Connecting Shame, the Fear Response and ADHD

In my last blog I wrote about shame being the true underlying emotion behind most angry outbursts and behaviors. People feel embarrassed so they lash out with anger, rather than admitting or expressing their real emotion of shame.

This connection is very clear in children labeled with “ADHD” and “Oppositional Defiant Disorder.” These children are considered to lack the ability to focus, pay attention and concentrate. They are impulsive, easily distracted and often hyperactive. Yet if you listen to what they say and understand the neuroscience of the fear response, you can easily see the emotional roots of shame to their reactions. As I’ve written before, these “disorders” are not mental illnesses, just the normal “fear response.”

Just yesterday in therapy one young man described the reasons he often leaves school or is truant. He reported that when he gets frustrated or fears failure on schoolwork, he doesn’t like that feeling. So to manage the shame (he didn’t label it as that) he daydreams, plays with his phone, or zones out. (This is the “avoidance” fear response.) Then if pushed by the teacher or under time pressure of a test, he bolts from the classroom or just doesn’t show up to school on that day (the “flight” fear response.)

His shame and embarrassment at potentially failing lead him to unthinkingly react with fear. Many kids with this “fear hijack” quickly react with the “fight” response by getting angry and being “oppositional.”

Of course, this young man has a mother who has been depressed and anxious all his life, he witnessed domestic violence, and has had other family instabilities. Childhood traumas slow or stunt the development of the cognitive areas of the brain, leaving the emotional or reactive parts of the brain in charge. He’s also had this fear response modeled by parents who became violent with each other. No surprise that when he feels threatened emotionally he is more likely to react with unthinking responses or impulsivity, rather than thoughtful problem-solving with an eye to the consequences.

Afterward he can state the consequences to his behaviors, as is usually the case with these impulsive kids. Yet in that survival mode of the fear hijack his cognitive abilities are narrowed and not in control.

Of course, his early traumas also make learning and memory development more difficult for his brain, leading to a label as “learning disabled.” So his family life has primed him for a life of misbehavior and academic failure that others will label as dysfunctional or maybe even criminal. All because his brain never had the chance to develop and to learn a thinking approach rather than an emotional response.

When you understand this connection, it becomes extremely obvious that what we need is not therapy and drugs (absolutely not!) for these children, but parenting classes and therapy for their parents years prior. It was their parents’ inability to manage shame in emotionally mature ways that started this whole mess.

Fight or Flight Causes “Mental Illness”

“Fight-or-flight” is a concept I discuss in depth in “Pack Leader Psychology,” because I believe this primal fear response is key to understanding human behavior. This natural survival instinct is also a powerful driver of human emotions and interactions, yet psychiatrists and psychologists seem to have ignored this important fact when developing diagnostic and intervention theories.

I believe we in the profession and in the general public should talk more directly about the fear response. As a psychotherapist, I believe that if we more routinely label these behaviors people will not only begin to understand them, but the behaviors will be normalized. By calmly and clearly explaining a behavior, such as anxiety or depression, as a normal, primal response, perhaps some of the mystery about human behavior and psychology will be removed. It should not abrogate responsibility for these behaviors, especially the violent, abusive behavior that often accompanies the “fight” response, but at least it will increase awareness.

I believe the psychology profession has, for too long, used obscure, confusing terminology. What could be more primal and clear than “avoidance, freeze, flight and fight?” These are behaviors that every animal understands at the level of the survival instinct and to label these reactions as “mental illnesses” is incorrect, stigmatizing and may reduce the effectiveness of therapy.

I routinely explain the “fight-or-fight” response to clients in therapy and many have heard of it, but never applied it to their own behavior.

In “Pack Leader Psychology” I also add new layers of understanding to this concept, explaining why people today are so quick to flip into a fear response in today’s world and how to stop this behavior.

Fear is not a Mental Disorder: Or What is Really Wrong with the DSM

As the American Psychiatric Association (APA) prepares to publish the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) in May 2013, there has been considerable debate about the changes in this document. Client advocacy groups and professional interest groups have stated many objections to DSM-5, with most complaints focusing on specific changes in diagnostic criteria, on placement of diagnostic categories, or on inclusion of diagnostic categories or criteria. Specific complaints about the diagnostic categories include:

  • Asperger’s syndrome should not be on the autism spectrum
  • the addition of disruptive mood dysregulation disorder (DMDD) may pathologize normal childhood temper tantrums
  • the definition of major depressive disorder should not be broadened to include normal bereavement

In addition, more broad-based, theoretical concerns have been expressed by such groups as the American Psychological Association’s Division 32: Society of Humanistic Psychology. In a thorough and thought-provoking letter to the APA in 2011, the group stated that, “it is time for psychiatry and psychology collaboratively to explore the possibility of developing an alternative approach to the conceptualization of emotional distress.”

The controversies surrounding DSM-5 have once again brought up a debate in the profession that the entire atheoretical construct of the DSM should be reconsidered from the ground up. Given the well-documented shortcomings of the DSM, I wholeheartedly concur and have written an essay titled Fear is Not a Mental Disorder The profession needs to move beyond arguing about minor reshuffling of diagnostic categories. These complaints may certainly be justified, but actually are just a rearrangement of the deckchairs on a poorly designed, poorly constructed, and doomed Titanic. The psychology profession must lead an effort to develop a new, improved, and fact-based diagnostic system that is more accurate, clinically useable, beneficial to clients, and provides an effective therapeutic framework.

I am a practicing clinical psychologist who for years has believed that the DSM is inaccurate and misleading in fundamental ways and could even be considered harmful to clients. The mythology of the DSM has for decades hindered therapeutic treatment of clients, and generally complicated what are very simple, understandable concepts that underlie human behavior.

I am not going join the argument of whether Asperger’s is or is not on the autism spectrum, or whether children who throw temper tantrums should be diagnosed with DMDD. Rather, this essay will take a broad, philosophical look at concerns about the DSM. I believe, as many do, that the time is right to completely re-conceptualize diagnostic strategies from the ground up, with the goal of developing a replacement for the DSM.

In Fear is Not a Mental Disorder, I present a powerful and concise theoretical framework to use when diagnosing human behavioral and emotional distresses. This new paradigm called Natural Psychology is explained in depth in my book Pack Leader Psychology. This paradigm offers numerous benefits not found in the DSM, corrects many of the theoretical errors in the DSM, and provides an effective diagnostic and therapeutic solution. And it does so in far less than the 943 pages of the DSM-IV-TR.

Natural Psychology is based on indisputable facts, not the unscientific, confusing, and complex “system” of “diagnostics” of the DSM. Most important, the Natural Psychology model brings numerous benefits to clients, whom we in the psychology profession are ethically bound to protect and help. Where the DSM pathologizes human behaviors as illnesses and disorders, Natural Psychology offers an innovative paradigm that explains these behaviors as normal, natural responses to perceived or real threats and fears. Natural Psychology is a more positive, optimistic, and straightforward framework that strips away harmful, judgmental labels and de-stigmatizes “mental illness” in a profound and fundamental way.

Quite simply, Natural Psychology is based on this concept:

The majority of “mental disorders” that people experience are due to the primal fear response. Fear is not a disorder, but a normal, adaptive human reaction.

I realize that criticizing the “bible” of the psychiatric profession may be sacrilegious to many, but I believe the psychology profession has a duty to serve clients. Keep an open mind as you read this essay. Remember that just because the DSM has an aura of scientific precision, does not prove that its ideas are valid. The DSM is published by a major medical organization and is loaded with technical language, complex numbering systems, obscure terminology, and weighs an intimidating three pounds, but that does not make its precedence unchallengeable.

The publication of the DSM-5 may the tipping point in a history of over-reaching and misinformation by the American Psychiatric Association, forcing the psychology profession to take action.

In Fear is Not a Mental Disorder I will discuss:

1. What is the DSM?

2. How the DSM ignores major psychological facts and concepts

3. A new diagnostic paradigm called Natural Psychology

4. 10 reasons why Natural Psychology should replace the DSM

I recognize these ideas are controversial, but please keep an open mind, click on the link to open the PDF and read the entire essay.   Then join me in a discussion about the DSM-5 and mental health diagnostics in general. I would LOVE to hear your comments.

PDF of Essay:  Fear is Not a Mental Disorder