not focusing on me, I might well decide that you've got a deficit of attention because you're not giving me the attention I expect.

Alex Partridge 11:10 Mm.

Dr. Martin Brunet 11:10 Um, and so I describe it as a deficit, whereas I suspect for you, doesn't feel like a deficit at all. Feels like you've got an attention ... You know, everything's demanding your attention.

Alex Partridge 11:20 Mm.

Dr. Martin Brunet 11:20 So it's, you've got an excess of attention. It's just trying to focus it that's the challenge. So, and yet we describe it as a deficit. Um, and then with RSD, um, I think the R and the D, rejection and dysphoria, dysphoria, that's a little bit technical, but, you know, as long as you understand that it's, it's sort of, um, that your mood and your emotional reaction is, is problematic or causing you problems, then maybe you can get round that. Um, rejection, that makes sense. But the sensitivity word, I don't ... That doesn't leave people feeling like I'd want them to feel because many people with features of RSD have been accused, as you've said on this podcast, of being too sensitive.

Alex Partridge 12:04 Mm.

Dr. Martin Brunet 12:04 "Oh, stop being so sensitive." So- And what are the problems with these names? I mean, we're kinda stuck with them, but I think they put people off sometimes. You know, I don't wanna be described as being sensitive, so therefore I'm not going to consider that I might have RSD cluster of symptoms because I, I can't go there. Um, particularly because if you've got RSD, being, you know, even a whisper of being told you're sensitive might well trigger your RSD, so [laughs]

Alex Partridge 12:31 Yeah. [laughs]

Dr. Martin Brunet 12:32 Um, and, you know, similarly with, with ADHD. We're, we're kinda stuck with it, but I would encourage people to say, look, if you don't like the label, maybe, maybe just reframe it in your own mind.

Alex Partridge 12:44 Mm.

Dr. Martin Brunet 12:44 You don't have to apply that word to yourself, even if you then go and say, "Yeah, I do have ADHD, but I like to call it..." Whatever you find-

Alex Partridge 12:52 Mm

Dr. Martin Brunet 12:52 ... makes you feel right about it.

Alex Partridge 12:54 Totally agree. It's like, if, you know, particularly for children-

Dr. Martin Brunet 12:57 Mm

Alex Partridge 12:57 ... who are really young and, and they get diagnosed, or they think that they have ADHD and they read that they're disordered-

Dr. Martin Brunet 13:06 Yeah

Alex Partridge 13:06 ... at such a young age. It's so damaging.

Dr. Martin Brunet 13:08 Yeah. Yeah.

Alex Partridge 13:09 Do you think there is a... Do you think there's two types? Do you think there is a... Because it's quite easy to separate the sort of stereotype of, the stereotype of what we think ADHD is-

Dr. Martin Brunet 13:22 Mm

Alex Partridge 13:22 ... which is like the, the, the loud, naughty boy syndrome-

Dr. Martin Brunet 13:26 Yeah

Alex Partridge 13:26 ... compared to what many people experience it today as, as very internalized.

Dr. Martin Brunet 13:31 Mm-hmm.

Alex Partridge 13:31 Can be very still. Lots of internalized hyperactivity.

Dr. Martin Brunet 13:35 Yeah.

Alex Partridge 13:35 Do you think there

Alex Partridge 13:36 are two types of ADHD? One is the, the, the, the, the physical hyperactivity, and one is very internalized?

Dr. Martin Brunet 13:44 I think there's probably a whole range, isn't there?

Alex Partridge 13:46 Mm.

Dr. Martin Brunet 13:46 Um, and, you know, how much is it, um, an issue of focus? How much is it an issue of hyperactivity? So I think those would be, I suppose two ends of the range. Um, but yeah, definitely. And, you know, you talked about how many women are being diagnosed late, and I think the other group that are being diagnosed late are the, if you like, well-behaved boys. In other words, at school they had ADHD, but they were behaving themselves-

Alex Partridge 14:14 Mm

Dr. Martin Brunet 14:15 ... so no one noticed. Um, and similarly, they, you know, many times have gone into adulthood and, and not been diagnosed, and they're probably, you know, 'cause they're not the, the loud, um, type, maybe, you know, their impulsivity, they're able to control so they don't end up doing some of the things that cause huge trouble-

Alex Partridge 14:34 Mm

Dr. Martin Brunet 14:34 ... and get them really noticed. Um, so... And yet they struggle to focus in tasks. They find it hard to prioritize. You know, I'm aware of, um, doctors, for instance, GPs, who late in life diagnose with ADHD, and all of a sudden it kinda makes sense why they've struggled to order their, you know, their clinics. They might go on a home visit, and they get so hyperfocused on the home visit that they turn up an hour late for their first patient, um, in the afternoon.

Alex Partridge 15:07 Mm.

Dr. Martin Brunet 15:07 And, you know, the surgery's going nuts thinking, "Well, where are you?" And everyone's cross with them, and they're thinking, "Oh, well, I was just trying to help. You know, she needed some food, so I made her a sandwich." And you're thinking, "Yeah, but that's [laughs] you got carried away there." Um, and then, you know, maybe it would explain why their surgery might run smoothly, but if they get interrupted, it's, they can drop the ball and-

Alex Partridge 15:29 Mm

Dr. Martin Brunet 15:29 ... you know, so they need... And, and yet they've obviously performed well at school 'cause they've gone to medical school, and they've qualified as a GP, and they've functioned very well. But they would've functioned better had they known from the outset.

Alex Partridge 15:42 Mm.

Dr. Martin Brunet 15:42 So.

Alex Partridge 15:43 As, as someone who's been part of that medical evolution of how the, the, the medical world views ADHD, like you said at the beginning, you, you had that opinion of it, and now you have a-

Dr. Martin Brunet 15:55 Mm

Alex Partridge 15:55 ... it's, it's evolved. If someone asked-

Dr. Martin Brunet 15:56 Yeah

Alex Partridge 15:56 ... you today to describe what is ADHD, what would you say?

Dr. Martin Brunet 16:01 Ooh. [laughs] I try not to use words like deficit and disorder.

Alex Partridge 16:04 Yeah. [laughs]

Dr. Martin Brunet 16:05 [laughs] Um, I'd say it's, it's how your brain works, that the brain, um, is wired differently in everyone. Um, and it can change. It's not fixed. But with ADHD, it often, um, is, is wired a little bit differently. I, I like the term wired for important... Sorry, wired for interest over importance.

Alex Partridge 16:30 Mm.

Dr. Martin Brunet 16:30 I think that's quite a helpful way of thinking, that actually you'll, if something interests you, you'll go with it and grab it. But if it's, you know, no matter how important it is, if it's not interesting, you'll, you may well find that very difficult. Um, and I'd like to... It, it's interesting. Another expression that's sometimes talked about neurodiversity is, is a spiky personality.

Alex Partridge 16:54 Mm.

Dr. Martin Brunet 16:54 Um, and this I think is a good way, but again, that's a word I don't really like, and, and first time I heard it, I thought, gosh, you know, you think of a spiky person, that implies that they're prickly, that they might be hard to get on with, which is not what it's-

Alex Partridge 17:07 A hedgehog.

Dr. Martin Brunet 17:07 Yeah, exactly. So it's not, doesn't make you feel right. Um, but what that's trying to say is that if you did a personality test, you would have, you know, highs and lows-

Alex Partridge 17:17 Mm

Dr. Martin Brunet 17:17 ... rather than them all being quite average. So I think I'd say to someone, if they've got ADHD, they probably have more strengths and more areas to watch out for than average, and that can be both very helpful and also very challenging.

Alex Partridge 17:33 Mm.

Dr. Martin Brunet 17:34 Um, and some of their strengths will be ability to really, you know, run with new ideas. Um, I, I think it might be a stereotype to say that all people with ADHD are naturally creative. I, I suspect that's too big a stereotype, but it might help creativity and-

Alex Partridge 17:48 Mm

Dr. Martin Brunet 17:48 ... spontaneity. Um, and, you know, being adaptable to change can be tremendous. You know, there, there's some people where if you suggest, you know, ring them up and say, "Do you wanna go for coffee?" They'll think, "Oh, but you didn't book it in at least a week ago."

Alex Partridge 18:03 [laughs]

Dr. Martin Brunet 18:04 "I can't possibly do that." Someone with ADHD will probably just go, "Yeah, off we go."

Alex Partridge 18:07 Yeah. [laughs]

Dr. Martin Brunet 18:07 As, you know, as long as they, they like the idea. So it can be tremendously, um- Positive and exciting to be around. Um, but on the other hand, they might go off for coffee with you and forget that actually they were meant to get their essay in, and they don't do it tonight, they might get kicked off the course.

Alex Partridge 18:25 [laughs]

Dr. Martin Brunet 18:25 So, you know, it's, it has challenges as well.

Alex Partridge 18:29 Have you

Alex Partridge 18:30 personally become better at spotting undiagnosed ADHD? And if so, what would you look for in a person if they come to you distressed?

Dr. Martin Brunet 18:40 I think, I think d- definitely, but then I was, like all GPs, probably starting from a low base 20 years ago.

Alex Partridge 18:45 [laughs]

Dr. Martin Brunet 18:47 So, um, there's a lot more I could, I could learn about it. Um, I think it's listening, um, having your antennae... As a GP, you need to have intuition and sort of have your antennae up, and I think mine are more attuned to ADHD than they used to be. And certainly, if I'm finding it hard to keep up with someone's conversation, then that, you know, maybe that, that now raises thoughts in my mind now. Um, but it's not all about that by any means. I think listening to a, a story and thinking back and thinking, "Well, how long have there been challenges for you?" is a, is a key thing.

Alex Partridge 19:26 Mm.

Dr. Martin Brunet 19:26 I guess there also will be people who've ended up... You- I, I suppose this probably relates particularly to men, but again, it's a stereotype. But, you know, there will be male patients who maybe have had trouble with alcohol or drugs or getting into trouble with the law or, you know, and, and actually no one's ever really appreciated that ADHD is the big reason behind that.

Alex Partridge 19:47 Mm.

Dr. Martin Brunet 19:47 And they've always just been branded a troublemaker and an alcoholic and a, you know. So trying to look for, why did you get to that place, rather than just, "Well, you're drinking too much. That's the problem." You know, what led to that?

Alex Partridge 20:01 Mm.

Dr. Martin Brunet 20:02 One of the challenges as a GP is you do, you know, your appointments, they're not really 10 minutes these days, they're more like 15, but it's still not very long. But over time, if you have a series of 15-minute appointments over a long period of time, you can really get to know someone. And actually, one thing I love about a G- being a GP is you don't discharge your patients. You know, they might move away, but you don't ever say, "Right, I've finished that. You're, you know, you're discharged, um, now." And so you get to know someone over potentially 20 years, maybe even longer, and then you can really build a picture of someone.

Alex Partridge 20:40 Mm.

Dr. Martin Brunet 20:41 Um, and that, that's tremendously helpful in trying to spot these underlying patterns.

Alex Partridge 20:49 Mm. You mentioned, um, prejudice earlier.

Dr. Martin Brunet 20:51 Mm.

Alex Partridge 20:51 You said yourself you had prejudice towards letters.

Dr. Martin Brunet 20:54 Mm.

Alex Partridge 20:54 Those four letters.

Dr. Martin Brunet 20:55 Yeah.

Alex Partridge 20:55 I certainly did when I got the diagnosis.

Dr. Martin Brunet 20:57 Yeah.

Alex Partridge 20:58 Brilliant. The medical community, so many of us have caught up, and that prejudice has been disproved or we've, the, our minds have been changed. But for so many people, it hasn't.

Dr. Martin Brunet 21:07 Yeah.

Alex Partridge 21:07 And unfortunately, it hasn't, and it's still there. Do you ever see ADHD in a child and propose the idea to the parent, and the parent-

Dr. Martin Brunet 21:16 Yeah

Alex Partridge 21:16 ... has that prejudice?

Dr. Martin Brunet 21:19 Absolutely. Um, I think probably schools do even more. Um, so, um, my wife, um, is a primary school headteacher, so I hear it from her. Because parents often don't want their child to be labeled, um, and you're also still learning about your child. You know, when a child, when a child goes to primary school, they might only be four, so there's still a lot to learn about them.

Alex Partridge 21:47 Mm.

Dr. Martin Brunet 21:48 Um, and to try and diagnose ADHD in a, in a four-year-old is very different to in an adult or even an older child. Um, and they're worried about their child being labeled and held back. So I, I think probably particularly in school it can be an issue. I think probably the assumption that if you get diagnosed with ADHD, that's gonna mean medication. Um, and, "Well, I don't want my child taking drugs," and therefore not pursuing that, um, is a, is a shame. And I, I think it's interesting, that's the reason why a lot of people don't go and see their GP about depression or anxiety, because they think all GPs are gonna do is prescribe medication.

Alex Partridge 22:28 Mm.

Dr. Martin Brunet 22:29 And, you know, I, I like to think that's not the case. Um, there's so much more. And, and also, it's always an informed choice, so, um, it's certainly not all about medication, although for some children, medication can make a massive difference to their schooling.

Alex Partridge 22:43 Mm.

Dr. Martin Brunet 22:44 I think in adults, you know, it's different, because, you know, some adults will have a conversation and think, "Actually, I, I think I might have ADHD, but I, you know, don't want to pursue a diagnosis." Um, there was an interesting TV program of, um, Bill Gates the other day, who, um, now thinks he would've been diagnosed with autism.

Alex Partridge 23:02 Mm.

Dr. Martin Brunet 23:03 Um, and you know, he thinks he probably has autism. But he sort of said, "Well, I don't need a referral or a diagnosis because now at my age, I kind of know myself well. I know what, how I tick, and I'm comfortable with it, and it works, so I don't need that revelation. I've kind of worked it out." Um, and I think some adults can just think, "Yeah, I think I've got some traits. I, I don't wanna pursue a formal diagnosis, but it's helpful to think about it." Um, while others, really, it can be a revelation to think-

Alex Partridge 23:35 Mm

Dr. Martin Brunet 23:35 ... "Yeah, actually, I do have ADHD or I do have autism." I think then the emphasis is what you're gonna do about that, um, because it just involves an awful lot of learning.

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Alex Partridge 25:49 someone's reluctant to do that learning or a parent shuts the door on the idea-

Dr. Martin Brunet 25:54 Mm

Alex Partridge 25:54 ... because they don't wanna put a label on their kid-

Dr. Martin Brunet 25:56 Mm

Alex Partridge 25:56 ... or an adult hears something like this and thinks, "Nah, doesn't... That might be me, but I don't wanna... I can't be bothered to, to, to, to deal with it."

Dr. Martin Brunet 26:03 Mm.

Alex Partridge 26:04 And they just raw dog through.

Dr. Martin Brunet 26:07 Mm.

Alex Partridge 26:07 What's the consequences of unmanaged anxiety, unmanaged stress-

Dr. Martin Brunet 26:13 Mm

Alex Partridge 26:13 ... on someone's physical health?

Dr. Martin Brunet 26:15 Well, I, I think the consequences for children are really saddest in many ways, because sometimes it's, it's the parental anxiety about the label that stops them helping their child understand. Um, and so I suppose they'd be a bit young at that stage for it to have an obvious physical repercussion-

Alex Partridge 26:35 Mm

Dr. Martin Brunet 26:35 ... in their childhood. But what they're storing up in the future, who knows? Um, I think, you know, what are the physical effects of undiagnosed ADHD? I suppose the most obvious one would be if someone u- self-medicates with alcohol or drugs to manage their ADHD. Um, but there's, that aside, there's, there's no doubt we just can't separate the body and the mind. Um, and I think we've got the Greeks to blame for trying to separate them as much as we do.

Alex Partridge 27:08 [laughs]

Dr. Martin Brunet 27:10 Um, and there's a real reluctance often to really understand how the two connect, but, but it's so obvious really. You know, if you're feeling anxious, your heart races, and you might feel shaky, and your gut might churn. So it's very obvious in the here and now that it affects our body, and it shouldn't surprise us that that then might have longer term repercussions.

Alex Partridge 27:32 Mm. How does anxiety tie in with the terms overwhelm and burnout?

Dr. Martin Brunet 27:38 Yeah, really good question. So burnout, um, burnout really interests me. It's not a medical term, but I think it's quite useful 'cause it's how people feel when they're overwhelmed. Um, it's, it's a big theme in my, in my book. Um, it's one of the sections in my book is about burnout. Because a bit like anxiety, I think people often don't understand their anxiety, and then they, they get bewildered by it. Um, and with burnout, often people don't understand their burnout. So people, people who burn out, um, will often come and say to me, "But I don't understand. I'm not the sort of person to be like this," because they have the impression that you burn out if you're not strong enough, um, and it's a sign of weakness to not be able to cope, um, which is a complete misunderstanding of burnout. Because it's only strong people that take on enough that tend to burn out. Um, and if you're the sort of person where when the going gets tough, you just pedal harder, then you don't necessarily notice the signs that you're heading towards burnout, which might be irritability or just sort of losing it when a trivial thing happens, and you just think, "Oh," you know, you overreact in a way that you just wouldn't normally. Or just a feeling of rising panic, where you look at what's going on in your coming week and you're just thinking, "Well, I can do this there, and I can do that there, and I, and I don't know how I'm gonna quite get through." Um, which are all the signs of someone who's about to burn out. [laughs] Um, and certainly people with ADHD are very likely to overload their plate and just take on more than they can manage 'cause they think, "All this, interesting, I'll pile this on."

Alex Partridge 29:27 Mm-hmm.

Dr. Martin Brunet 29:28 Um, and they... And maybe not get, not get things ordered, so they feel they carry more burden than maybe they need to. Um, people with autism can often burn out, I think partly because just masking is such a huge chunk of pressure on you, um, that there is less capacity for ev- everything else before it overwhelms you. I think overwhelm is a really good description of how people feel when they are burnt out. And, and what tends to happen, if... Generally, burnout's to do with stress. Um, and I talk in, in my book about how stress and, um, performance interact. So some stress is good. If we've got no stress at all, we're probably not gonna perform very well because there's no purpose, there's no drive, nothing to get us up and going. A bit of stress then, we start performing better, and I, I mean at work, but also just generally in our life, we're thriving. So we get to a point where you've got the sweet spot of really thriving with stress, and then you can pile more and more stress on, and actually, your performance is the same. People wouldn't notice it any different. You still seem to be functioning. Everything's going well. But you're increasingly just surviving. You're not really thriving anymore. You're getting here, and then you fall off a cliff-

Alex Partridge 30:43 Mm

Dr. Martin Brunet 30:43 ... and you're, you're burnt out. Um, and at that point, someone might have their first panic attack Um, or they might just open their emails, and they, they just burst into tears, or they can't face going into work, or they just think, "I, I can't get out of bed." And it might... For one person, it might be manifest as depression. For another person, it might be exhaustion or overwhelmingly physical symptoms. For another person, it might be a panic attack or floods of tears. Um, and at that point, anxiety is often a big feature. Um, I think anxiety is often a feature along here, but it's kind of a rising sense of anxiety and not being able to quite cope, but you still can cope, and you still function.

Alex Partridge 31:30 Mm.

Dr. Martin Brunet 31:30 And then, whomph, it's, it then overwhelms you, and that's when people are bewildered, when they haven't spotted the signs-

Alex Partridge 31:37 Mm

Dr. Martin Brunet 31:37 ... that they were only just surviving, and they've ended up at the bottom of the cliff.

Alex Partridge 31:42 So interesting. I, I, I think of bu- burnout as often a, a productivity issue, and it's y- you've, you've worked too hard, or you've taken on too much-

Dr. Martin Brunet 31:51 Yeah

Alex Partridge 31:51 ... or you've committed to too much, and suddenly you just, you've got nothing left. But could you look at burnout in a social context? Uh, 'cause you mentioned heavily masking there for if you have autism.

Dr. Martin Brunet 32:01 Mm-hmm. Yeah.

Alex Partridge 32:02 And you go to a social event, and, and you spend an hour socializing, and you maybe not even realizing you're doing it, but you're so exhausted from meeting new people that suddenly your social battery just goes from sort of 50%-

Dr. Martin Brunet 32:16 Yeah

Alex Partridge 32:16 ... to zero quite instantly.

Dr. Martin Brunet 32:18 Yeah, yeah.

Alex Partridge 32:18 And we call that, "Well, my social b- battery has just run out."

Dr. Martin Brunet 32:21 Yes.

Alex Partridge 32:22 So is... Could you reframe that as a, as a form of social burnout?

Dr. Martin Brunet 32:26 I think for me it would depend how quickly you bounce back, in that definitely you could just reach a state of exhaustion or just know that actually this is draining you. And, and part of that comes to things like introversion and extroversion, doesn't it? How do you recharge your batteries? And one person might have a really busy week, and they're quite stressed, and actually the, the best thing they can do is get away from it all and go and be with people, and that will recharge them. And another person, if they don't have some space on their own or just with someone they feel very safe with and they can relax with, they're maybe a bit more of an introvert.

Alex Partridge 33:05 Mm.

Dr. Martin Brunet 33:05 They can't recharge. So I think definitely the concept of your social battery has gone is a really good one, and to know yourself well enough to know how much battery have you got left. Am I gonna recharge by going to this event, or is it gonna drain me? Can I afford it to drain me? Maybe I can, but maybe I need to know my limits. But then the question is, when [laughs] we, we laugh at home, we sometimes call our bed our charging mat.

Alex Partridge 33:31 [laughs]

Dr. Martin Brunet 33:32 That's why, why we really like that concept. Oh, just wanna get on the charging mat. Um, and if the charging mat of your bed recharges you, and the next day you're fine, then I wouldn't call that burnout. I'd just say, you know, that that's a... If you left the party too late and you really were drained, maybe learn from that and do better next time. On the other hand, if your diary is so full that you're not having times when you can recharge, and you don't recharge, and you feel drained all the time, then I'd probably use the, the expression burnout in that context.

Alex Partridge 34:07 Mm.

Dr. Martin Brunet 34:07 It, it's a bit like the difference between depression and fed up. Sometimes people will say to me, "Well, how do I know if I'm depressed or whether I'm just fed up?" 'Cause in the short term they can feel quite similar. You know, you can feel really flat, and I can't be bothered and, you know, maybe even a bit, a bit weepy when you're fed up and a bit hopeless, but you bounce back.

Alex Partridge 34:26 Mm.

Dr. Martin Brunet 34:26 If you're just fed up, you'll bounce back. You know, maybe you're just tired, and you need a good sleep and eat well and don't have anything to drink. You don't have any alcohol for a bit, and you'll, you know, you'll just bounce back quite quickly. Whereas depression, you've lost the bounce back.

Alex Partridge 34:40 Mm.

Dr. Martin Brunet 34:40 You're... You know, it's much deeper and longer lasting than that.

Alex Partridge 34:44 The whole s- the whole social event thing for me is massive. Um, and putting on this, this mask and feeling that social battery-

Dr. Martin Brunet 34:52 Mm

Alex Partridge 34:52 ... draining almost instantly sometimes.

Dr. Martin Brunet 34:54 Mm.

Alex Partridge 34:54 And then the consequence of that is you can go home and be quite anxious or overthink those social encounters.

Dr. Martin Brunet 35:04 Yeah.

Alex Partridge 35:04 'Cause suddenly you're thinking, "Oh, my gosh, I've, I've left early. They think I'm rude. I shouldn't have said that."

Dr. Martin Brunet 35:09 Yeah.

Alex Partridge 35:09 "They now hate me." And that can create anxiety, which can keep you up.

Dr. Martin Brunet 35:14 Yeah.

Alex Partridge 35:15 Do you think for those reasons, and maybe others, it is, there is a higher concentration of late night or middle of the night anxiety amongst the neurodivergent population?

Dr. Martin Brunet 35:28 I think middle of the night anxiety is a very common thing, without a doubt, um, for everyone, and there's lots of reasons why it might be. If... One of the problems if you wake in the middle of the night is you might wake in a cycle of your sleep when it's quite hard to go back to sleep again, and then what are you gonna think of? Um, I think particularly if you've ADHD and you're feeling awake, and then your brain starts going, that's not very conducive to going to sleep. And with ADHD, you might well fall into the trap of thinking, "I can't sleep. I'll, um, I'll do something. Um, and I might as well make use of the time 'cause I'm not asleep." And then you then stimulate yourself either by jumping from thing to thing, or maybe you get focused on something, and then you've been awake for two hours, and, you know, now you can't get back to sleep. And before you know it, the night's passed and you've barely slept, and you've gotta go to work tomorrow. So definitely it's gonna color the-

Alex Partridge 36:32 Mm

Dr. Martin Brunet 36:32 ... the flavor of that, if you like. Um, and maybe the impulsivity of ADHD means that it's harder to prepare for sleep, 'cause you definitely want to have a bit of a wind down-

Alex Partridge 36:43 Mm

Dr. Martin Brunet 36:43 ... so that you're not buzzing as you go to bed. And ideally, you want your brain to have something in it that you're not really that interested in before you go to sleep. [laughs]

Alex Partridge 36:54 Mm.

Dr. Martin Brunet 36:54 So, you know, the... I- The best nighttime book, I would always read a bit before I go to sleep. It helps turn, turn my brain off. But what I want is a book that I'm interested enough to pick up, but is not so gripping that I can't put it down after three or four pages.

Alex Partridge 37:11 Mm.

Dr. Martin Brunet 37:11 Um, so if your brain is wired to interest rather than importance, you might well, whatever you do just before bed is, you're so interested in it that it doesn't prepare you for sleep.

Alex Partridge 37:22 Yeah.

Dr. Martin Brunet 37:22 So that could be a real challenge.

Alex Partridge 37:24 Mm.

Dr. Martin Brunet 37:25 And one of the other things I was just gonna pick up on with regard to social events, I think it's a real challenge for people with neurodiversity to know if you're thinking, "Shall I go to that thing?" Um, is it anxiety that is making you not wanna go? And actually, if you went and got more practice at it, you'd get better at it, you'd be less anxious. Um, and you would then find you, you're better in that environment, and you can enjoy it more. Because one thing we know about anxiety is that avoidance is the worst thing you can do with anxiety. Or is there something inherently unpleasant about that thing you're avoiding, whether it's a party or a social event or, or just going to the supermarket or whatever. Um, and I think that's a real challenge because if it's inherently unpleasant, if, for instance, you know that the sensory overload is always going to be very tough, that probably won't get better with practice. And the, the example I use is I, um, get very nauseous on roller coasters. And I actually quite enjoy roller coasters. And, uh, it's not the anxiety that stops me, it's nausea. And I know that I could never practice my way out of the nausea I get on a roller coaster. It is inherently unpleasant. Um, but if, because I'd had nausea on roller coasters, I had a panic attack when I went to a theme park 'cause it was so unpleasant, the anxiety of the panic attack might stop me taking my child to a theme park when they'd like to go.

Alex Partridge 39:03 Mm.

Dr. Martin Brunet 39:03 And yet I could overcome that anxiety if I only practiced, and avoiding is just gonna make it worse.

Alex Partridge 39:10 Mm.

Dr. Martin Brunet 39:10 So I, I mean, I'd be interested to know how you find that challenge, but you can easily... One of the dangers with neurodiversity is you can say, "Well, I can't do that 'cause of my autism," or, "I can't do that 'cause of my ADHD," when actually it's anxiety that's stopping you doing it.

Alex Partridge 39:26 Mm.

Dr. Martin Brunet 39:26 And that's the one where you should go and practice it. Whereas there'll be something else where actually you're genuinely right to either do it in an adapted way, like wear headphones when you go to the supermarket, or order your shopping online, because supermarkets are always going to be an unpleasant experience.

Alex Partridge 39:42 Mm.

Dr. Martin Brunet 39:43 I think that's quite a challenge.

Alex Partridge 39:46 Yeah, I mean, I think there's a lot, there's a lot more ingredients in this, this equation with social events. I think RSD can come into it.

Dr. Martin Brunet 39:52 Mm-hmm. Yeah.

Alex Partridge 39:53 I think you could have enough evidence in your brain to tell you, well, last time you went to one, someone... You picked up on a perceived criticism.

Dr. Martin Brunet 40:03 Yeah.

Alex Partridge 40:03 That you were then overthinking for weeks.

Dr. Martin Brunet 40:04 Yeah.

Alex Partridge 40:04 You couldn't sleep, so you've almost got this, this avoidance. You don't want that to repeat.

Dr. Martin Brunet 40:09 Mm.

Alex Partridge 40:10 Um, and anxiety that might just come from being in a room full of lots of people-

Dr. Martin Brunet 40:15 Yeah

Alex Partridge 40:16 ... um, could stop you. But the, the thing that draws me often, and it, it's often an internal tug of war, is I'm also trying to avoid something else if I don't go, which is loneliness.

Dr. Martin Brunet 40:28 Yeah. Yes. Yes.

Alex Partridge 40:29 I mean-

Dr. Martin Brunet 40:29 Yeah, absolutely

Alex Partridge 40:30 ... and so it's like, okay, well, if I go, I'm gonna potentially expose myself to, to a criticism, a rejection.

Dr. Martin Brunet 40:34 Yeah.

Alex Partridge 40:34 I'm gonna pick up on some, someone might say something, and it's gonna trigger me.

Dr. Martin Brunet 40:38 Yeah.

Alex Partridge 40:38 Um, it's gonna be very anxi- an- anxious. But if I don't go, I'm going to be sat on my sofa feeling very lonely-

Dr. Martin Brunet 40:44 Yeah

Alex Partridge 40:44 ... very isolated.

Dr. Martin Brunet 40:45 Yeah. Yeah.

Alex Partridge 40:46 Um, it's not always clear which one's gonna win. [laughs]

Dr. Martin Brunet 40:49 Yeah.

Alex Partridge 40:49 Sometimes I don't go.

Dr. Martin Brunet 40:50 Yeah. Mm.

Alex Partridge 40:50 Sometimes the fear of RSD, the, the anxiety wins.

Dr. Martin Brunet 40:53 Yeah.

Alex Partridge 40:53 Sometimes the avoidance of loneliness-

Dr. Martin Brunet 40:55 Yeah

Alex Partridge 40:56 ... wins, and I do go.

Dr. Martin Brunet 40:57 Yeah.

Alex Partridge 40:57 Um, and, and the outcome is unpredictable, but-

Dr. Martin Brunet 41:00 Yeah

Alex Partridge 41:00 ... it's just interesting to...

Alex Partridge 41:02 Do you think running away from loneliness is a motivating factor for people to put themselves in uncomfortable situations?

Dr. Martin Brunet 41:10 I think it can be, yeah. I mean, I, I have... Sometimes I'll have a patient who is terrified of being on their own, which is a little different. Um, and there they might need to practice actually being on their own at home and, and learning to be content with it. Um, but I think recognizing that being isolated isn't good for you is a good thing to recognize, and then think, "Actually, I need to go and do the thing I'm uncomfortable with-

Alex Partridge 41:39 Mm

Dr. Martin Brunet 41:39 " ... because it's unhelpful to just stay at home all the time." Um, and, you know, with, um, with rejection dysphoria, you can, it can become self-fulfilling. You know, I don't wanna risk being rejected, so therefore I won't go to any social events. I always say no, and therefore people don't ask me, and therefore that makes me feel rejected 'cause no one ever wants me to go.

Alex Partridge 42:04 Mm.

Dr. Martin Brunet 42:04 Well, that's kind of a trap that, that's easy to fall into. Um, so I think one of the things you want with, if you're working on rejection, is to have a range of experiences so that as well as the times w- that will be very loud in your mind of when you've perceived rejection or had rejection, there will be plenty of other experiences of where you've, people have been glad to see you, and you've gone to a social event, and it's gone well. And so in many ways, you've gotta just, you've gotta keep putting yourself into situations where you might be rejected and be willing-

Alex Partridge 42:44 Mm

Dr. Martin Brunet 42:44 ... to take that risk, um, in order to learn how to desensitize yourself to rejection.

Alex Partridge 42:50 Mm.

Dr. Martin Brunet 42:50 Um, I'm not saying that's easy, but, but all of, all of life is about managed risk. Um- You didn't wanna take any risks at all, you just stay at home on your own. But actually, that carries risks 'cause then you have all the mental health problems of loneliness and the lack of exercise, so.

Alex Partridge 43:07 Mm.

Dr. Martin Brunet 43:07 Um, but, you know, even crossing the road carries a risk. There's always a risk in all the decisions we're making, and we need to manage it and think which, uh... So is the risk of rejection something I'm willing to sometimes expose myself to because I know actually in the long run it does me, does me good, even though my instincts are to run away?

Alex Partridge 43:26 Mm.

Dr. Martin Brunet 43:26 Um, so yeah, if you can turn fear of loneliness into something that helps you overcome fear of rejection, um, I think that's quite a useful way of framing it-

Alex Partridge 43:35 Mm

Dr. Martin Brunet 43:35 ... and getting your brain to do what you know it ought to do.

Alex Partridge 43:40 Absolutely. For me, it's also about just putting myself in, in, in those situations of a... as often as possible-

Dr. Martin Brunet 43:48 Mm

Alex Partridge 43:48 ... which seems quite counterintuitive sometimes because my knee-jerk reaction is often to avoid the discomfort.

Dr. Martin Brunet 43:54 Yeah.

Alex Partridge 43:55 But I have to do it enough to justify the fact that when it does go wrong, that's an anomaly.

Dr. Martin Brunet 44:01 Yes.

Alex Partridge 44:01 'Cause if I just did it once or twice and that I got triggered both times, then that would be 100%-

Dr. Martin Brunet 44:06 Yeah

Alex Partridge 44:06 ... negative.

Dr. Martin Brunet 44:07 Absolutely.

Alex Partridge 44:07 Whereas if I go to 50 social events and only-

Dr. Martin Brunet 44:09 Yeah

Alex Partridge 44:09 ... got triggered 10% of the time-

Dr. Martin Brunet 44:11 Yeah

Alex Partridge 44:11 ... uh, at five of them, then that would be evidence for my subconscious to say that, you know, it's not me.

Dr. Martin Brunet 44:17 Yes.

Alex Partridge 44:17 Um, and out, out of those five times that someone... I did pick up on a perceived comment-

Dr. Martin Brunet 44:23 Yeah

Alex Partridge 44:23 ... but maybe it, it was irrational and, and it, it wasn't evidence to cement my fear of social events in the future.

Dr. Martin Brunet 44:31 Mm-hmm. Yeah. Absolutely.

Alex Partridge 44:33 So where does the conversation of medication come into all of this? And, and it's, it's... At what point do you think you, you see a patient and, and they, they mention various things we've spoken about in this conversation-

Dr. Martin Brunet 44:46 Mm

Alex Partridge 44:46 ... RSD and, um, productivi- relationship issues, self-esteem. At what point do you recommend medication? At what point-

Dr. Martin Brunet 44:56 Mm

Alex Partridge 44:56 ... does someone have to get to before that's considered an option?

Dr. Martin Brunet 44:58 Yeah. For ADHD.

Alex Partridge 44:59 For ADHD.

Dr. Martin Brunet 45:00 Yeah. So I mean, firstly, as a GP, I'm not allowed to just initiate medication. It is a secondary care drug that should be started and stabilized in secondary care. But we'll often have a conversation beforehand about why might you want to think about it. Um, I think, I think medication without understanding isn't, is not gonna be helpful. Definitely if someone's been diagnosed with ADHD or trying to get their head around what to do, I would say learn about it. Um, you know, maybe apply some of your hyperfocus if you can g-get yourself-

Alex Partridge 45:37 [laughs]

Dr. Martin Brunet 45:37 ... interested in ADHD and, and at least have some managed hyperfocus about ADHD, that would be great. But, you know, try and become an informed expert about your own brain and how it works. Um, I think when patients tell me that their medication makes a difference, they usually say it really helps them with focus. So it's, it's often when they're finding it very hard to focus on things they know that are important and they want to focus on it, that the, the medication can be helpful. And one thing that, that I quite like about ADHD medication is it has, it has an immediate effect rather than you've gotta take it for six weeks like an antidepressant before you feel its full effect. Um, and so that does mean that people can, um, fairly quickly tell whether it's helpful or not and whether they've got the dose right. Um, and it also means some people would just take it on days when they know they've got to get their focus right, and on other days they don't. Um, and the best description I've heard when it's working well, and this isn't everyone's experience, is some people say it's just like putting on a pair of glasses. When I take my medication, it's like everything is, is in focus, and when I don't, it's like, "Oh, where are my glasses?"

Alex Partridge 46:58 Mm.

Dr. Martin Brunet 46:58 So... And that's quite a nice way of thinking about it. Um, but it's, but it's a very personal decision. It's not needed for everyone, and it all depends a bit on, well, how do you feel about taking tablets. But I think, I think because of the fact that you can tell quite quickly if it's gonna work or not, and because they're very easy to stop, there's, to some extent you might wanna give them a try because you don't really know whether you're gonna like them or not unless you've known how much benefit-

Alex Partridge 47:29 Mm

Dr. Martin Brunet 47:29 ... or otherwise you'll get. And maybe it's easier to try that than with other tablets where you might have to take it for a long period of time before you know if it's gonna work or not.

Alex Partridge 47:38 Mm.

Dr. Martin Brunet 47:39 So I'll, I'll have that sort of discussion with someone. Um, but it's, yeah, it's a very personal decision.

Alex Partridge 47:46 Mm.

Dr. Martin Brunet 47:46 But I would say to people, like I would with most drugs, um, certainly for mental health, don't expect the drug to do it all. It would... It might augment and help what you're-

Alex Partridge 47:58 Mm

Dr. Martin Brunet 47:58 ... trying to do, but especially with mental health, you need to understand what's going on in your own brain and learn about it and embrace what's good about it and know where your challenges are. And I, I think one of the dangers with labels is someone can... Labels can be very freeing 'cause you understand yourself, but if you use them in a way that restricts you, you can, you can get stuck.

Alex Partridge 48:21 Mm.

Dr. Martin Brunet 48:22 You can just say, "Well, I can't do that 'cause my ADHD." Or, you know, "Well, of course my house is chaos, so I've got ADHD, what do you expect?" When actually maybe you need to think, "Okay, these, these are the areas that need attention." You know, as a doctor, if, if a doctor has ADHD, a GP, they can't say, "Well, look, you've gotta expect me to miss some blood tests res- results. You know, I can't file them all."

Alex Partridge 48:40 [laughs]

Dr. Martin Brunet 48:41 Well, actually, as a patient, I want you to file every single one of my blood results-

Alex Partridge 48:44 Yeah. [laughs]

Dr. Martin Brunet 48:44 ... and act on all the ones that matter. So you've got to learn, "Okay, this area needs special attention because of what I'm doing, um, and I have to work out how to do that well and safely."

Alex Partridge 48:58 Where would you like to see the medical community at in terms of ADHD in, say, five years' time?

Dr. Martin Brunet 49:05 Yeah. I would love psychiatry and mental health to be more joined up. So in physical health, there's been more subspecialisms. You know, when, when I was first a medical student, you know, an orthopedic surgeon would, would just be an orthopedic surgeon, and now they're, um, a knee specialist. Um, and actually, that can work really well because it's very specialized to surgery, so you know, you, you want your knee specialist to do your knee and a shoulder specialist do your shoulder and... But in mental health, I don't think it works as well. If, if I want to get a diagnosis on some- someone who might have both ASD and ADHD, I can't refer to one person who's going to do that assessment and help them understand themselves. Gotta get a separate assessment. If they've also got, um, maybe anxiety or maybe OCD, obsessive compulsive disorder, that disorder word again, don't really like it, but anyway, it's in there. Um, or maybe they've got an alcohol problem, I've got to use another team, and there's no joined up thinking. I'd love it to be more joined up, and that maybe if you needed secondary care, you could be referred to one person, and maybe it's the ADHD consultant who coordinates your care, but they don't say, "Oh, you might have autism. Go and see someone else about it." Um, so I'd love to see it more joined up. Um, I'd love to see better provision. The... Certainly in the UK, the NHS is not coping with how many people are being, needing a diagnosis of ADHD, and it's very much emergency measures at the moment. Um, a lot of it is being passed to GPs without proper funding, and that's creating all sorts of problems. So I'd like people to be able to access a diagnosis with less difficulty, and if they want medication, access those better. Um, and you know, it's very easy to blame GPs and say, "Oh, they don't know anything about this." Um, but we need-- we don't just need training. We need more time to be with people, to be able to really look after them holistically. And the trouble with ADHD is it's, it's one of those things that's important but not urgent. You know, if someone's having a heart attack, it's urgent. If they might have bowel cancer, it's urgent. Um, and the important, not urgent things in our lives in general tend to get pushed out.

Alex Partridge 51:30 Mm-hmm.

Dr. Martin Brunet 51:30 Um, and in a GP's consultation, it can get pushed out because you could always diagnose their ADHD next time, and yet then it can just get missed.

Alex Partridge 51:41 Just before we end, Martin, um,

Alex Partridge 51:43 I wanna find out what your ADHD item is.

Dr. Martin Brunet 51:45 Okay. Yes.

Alex Partridge 51:46 I ask all my guests to bring in an item that represents ADHD for them.

Dr. Martin Brunet 51:53 Yes.

Alex Partridge 51:53 You're going to reveal yours underneath this cloth.

Dr. Martin Brunet 51:55 Yes. And I will tell you why.

Alex Partridge 52:01 There we go.

Dr. Martin Brunet 52:01 So-

Alex Partridge 52:01 I'll leave you to explain. [laughs]

Dr. Martin Brunet 52:03 So it's two items. This, um, represents a glass ball, and this is kind of how I felt. I don't have ADHD, but I've worked with people who have ADHD, and I have patients with ADHD. And initially, when working with or having a patient with ADHD, it's felt like they're throwing balls in the air all the time. Um, all these thoughts are flying about. You know, particularly when I worked with a, a colleague who was tremendously creative, coming up with all sorts of great ideas. And initially, I kind of felt a bit panicked because I, I imagine all these balls being glass balls, and I've got to catch them all. You know, you've suggested this. Oh, okay.

Alex Partridge 52:41 [laughs]

Dr. Martin Brunet 52:41 I've got to work out what we're gonna do about that. Um, and if I didn't catch them, then, then they might break. Um, and I remember having a, a realization that I could relax, and they were more like juggling balls. And actually, the juggling balls, if they, you know, landed on the ground and I didn't catch them, it's fine. And the... You know, my colleague was more-- didn't-- had never expected me to catch all the balls she was throwing up in the air. And if, you know, she kept picking up a ball and throwing it, I needed to pay attention. And what she particularly liked was when I could go, "Oh, that one. Let's go with that one."

Alex Partridge 53:17 Mm.

Dr. Martin Brunet 53:17 Um, and sometimes she'd go, "Oh, do you think so?" [laughs]

Alex Partridge 53:21 [laughs]

Dr. Martin Brunet 53:21 Um, and that just helped me relax about dealing with ADHD. And it, it's similar with patients. Sometimes a patient will just throw all sorts of symptoms at me, and it's over- a bit overwhelming because you just think, "You've just told me about ten different symptoms, some of which could be really significant." And, and you can just be panicked and a rabbit caught in the headlight as a doctor and think, "I, I can't-- I don't know where to go with this." And recognizing that actually they're okay about that. They're not glass balls. They kind of want to be able to say all these things, and allowing, going with the flow can be helpful with it.

Alex Partridge 53:57 Mm.

Dr. Martin Brunet 53:58 Um, and then as a doctor, recognizing, okay, which of these are significant, I think I've got to follow up, or which of these are important to you? What-- One of the things I really think, one of the goals in general practice is to work out what matters to the patient and what matters to the doctor and bringing the two together.

Alex Partridge 54:15 Mm.

Dr. Martin Brunet 54:15 And then you decide together what to do about it. Um, in fact, my, uh, my anxiety book's my second book. My first one was about how GPs communicate, and that basically summarizes my entire book.

Alex Partridge 54:25 Mm.

Dr. Martin Brunet 54:25 Work out what matters to them. So with, with a patient with ADHD, I need to understand, okay, what are, what are-- about what you're telling me is really important to you and what's some of the, just, you know, the other stuff that you've thrown at me, and is there anything that you've thrown up that you might not realize is actually really quite important? And then we need to go with-

Alex Partridge 54:46 Mm

Dr. Martin Brunet 54:46 ... go with that. So the balls that someone with ADHD throws up are not made of glass, um, and you can relax a bit and enjoy-

Alex Partridge 54:54 Mm

Dr. Martin Brunet 54:54 ... them being thrown up and catch them. So I, I don't know whether that [laughs] feels like... Oh, I've just broken this one now.

Alex Partridge 55:00 [laughs] Well, that's-

Dr. Martin Brunet 55:01 Gosh, I really have broken it.

Alex Partridge 55:02 Oh, careful. Don't cut yourself.

Dr. Martin Brunet 55:03 No. It's- [laughs]

Alex Partridge 55:05 No way. Right. But otherwise completes the ana-- completes the analogy quite well.

Dr. Martin Brunet 55:09 It does. [laughs] That wasn't intended.

Alex Partridge 55:10 Demonstration of how fragile. Um-

Dr. Martin Brunet 55:12 Exactly. I don't know if that is- If you'd like to think someone is thinking like that or, or not, as someone with ADHD

Alex Partridge 55:21 Hmm. No, it's beautiful. Really nice analogy. Um, and they'll be on the shelves for the rest of time to-

Dr. Martin Brunet 55:27 Okay

Alex Partridge 55:27 ... to, to remember. Penultimately,

Alex Partridge 55:29 Martin, we're going to do the ADHD agony aunt section.

Dr. Martin Brunet 55:32 Yes.

Alex Partridge 55:33 Um, which is called the Washing Machine of Woes, because my item is a washing machine.

Dr. Martin Brunet 55:37 Yes.

Alex Partridge 55:37 Because I always forget my laundry in the machine. I have been using the Tiimo app, which is the sponsor of the show.

Dr. Martin Brunet 55:43 Yes.

Alex Partridge 55:43 And since I've been using them, I have been getting better at remembering to empty the washing machine.

Dr. Martin Brunet 55:46 That it's in there, yes.

Alex Partridge 55:48 Um, this week in the Washing Machine of Woes, somebody has asked, "I have diagnosed ADHD, and I've been on medication for 10 years."

Dr. Martin Brunet 55:57 Mm.

Alex Partridge 55:57 "But I feel like they have some negative effects too, after a while. Do you treat a lot of people with negative effects from ADHD medications, and how can you counterbalance this?"

Dr. Martin Brunet 56:09 Yeah, so I mean, every medication has potential side effects. You know, there's, there's an old adage in medicine, "Show me a tablet with no side effects, and I'll show you a tablet that doesn't work."

Alex Partridge 56:17 [laughs]

Dr. Martin Brunet 56:18 Um, so there's always a potential for side effects. Um, I think, generally, the side effects of ADHD medications are gonna be ones you'll notice in the short term, as opposed to a long-term risk. So some drugs that we prescribe carry long-term risk, like if you're on steroids for years, for instance, there are risks of being on them, and ADHD medicines I wouldn't put in that category. So you only have to worry about the side effects that you're aware of, if you like, and if you feel fine with it, great. Um, and ultimately, the only way of knowing if it's causing you a side effect is trial and error, really. You might know that, yes, this is a typical side effect. Um, and one of the things you can do if you're thinking, and do talk to whoever's prescribing before you do this, um, off your own back, but you might want to trial, trial without and see if the side effect goes away, and then try it again. You know, re-challenge and see if it comes back. So that can give you an idea of, yes, is this a true side effect? Um, because it's very easy to think, "I've got this symptom. It must be the tablet," and it might well be, and it might not be.

Alex Partridge 57:27 Mm.

Dr. Martin Brunet 57:27 It might be coincidence. Um, but many people, and, and again, I would say talk to your prescriber, which usually is going to be your secondary care prescriber, 'cause as GPs, we don't fiddle with doses of ADHD drugs. Um, but many people will, um, take them on days they need and not on days when they don't. So it might be that you don't really like how they make you feel, but on, you know, weekends, days when, you know, you're, you're not having to focus, you can not take them, and on days when you really need them, you do take them.

Alex Partridge 58:01 We have a

Alex Partridge 58:02 closing tradition on the podcast where I deliver to you a letter that was written by the previous guest. Previous guest has written three rules to live by.

Dr. Martin Brunet 58:10 Okay, fantastic. So I like this... Well, I'm probably gonna like all of them, but, um, first one, "Talk to and treat yourself as someone who matters." I like that. Number two, "Nothing is as important as you think." That's a very good thing to remember if you're prone to burnout. And number three, "Live fully now. Don't wait for perfect."

Alex Partridge 58:37 Very nice.

Dr. Martin Brunet 58:37 Those are good life tips, aren't they?

Alex Partridge 58:39 Yeah.

Dr. Martin Brunet 58:39 Like those very much.

Alex Partridge 58:40 Nothing is as important as you think. I think it was you, we've both been on a similar podcast recently. I think it was Dr Alex George.

Dr. Martin Brunet 58:46 Mm.

Alex Partridge 58:46 When he first came on here, he, he, he said to, if you are feeling particularly down or anxious, to zoom out into the s- you know, really take yourself out into the solar system and look back on yourself, and you'll see how, how small-

Dr. Martin Brunet 59:00 Yes

Alex Partridge 59:00 ... um, you know, we are, and how therefore, um, small some problems are that maybe are magnified in our heads.

Dr. Martin Brunet 59:09 Yes. So yeah, some of the problems we see, maybe we're over-magnifying. I think also, like, when it comes to burnout, 'cause I was thinking about burnout there, often we find it very hard to let go of things.

Alex Partridge 59:20 Mm.

Dr. Martin Brunet 59:20 We sort of think, "Well, I've got to do it. I couldn't let anyone down." And, you know, sometimes something comes along where you have to drop everything.

Alex Partridge 59:26 Mm.

Dr. Martin Brunet 59:27 Um, there's some crisis going on, and then you look back and think, "You know what? The world didn't stop turning 'cause I didn't do all those things that seemed so important. Other people stepped in. I, I wasn't so important after all," um, in a good way. Um, so yeah, maybe it helps us let go and also see our problems in perspective.

Alex Partridge 59:44 Mm.

Dr. Martin Brunet 59:44 So two meanings there.

Alex Partridge 59:44 Yeah. [laughs]

Dr. Martin Brunet 59:45 Yeah.

Alex Partridge 59:46 Truly fascinating, Martin. Thank you so much for your time. This has been amazing.

Dr. Martin Brunet 59:50 I've really enjoyed our conversation, Alex. Thank you for inviting me. [outro music]