Dorothy Rowe

Not mad or bad, just scared (June 07)

Suppose you're at home awaiting the arrival of the person on whom you feel your life depends. The person is very late and the minutes are flying by. You try to watch television but you can't concentrate. You move from chair to window and window to door. Acting on sudden impulses, you make phone calls, check diaries and traffic news. When a friend phones you for a chat you rudely order them to hang up. The line must be kept clear.

You're exhibiting hyperactivity, impulsiveness, distractibility and emotional lability (short temper). You have been stricken with Attention Deficit Hyperactivity Disorder. Or it may be that you are afraid. The symptoms of ADHD are the symptoms of fear.

ADHD is the mental disorder which millions of children in the developed world have succumbed to in recent years. At the same time the numbers of children diagnosed with bipolar disorder 'have risen astronomically' (NS 19/5/07). The symptoms of this disorder are hyperactivity, irritability (not getting your own way), psychosis (grandiosity/inflated self-esteem), elation (expansive mood), rapid speech, sleep (lack of).These symptoms are an exaggeration in a particular way of the symptoms of ADHD. The person is very, very afraid.

Each of us has our own individual way of dealing with fear, but generally our method follows one of two common patterns. Many of us become quiet when we're very frightened. We're engaged in trying to keep our emotions under control. We want to think clearly about what is happening and to develop some kind of plan for understanding and dealing with the source of our fear. Our theory mightn't be realistic or sensible, but it's our way of trying to keep things under control.

Other people see this quiet thought as being unnecessary. Their policy has always been to act, not waste time thinking. They use action as a way of dealing with their fear.

Adventure movies often feature a thinker and an action man - Spock and Captain Kirk - working effectively together. However, when the fear becomes exceeding great, the Mr Spocks retreat into their private world, while the Captain Kirks become increasingly and less sensibly active.

One of the outstanding differences between the Captain Kirks and the Spocks is their attitudes to what goes on inside them - their thoughts and feelings. The Spocks mightn't always approve of their thoughts and feelings but they're not afraid to go into their inner world, whereas the Captain Kirks might say that they value their emotions, but it is only their admirable emotions they're prepared to acknowledge. They deny their fears, hatreds, jealousies and resentments because they fear them. They try to run away from their feared inner world by being busier and busier, but of course their inner world stays with them. Stephen Fry says that manic-depressive people like himself are enjoying themselves when they're extremely active and energetic, but this wasn't the case with all manic people I've known in my long career as a clinical psychologist. They were always very, very frightened.

It's unlikely that the psychiatrists who've diagnosed these children with bipolar disorder have spent much time in long, detailed conversations with them as I did with my patients. Rather, they diagnosed the children on the basis of their behaviour as seen in the consulting room or described by the parents and teachers. They didn't see the behaviour as the outward signs of great fear. Why did they do this?

We don't simply become afraid. We are afraid of something. That thing can be outside us or inside us - a cancer, or a wicked thought. Children can become frightened of many things, but the one thing that all children fear is adults. Adults have the power to hurt the child, and many of them do. Loving parents and kind teachers know that they might inadvertently frighten a child, and, if so, it's their task to reassure the child. If a child goes on and on being frightened and becomes unable to function normally and be happy, then the people who are responsible for this child's welfare aren't doing their job properly. In saying this I have broken a very powerful rule. Parents, and those who stand in loco parentis, must not be criticised. If a child doesn't behave properly, it's the child who is at fault. If he can't be regarded as naughty and punished, he must be mad, and the madness treated with brain-altering drugs, the effect of which on the developing brain is unknown.

Blaming and punishing the child is a custom found in all societies throughout human history. In her book Thou Shalt Not Be Aware the psychoanalyst Alice Miller showed that in the Bible there are many stories of children sacrificing themselves for their parents, but not one story of a parent sacrificing himself for his child. Diagnosing children with ADHD or bipolar disorder requires collusion between the parents and the doctor. They agree that the fault is located in the child. The parents fail to mention, or they underplay, the economic, social and personal difficulties with which they struggle, and the doctor doesn't inquire about these matters because he lacks the skills and resources needed to help the parents. Thus the parents can maintain their illusion that they are good parents trying to deal with an intrinsically flawed child, and the doctor his illusion that he is a good doctor. The child continues to be afraid.

Dorothy Rowe Beyond Fear third edition HarperCollins 2007.