Joubert Psychology & Art-Therapy

11/16/2023

Now working with kids again :)

10/19/2023

Often overlooked biological and environmental considerations for wellbeing.

Therapy and counselling can be an incredibly effective, transformative, and healing way of shifting how we feel, how we relate, how we see ourselves and the world around us. But sometimes there are simpler, biological solutions to ailments, or considerations which cannot be ignored if one wants to foster wellbeing. Biology does, after-all, support, shape and inform psychology.

In my own practice, I make a strong point of checking in about these with my clients for these reasons. Somehow, when times are tough – many seem to forget about these, they just seem to fade from awareness. I wanted to take some time to write about biological, physiological, and related environmental factors that have an impact on wellbeing.

The following matters apply to all persons, but most especially to children whose immune and self-regulatory systems are still developing, or those in long-term, geriatric, or palliative care who may need additional support. Of course, the following is by no means a panacea, but it does make a rock-solid starting point. These are also by no means a replacement for spending time working through matters with a medical practitioner – but can serve as a salient adjunct.

The first thing to think through is biological aetiology.

Our mental health and wellbeing are interwoven with our psycho-physiological state. The brain operates on an electro-chemical basis. Your consciousness as-you-read-this-sentence-now is fostered and supported by an incredibly complex network of electric and chemical factors. These constantly respond, react, re-wire, change, and adapt to what you notice in your awareness, what you think, what you remember and so on. Your brain relies on input from your body to function as such. So, when the body is unbalanced, the mind follows.

Serotonin, for example – a neurotransmitter (electrochemical element) is harvested in your gut-tract. Something like 95% of this comes from your guts, so – if your gut function is off you can well expect your mind to follow. The same is differently true of many other such elements. There has been an increasing awareness of how gut-health is interwoven with different mental health ailments – more evidence is emerging indicating different disorders such as Autism or auto-immune dysfunctions, possibly even ADHD. While I cannot say this is a sole aetiological factor, it does beg a simple question, are you eating and drinking well? How is your gut health?

Are you on any medication and have you read the side-effects? Commonly used medications may have an impact on your mental health as well – things as simple as antihistamine could be a culprit. Some items to watch out for are birth-control hormones, corticosteroids, statins, certain dermatological agents, asthma medicines, insulin, antihypertensive medications, anticonvulsants, anticholinergic agents, muscle relaxants, anti-inflammatory drugs, and pseudoephedrine among others. Our neurophysiology is as unique to each person as the differences between two different gardens. Things sometimes just land differently for different people – discovering if this is the case for could take some experimentation.

Sleep is another no-brainer. If you are not resting deeply or sufficiently and wake feeling refreshed in the morning, you cannot expect to be well. Our bodies and minds just need to sleep, it’s as simple as that, and when we don’t get enough (quality or quantity), it will have a massive deleterious impact.

While insomnia is often the consequence rather than the cause of some type of emotional or stress related disturbance, sleeplessness creates a feedback loop that exacerbates both sleep and difficult feelings. So then, you feel bad, you don’t sleep, you feel worse. Plus, many difficult emotions can be well soothed with a good rest. Turn every stone to make sure your sleep hygiene is as good as possible, speak to your doctor to explore things such as sleep apnea, see if you can visit the sleep-clinic, etc. There is no psychotherapy treatment that can replace the value of sleep. There has been the notion among working adults in Northern American culture of late to celebrate insomnia as some type of badge of adulthood. The social benefit of this does not outweigh the benefit of a good sleep.

Health stress management is another key piece in fostering wellbeing. Cardio is the next best thing after sleep. Our bodies did not evolve in the largely sedentary (if not by definition, then by contrast) lives of modern societies, whereas our ancient ancestors were persistence hunters. A fit human being can run further than a horse – for example, the San-bushmen in the Kalahari run for days when hunting. Our bodies will not feel well if they don’t receive some of the same contextual factors that they have evolved to respond to – so exercise. Just put a kid on a playground and you may stand there in adoration, reminded of how we’re all a chimp’s distant cousin – as your child swings and jumps and plays. Or watch primates playing on Planet Earth to further see this point illustrated. We need to do what nature made us to do to be well.

Other biological factors may be related to a host of personal medical conditions to be aware of. For example, a person with a differently functioning thyroid gland is more likely to have mental health related symptoms – because hormones also regulate wellbeing. Hormone dysfunctions such as hypo-gonad syndrome, menopause and Addison’s are all quite relevant. Diabetes and conditions such as hypoglycemia need no explanation as to their impact on mood and energy mobilization. However, there can be many more subtle conditions that affect wellbeing – such as a food intolerance, allergies, sinus issues (there are actual studies pointing to a link between ADHD symptoms and sinusitis), auto-immune conditions, hypertension, and many others.

This is further significant because the way one would treat someone with anxiety due to, for example, a hyper-active thyroid is quite different than how one would treat anxiety in an otherwise healthy individual. Psychology has demonstrated that biology becomes thought – that which our bodies need can present itself as “logical” to us. For example, have you ever needed to go to the bathroom at night, held back and dreamt of running water or a water bowl filling? Intelligence can just further complexify this – adding reasons to justify the rationalization, skewing logic.

Some of the most frequently used treatments of anxiety involve challenging skewed perceptions and thoughts to be more balanced. This involves a process of looking more closely at our own thought patterns, and challenging cognitive biases and misperceptions or misrepresentations with critical thinking and evidence. For example, we often maximize or minimize beliefs about ourselves or the world in the back of our minds. Instead of ruminating on how, say, your child never contributes to the household (a thought which will foster a negative attitude and stress), ask yourself “What’s the evidence for that?”. Do they actually-really-never-ever contribute? Or do they contribute sometimes, in small ways, or perhaps differently? What value do they bring? Certainly, there are children who don’t do their chores, but if your thoughts ruminate on how nobody ever helps, you’re setting yourself up for conflict.

Someone with biologically driven anxiousness may continue to think of inflated, embellished rationalizations to be anxious regardless of what evidence is presented to the contrary. This is precisely because their biological drive overpowers their mental response. So, for such a client, treatment must be different.

Further, consider the presence of neurodiversity. For kids, a teacher is often a really good source of information for this, as they see a ton of kids that fall in the middle range – they just know what to expect. If your teacher flags a concern to query further assessment, it may well be wise to follow up on this. If two teachers’ flag this, follow up on it. For adults, well think back to how you did at school, how you’re doing at work and contrast this with your colleagues. Many adults go through without ever knowing that they have a condition, a sad situation in which they never quite receive the support they need and feel different, alienated.

Everybody is unique, and some grow up to be unique in divergent ways that are not considered normative and can be classified as a disorder. If this is the case, it is well worth knowing as soon as possible. Diagnosis such as Autism Spectrum Disorder, ADHD, FASD and others are critical to be aware of, as these individuals may need accommodations at school or in the workplace. They likely need slightly different ways of relating to experience good connections with people.

Sometimes this can be as simple as more time on a test, other times it’s more complicated. Regardless, being aware of a mental health diagnosis, learning to understand what this means, educating oneself and finding or advocating for the right supports is critical. We all want to set our loved ones (and ourselves!) up for success, sometimes this means understanding what our or their unique needs are.

I strongly suggest that you discuss any matters above with your doctor or nurse practitioner if relevant.

Next up is environmental-physiological factors

Asbestos, Lead, and others are clear culprits that could have a deleterious impact on your wellbeing and have thankfully been removed from most homes. There are many other potential culprits though. Mould, dust, smoke, poor air quality, overly zealous or abundantly used cleaning products containing formaldehyde or others, certain pesticides, aerosols, BPA, etc. I suggest looking into whether these are present in your home and experimenting with their removal to see how this impacts your household or workplace. Adding air filtration systems, water filtration systems, and so on can also be salient. For most people such factors form only part of the big picture of their wellbeing – but regardless should not be ignored.

Ask yourself next, what does your dwelling look like inside? Does it instill a sense of rest and safety, or do you sense it could contribute to a feeling of overwhelm? People (and especially children) have different sensory profiles and subsequent needs. Some need more stimulation and others need low stimulation to feel restful good. A house that is in constant disarray or jam-packed could over-stimulate easily. The reverse is also thus true, a person that is dysregulated will likely have a house that’s a disaster. On the opposite end of chaos, a house that is too picked-through, hyper-organized or controlled to the extent that it feels rigid might also not be very comforting. It seems to contain suggest a feeling of non-acceptance, which instills disquiet. Most people need an environment that’s somewhere in-between rigidity and chaos. Loose enough, organized enough, consistent enough to feel safe.

Environments can also have an uplifting impact. Adding flowers, art, opening the curtains, cleaning up, re-prioritizing what can go into storage and what should stay, de-cluttering rooms, adding seasonal touches such as pumpkins can all be quite helpful in making your home feel like a nest. A utilitarian home in which function is prioritized above all else will also feel a bit hollow and could instill a gloomy feeling. Studies in architecture and interior design demonstrate and follow this principle. These principles can further be extruded into society at large – hence the importance of parks, gardens, of clean streets and so on.

Further factors that are important in fostering wellbeing include one’s social environment at work, school or in community, the cultural context, economic context, the interaction of these, the connectedness and quality of relationships at home and in these environments, and how one has personally integrated into and made meaning of these environments. An economical or politically oppressive environment will feel more stressful, less safe and lead to less emotional wellbeing. Being immersed in a toxic work culture, or in a society in which independence is more important than relationships, or in a physical environment of abundance can all play a part. This highlights the importance of working to foster a culture, environment, and city in which that which is beautiful, true, and good is cultivated and supported.

I will describe these in future articles. However in conclusion, I hope you can see how impactful the physiological characteristics and qualities of our environments and our bodies are, and would like to encourage you to treat these well.

See more at my blog at:
https://joubertpsychology.ca/index.php/2023/10/19/often-overlooked-biological-and-environmental-considerations-for-wellbeing/

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10/16/2023

10/06/2023

Dispelling stigma and myths on ADHD:
https://joubertpsychology.ca/index.php/2023/10/06/dispelling-stigma-and-myths-on-adhd/

I wanted to talk about ADHD – a condition I find to be quite misunderstood.

While ADHD is prevalent enough to be in most workplaces or schools, people with ADHD are often misconstrued through a bunch of myths, misinformation, and a lack of awareness about their condition. ADHD is sort of like an invisible disability, making it harder to discern the unique qualities of people with this condition. For those with it, this can be a recipe for an unhappy work, personal or academic life.

So, if you have someone in your family with ADHD, or in your workplace, it is my hope that in addressing some common misconceptions here, you may begin to understand, accept, and support their success just a little better.



“Okay, ADHD, so that means they can’t pay attention, right?”

This is untrue. Just put a kid with ADHD in front of their favorite video game and you will see them pay plenty of attention. ADHD involves a discrepancy between performance and ability – the issue is not that they cannot pay attention, but rather that they either cannot (or cannot without monumental effort) switch their attention on or redirect it when faced with a boring task. I have often wondered if something like contextual-attention deficiency might be more apt.

Bear in mind that ADHD is all about a person’s internal reward and motivational circuitry being under-stimulated or moderated. Internally this can feel like having sluggish cognition (this has been suggested as an alternative label to ‘ADHD’). They are just not motivated enough, and don’t feel a sense of reward from the mundane enough to be motivated.

While many may feel this way at times, most can – with some self-discipline and effort – shift this. For people with ADHD this becomes far more difficult. Until the context or the task becomes something they are interested in. Then, it flips around and they hyper-focus.

You may have seen them doing something they like with feverish focus and energy. They can be brilliant at interesting tasks, and when focussed on their passion can do exceptionally well. May we all live in a world where this is our reality, but for those who are not so fortunate, this can create a heightened sense of suffering. Inconsistent work performance, difficult and avoidant interactions and many other behaviours may arise.

ADHD means in part that the person struggles to find that middle ground between inattentiveness and hyper-focus. Certainly, they can pay attention. But in comparison to people without ADHD they must push themselves far harder, must be way more emotionally invested, and must be willing to bear an excruciating internal sense of tension to redirect their attention.

“I can’t have ADHD, I’m an adult!” Or “Kids grow out of ADHD”, or “they should’ve grown out of it by now”.

This is just plain wrong. So about 5-12% of people in any society have ADHD. Many more adults are now being diagnosed then previously - and subsequently going through a process of realizing why things were so hard for them growing up. Sort of like a grief and identity re-integration process. Regardless, it was believed in the 80s that ADHD fades as you age. Our science has improved, it is now clear that this is untrue.

Sixty percent of children no longer meet criteria for ADHD by the time they are teenagers. But is this because they’ve learnt strategies to manage their symptoms – and as such the symptom intensity is harder to see? Or could it be social learning? That is, in the awkwardly self-conscious life of a teenager, figuring out that it really doesn’t contribute to their popularity if they keep speaking out of turn. We do not know the exact answer to this yet. We do know that even if ADHD symptoms have declined, persons with ADHD will continue to have emotional, social, and academic problems and anxieties about it. Clearly ADHD continues to impact their lives.

And what about the other 40%, who still have measurable ADHD symptoms as adults? At the prevalence mentioned above, this group constitutes about 3.4% of 31.6 million adults aged 18 and up – which comes to 1.07 million Canadians. That is a lot of people. It means that at least one kid in your class will have it, you’re likely to work with people who have it – it’s around you and it isn’t going anywhere.

Measurement error may also play a role. Kids – especially boys – tend to be noticed for ADHD-like behaviors more than adults. Girls and adults may have more subtle symptoms or may just have learnt how to cope in a way that makes them put on the visage of being functional.

It is not yet a perfect science, but we are clear that ADHD both exists and persists.



“ADHD is a new thing”

ADHD-like symptoms have been described since the late 1800s. While the diagnosis and assessment of ADHD as a disorder is a newer thing, this does not mean the condition itself is new.

Consider some environmental, heritable factors to developing ADHD.

When a child’s parents are smokers, it has been clearly demonstrated (even using lab-mice) that this leads to ADHD-like symptoms. So then, how has the trends of prescribed to***co of the not so distant past, the coal-fired heating systems of the last few centuries, the daily environment of workers during the industrial revolution, of miners, of those working near any type of machinery during the time of the steam engine impacted children?

What about lead? Once commonly around society in petroleum, paint and other sources, its presence has been linked to a host of medical issues – an increase in ADHD symptoms among them.

Without time travel, we cannot be certain that ADHD did or did not exist in our history. It sure seems that it would’ve, at least since the end of the agrarian age.

There is also evidence which suggests that distractibility and inattentiveness are present in other species. One group of researchers managed to measure the attention span of a fruit fly, found that there was a sub-group of inattentive fruit flies who, when given ADHD medication, experience improved attention spans. This may mean that ADHD serves a bio-evolutionary function to a larger in-species group.



“They’re just lazy” or “they can do something about it”.

Well yeah-no. They are not just lazy. If you had to do the laundry, would it be a straightforward process? Well, what if it’s not? Because there are several steps of planning and follow-through involved – ie, gather the clothing, put it in the machine, put it on, remember to come back to take it out, etc. What if, instead of being able to go about your business taking care of those tasks, it felt like you had seven pets, ten kids and five colleagues demanding your attention, while you can smell something is burning in the oven and the front door and the phone is ringing. A bit overstimulating, no? How would you behave if this was your internal experience? I would imagine the laundry may not get done efficiently.

People with ADHD struggle to sort between incoming sensory information and choose the most appropriate response – it is a “top-down” disorder. Because it takes them more effort to engage in a task, it can just feel more like trying to climb out of a hole than walking along. Or if they are hyper-focussed, it might feel like you are driving a F1 car down the racetrack with Michael Schumacher hot on your heels and then your boss or partner or parent or child stops you and asks you to do the laundry. How would you feel? A little unwilling, I would think. Maybe even a little irritable.

But yes, there are some strategies people with ADHD can apply to improve their functioning – however it is a question of managing it – there is no perfect cure, set of behavioral modifications or medication. Different people respond differently to these and have different ADHD symptoms, further complicating their effectiveness. Some people have horrible somatic reactions to some of the medications – and then instead of trying something different, give up. Finding just the right medication and dosage is often a journey. There are also many false myths about ADHD medication which can further sabotage this.

The strategies one can apply to shift, moderate, and manage ADHD symptoms are by no means a cure either, but certainly can help reduce intensity. But with some strategies in place such as medication, meditation, quality sleep, nutrition, exercise, having an accountability buddy, and creating habits which support you such as always writing down everything you must remember, a person with ADHD can begin to do a little bit better. There are many other strategies and I will discuss them in a different blog post.

When ADHD is not managed and not medicated, it certainly is worse. Life circumstances, personal beliefs, and the availability of good guidance can all too easily influence this outcome.



“But wait, my uncle/brother/etc has ADHD and is a lot more organized than you”

ADHD symptoms show up differently for different people. It can look different in different life stages, different contexts as well as being potentially exacerbated by things such as food sensitivities, stress, sleep quality, etc. Some people have all the symptoms of ADHD but do not have it (especially insomniacs), whereas others (more often girls) may have none of the symptoms but do have it. Bottom line is that how a person’s ADHD symptoms show up in their lives is unique to their context.

Misinformation, misconceptions, and false myths turn ADHD management strategies into a swiss cheese. It will just take time, experimentation, resilience, and the privilege to be able to try different things to find a way to balance and manage one’s ADHD appropriately. Of course, as we go through changes in contexts and life-stages, some well-used strategies may no longer work and it’s back to experimenting.



“well okay but then why not just take your medication already?”

Medication may help in some respects and may hinder through causing unwanted side effects. It is most likely to be quite effective. It may even work instantly - or may take many trials to find just the right dosage and type for a person. Side effects may dissuade a person or may foster their hope in further trying to find what is just the right thing for them.

Many people have strong beliefs against taking medication for ADHD. One fear is that medication may lead to substance abuse – when the reverse has been demonstrated in studies. Persons medicating their ADHD appropriately are less likely to engage in substance use than those who do not. Part of the drive towards substance use has to do with seeking a reward, an internal feeling of pleasure – a dopamine payoff. If a person with ADHD’s internal reward and motivation circuitry is under-stimulated, in other words they do not as easily, readily, and deeply experience a sense of reward, it may seem natural, obvious to seek a larger reward.

Coincidentally, this is also why many people with ADHD gravitate to things like extreme sports, make life decisions that can put them in contexts where they would experience heightened emotions, seek intense careers, and so on. With appropriate management this can become more balanced.



“they are just too sensitive and emotional”

People with ADHD do experience emotions more strongly than others. Part of the mechanism that creates emotional self-regulation is what is not as active for those with ADHD. So thus, this can make them more reactive, more sensitive, more emotional, more dramatic at times and subsequently more difficult. Which of course leads to social situations where they may experience rejection, judgement or other strong emotions and perceptions, creating an unfortunate feedback loop.

From their experience, can you imagine if you had to dial up the intensity of your internal experience of what you feel – your dislike of your job, your anger at the economy, your attraction to that person, your desire to do something fun and risky. What would that be like? Would you smile at your boss less or accidentally call them an expletive? Would you be more likely to act on desire? Would you be more likely to do something that would otherwise seem too risky?

Imagine if you could not rely on your brain. You memorized some important information, perhaps even became an expert in it but when you need it, it’s gone. Later that night, on a date with someone you really like, it comes back with radiant clarity, and you can’t help explaining it in detail – your date feels a little unsure what to make of it and finds your perspective just a tad opinionated. Might you feel a bit anxious and unsure of yourself in such a situation?

Or you’re hanging out with friends or colleagues and can’t seem to grasp the group rules or norms. You talk about your relationship issues or a sports match or an exciting new movie when everyone else was focussed on work. You can’t seem to see what the appropriate thing is for you to do, but you have a lot of fun ideas you really want to share with them. Or you just cannot seem to keep up the pace of the conversation (unless you’re in the spotlight about a topic you love, in which case, you monopolize the group). Others may begin to see you as different, intrusive, out of line and you end up being excluded.

Taking this further, some cultures and settings are centered around conscientiousness. If you’re in Japan, you take your shoes off before you enter the house. Someone with ADHD is more likely to forget this – and will more easily as a result appear impertinent. People with ADHD may just find life in a polite, rules-observant society slightly harder to adjust to than in a culture where, say, being a little chaotic is more expected.

Sadly, these parts of ADHD does often mean that they experience less inclusion. While it can be “a lot” to be around a person like this, please remember that it is the hardest on them – many people with ADHD have amounted an excruciating amount of shame in little moments like these.



“they made bad choices, it’s their fault”.

Fault and responsibility are different. Certainly no one is at fault for having ADHD and its subsequent behavioral, social patterns of relating and being. But yes, as adults we all must take and learn to take responsibility for ourselves and our actions. Unmanaged ADHD can create kind of a wasteland of poor decisions, unfinished projects, missed opportunities, the self-sabotage of constantly changing course, etc. In some domain or other, those with ADHD may well end up making poor choices a little more than others at times because of all the reasons mentioned.

Some say that you should, when working with a child with ADHD, take 2-3 years off their chronological age to understand what you’re working with. Or take 30% off the age of an adult to understand where they’re at. Yes, that 40-year-old that doesn’t have a steady job and a mortgage but a ton of credit card debt from some irresponsible fun activity, they don’t sound quite so far behind when you see them as really being a 28–32-year-old.

Persons with ADHD move through a socio-economy and culture that is not designed in a way to create equality of access. While ADHD is legally considered a disability in Canada and they are meant to have this equality, they do not. So, they will just often have a harder time doing the “adult” things, like career planning, financial planning, and budgeting, time-management, like living a healthy lifestyle, paying bills on time, remembering the dentist’s appointment. People with ADHD on average live 10 years less than their peers – because of conditions that healthy life choices can prevent or defer, such as type 2 diabetes, obesity, or substance use.

We further now live in a techno-economic era wherein attention is being bought and sold. One psychologist refers to it as an “attentional-industrial complex, where whatever receives the most attention has the most net worth”.

So yes, sometimes people with ADHD do not make the best choices, but the context, the ground of what constitutes a “best / good choice” and the conditions in our modern, Western society is conducive to their favor.

Think back to some of the trouble you’ve been in. If that phase just lasted and lasted, who would you be now? I hope you can see how out of line it would be to judge or discriminate against someone with ADHD for having made some bad choices. Still, responsibility is responsibility. If you have a friend or loved one with ADHD, please keep supporting them, believe in them and trust that they will find their way with time.



Benefits of having ADHD

It is after-all not a clear-cut deficit – there are certain unique advantages to having ADHD too. Many examples of successful leaders in business and industry are people who have ADHD – you can find examples in every domain out there.

Remember that if they are hyperactive, they are also energetic, strong-willed, tenacious, and persistent. They are natural risk takers - essential to the advancement of society, science, business, sports teams, etc. Their natural assertive questioning of authority is essential to prevent the corruption of power. Remember that if they are a day dreamer, they are also very creative. If they are lazy, well maybe they are just laid back or relaxed. If they’re argumentative they may make a good lawyer or business executive – jobs which demand being a little disagreeable. If they are impulsive then I would bet, they are fun and spontaneous. If they are bossy, well some people cannot figure things out without being told what to do so there’s a job for that too. If they are distractible then they are also curious, observant and think out of the box. And if their work is inconsistent – remember that when its good it is REALLY good.