Divine Enigma
At Divine Enigma, we're here to explore the wonders of neurodiversity amid busy corporate life and career dreams. Our platform is like a cosy sanctuary where everyone - whether you're a professional or an entrepreneur - can join in uplifting conversations. From simple tips for managing projects to self-care practices that work, we're all about helping you grow in your career journey. Picture us as your friendly guide through the twists and turns of corporate life, offering a holistic approach perfect for neurodiverse folks to not only get by but to truly shine in their careers.
Divine Enigma
Understanding ADHD in Female Inmates with Dr. Alex
Imagine uncovering the hidden narratives of neurodiversity within the prison walls—Dr. Alex, a distinguished psychiatrist, guides us through this transformative journey. From Italy to London, discover how a groundbreaking experience in a prison setting ignited their passion for forensic psychiatry. Dr. Alex sheds light on the unique mental health challenges faced by incarcerated women with undiagnosed ADHD, painting a vivid picture of the internalized struggles that often go unnoticed. With heartfelt anecdotes about balancing a demanding career with personal respite, listeners gain an insider's view into the life of a professional navigating complex psychiatric landscapes.
Unpacking the gender-specific manifestations of ADHD, our discussion with Dr. Alex reveals how societal norms shape the experiences of neurodiverse individuals. The conversation contrasts the silent battles of women with their externalised counterparts in men, offering a nuanced perspective on the mental health crises within female prisons. These insights encourage a shift towards more inclusive treatment strategies that honor the diverse backgrounds of those affected. Dr. Alex's reflections emphasize the pivotal role of understanding and empathy in transforming mental health approaches, especially in challenging environments.
Beyond the clinical and into everyday life, Dr. Alex shares practical strategies for managing ADHD, advocating for a holistic blend of lifestyle adjustments and medical interventions. From consistent sleep patterns to stress-reduction techniques, they offer a roadmap for enhancing focus and well-being without overly relying on medication. The episode concludes with a personal touch—Dr. Alex recounts their own ADHD journey, highlighting the emotional impact and empowerment that comes from receiving a diagnosis later in life. Listeners leave with a deeper appreciation for supporting neurodiversity, not only in prisons but across all facets of life, including the workplace.
Join, support, and access exclusive episodes now.
https://www.buzzsprout.com/2083560/subscribe
(@divineenigma338) Instagram (@divineenigma)
please complete the form before you book
● Join Sarah’s 6-week coaching: https://divineenigma.org/product/6-week-coaching-plan/
Join Today!
NeuroEnigma Membership
if you'd like to support this independent podcast, click for free ebook Producer & Host: Sarah
Music: “She Royalty” by Amaro & “Whistle” by Lukas Got Lucky
I used to like both my boys. Now I know why. I'm not the way I am.
Speaker 2:You know actually that happens a lot with ADHD.
Speaker 1:It happens more than with other conditions in my women in prison where they really had little support in life, starting from family to go on with school where they probably were coming not from a good family, and so you know know what happens in school that not necessarily you are considered unless you know you have a parent around to take care of you as well or to sponsor you in a way hello and welcome to divine egmar, a podcast that talks about how to navigate through the complexities of the workplace as a modern day professional, whilst simultaneously having a side hustle. We appreciate all of our audience members for taking some time out of their day to tune into another episode and look forward to providing you all with some value through our show today. My name is Sarah and I will be the host for this podcast. This podcast will be available on all platforms where you can find podcasts, including Spotify, amazon, apple Podcasts and we're also on YouTube. Now, before we dive in, I have a small favour to ask. Creating this podcast takes a lot of time and energy, and every bit of support helps me keep it going and growing. If you're enjoying the show, five star rate comment on Apple Podcasts or Spotify can make a significant difference in helping new listeners discover us. Your support is invaluable in our growth journey and if you're also watching on YouTube, hit the subscribe button and tap the bell so you never miss an episode. Want to show your appreciation more? You can even buy me a coffee through buy me a coffee page. It's a simple way to support the show directly and helps cover production costs. Together, we can build an incredible community for ambitious professionals like you. Thank you for your support. It means more than you know. Now let's get started.
Speaker 1:Hello listeners, welcome back to another episode of Divining Eggma. Before we begin today's conversation, we want to give you a heads up about the topics we'll be discussing. This episode includes discussions about mental health challenges, murder and prison experiences. We understand that these themes can be heavy and may not be suitable for all listeners. If you think these topics might be upsetting or triggering for you, please feel free to skip this episode or listen with someone you trust. Your well-being is our priority, so please take care whilst listening. If you're ready to continue Now, let's get started and let's begin to listen to this episode. Hi, dr Alex, thank you for coming on to Divine Enigma. It's been a pleasure. It's a pleasure having you on this podcast and us meeting together. How are you today? How's your week been? Today is Friday and I don't know when this episode is coming out, but we're going to be having a bank holiday, so first of all, how's your week been and do you have any plans for the bank holiday?
Speaker 2:Well, the week has been extremely busy because, as every person actually is going to probably I don't know if it's every person, every doctor that is going to take annual leave soon I'm basically having to work triple for uh, just to allow myself to actually be off. Um, so, very busy week and I don't have any exciting plans for the weekend. I hope to be able to work a little bit less, but yes.
Speaker 1:Yeah, the weekend. Sometimes we need those long weekends. We just sometimes you don't want to do anything. I think I'll be doing a few things. I'm going to a couple of events that I've been invited to just to meet up with a few people over the bank holiday, and I think I'm going to have a facial, which I haven't done in a long, long, long time. So, yeah, that's like what I'm doing for back calling. My week has been similar to yours super, super busy. It's weird because, because so many people are off during the week, you just feel like all the work has been piled onto your desk and I've had like little breaks within the week. But I'm like, okay, there's more work to do. Oh my gosh, there's more work to do. Yeah, I just want to get it done. So, yeah, that's how my week will be. So I'm looking forward to something a bit more relaxing, and I also have a holiday coming up, so I'm kind of like working towards that too.
Speaker 2:So amazing me too. Where are you going?
Speaker 1:I'm going to Spain, so I've been to Spain before, but I haven't been to this part of Spain. I don't know whether you've heard of it. Seville yes, yes, I have been.
Speaker 2:I've never been, so I've been to like.
Speaker 1:Barcelona and Madrid, which is like the kind of main areas that people tend to go to, but, like, I've never been to Seville, so I'm looking forward to that and I'm just yeah, I just, need a really good break. So let's talk about you. So can you tell us a bit about your background? What made you specialize in psychiatry?
Speaker 1:particularly ADHD and forensic psychiatry Because, yeah, this is a neurodiversity podcast and ADHD is like a hot topic amongst us right now. But I don't just like to focus on one neurodiverse condition. I like to look at different ones, because I feel that with neurodiversity, people tend to have a pick and mix of all different types of traits. So, yeah, it's true, yeah, um myself.
Speaker 2:Well, um, I am a medical doctor. I uh, originally come from italy, so I studied medicine in italy and then I specialized in general psychiatry, partially in Italy and partially it was in London, and then I moved to London. It was around 2012. Like, I remained stable. I was more stable in London from 2012.
Speaker 2:And I discovered a true love for forensic psychiatry, and that was by chance, really by doing a job that I really loved, that was working in a prison actually a prison that is famous probably for the wrong things at the moment, but I really enjoyed it at the time and fell in love, decided that I wanted to re-specialise, so I take a second specialty in forensic psychiatry and decided to become also an expert witness for courts.
Speaker 2:For the people that don't know what it is, forensic psychiatry is simply psychiatry, but with a particular attention for those patients that have been in touch with the criminal justice system. So, where there is also potentially a higher risk to others because obviously there is criminality involved, or the expert witness in court has the role to understand or to advise the court. Is this person a risk to society or, in this particular offence, is that something that we need to consider? For example, would it be better for this person to be sent to prison or would it be better if this person is actually sent to hospital, because sometimes the risk could be higher. It could remain higher in prison because they don't receive the same treatment that they could receive in hospital.
Speaker 1:So I guess maybe we are assessing the person. Could they be a danger to themselves and others? Yes, and if they're in prison, they could be a danger to other and others. Yes, um, and if they're in prison they could be a danger to other prisoners as well or even cause harm to themselves yes and also there is the other.
Speaker 2:The other thing important is that at some point the prison sentence finishes and then they are released in the society. So there is a big difference. For example, if a person um does something to another person and they are released after five years, theoretically you could believe that in five years they may receive a better treatment for a mental disorder in hospital rather than in prison, especially if they don't want to take medications. Prison that you cannot apply the mental health act, so you cannot section be. You cannot, for example, give them medications unless they want. Oh, so you can have a person in prison which remains untreated. So how can you tell?
Speaker 1:if somebody and I've always found this quite fascinating how can you tell if someone has a mental health issue or they're just they've just done something bad and they're trying to use oh, it's my mental health issue that has caused me to do this bad thing, that they've just done something bad and they're trying to use. Oh, it's my mental health issue that has caused me to do this bad thing that they've caused? I don't. I don't know what crime it is, but say it was, I don't know, murder or manslaughter which yeah, a bit extreme.
Speaker 1:But someone might say I, I murdered someone because I had a mental health issue. I had a breakdown in that moment and I'm not mentally well, so I killed this person, which, well, that's essentially what someone would say to try and defend themselves from going to prison and would rather go to a hospital rather than someone who is, I guess, calculated. And they did murder the person and they premeditated it in their head and that was something they wanted to do. But they're now falling on, I guess, using their mental health issues like hop out to get out of their sentencing how do you?
Speaker 1:navigate, because I've always found that really interesting, and how does a doctor assess that it's?
Speaker 2:very that's. That's specifically the role of the expert within a psychiatrist. Obviously, cases like a murder could be particularly tricky, and you're very right, there is the public opinion that we need to consider. There is the justice, isn't it? But justice is for the general public and for the person, because if a person genuinely was mentally unwell, obviously there is also that sort of justice that we need to consider.
Speaker 2:And yes there is more lingering, which is something that all it's very often. An opinion is based on judgment and on what you can see or what is presented in front of you, coupled, obviously, with a medical record and some objective measures. However, there is nothing completely objective. It's not like a blood test that you do a blood test and you know yes have it?
Speaker 2:no, you don't have it, it's more an opinion. So, yes, what happens in court? That's that's basically the role of the expert witness. What happens in court is that they that there will be not just one psychiatrist. Often when in a murder case which is disputed, you will have several experts, both from the defense and from the prosecution, and sometimes there may be disagreement, which means that the court will cross-examine the expert, the experts, because sometimes there is no, no, not necessarily agreement on now, on the fact that a person was mentally unwell at the material time and, uh, and whilst in some cases it's absolutely clear cut, in others is not. But just to go back also to how this is done, you need to consider the person. What, at the moment in which you see them, the expert witness also will consider, for example, all any records also, for example, when the person was arrested, any records from the police. Uh, if was, what was this person? For example, was a that the person accused doing something weird, was it?
Speaker 2:saying something weird was did they appear intoxicated with drugs or did they appear like mentally unwell? Because you can already say there is already some evidence and obviously, very importantly, we also always examine the medical records. It is very, very often when someone has a mental illness that has been there for a long time, you will have some records on the system.
Speaker 1:often people have been on the system for several years and you will have some sort of records there as well and that can then decipher if that person in this case right, just using the example of the premeditated murder then a mental health issue causing that person to murder yeah that's interesting.
Speaker 1:No, it was just something I thought like it wasn't a blank question, but it was something that I always, like, baffled me in my head about that. Um you mentioned growing up, um you mentioned a growing awareness of neuro development, um disorders in the last 10 to 20 years. Has this shift in awareness impacted your work and the field of psychiatry as a whole?
Speaker 2:Definitely, definitely, I definitely would say so, and that's probably something that happened, especially since I started, probably in the last seven years, especially, uh, in my um work in a female prisons in surrey, um myself, but together with other colleagues, one of the the sad, one sad realization it was, uh, uh, noticing that the level of mental health problems and mental disorders and the acuity in female prisons was extremely high and didn't really necessarily tick the normal boxes of mood disorders or anxiety or depression.
Speaker 2:It was that, but much more, and it was the realization that there was so much neurodiversity undiagnosed in the female population, particularly, even more so in prison, and that makes working in prison particularly challenging, working in prison particularly challenging, and I'm not sure if you are aware, but working in prison in female prisons is extremely challenging, especially for the level of self-harm, which is extremely high, and some of this self-harm probably also comes, we know now, from impulsivity, and we also know now that treating, for example we know that ADHD, for example, is a you can have some presentations that have got much more impulsivity than others.
Speaker 2:We also know that treating some mental disorders that are treatable, like, for example, adhd, could actually potentially improve the results and the presentation of people in prison and their well-being as well. So I guess, going back to your question, yes, I think that understanding more about ADHD and autism and setting up in, in reality, when I started working in those prisons, there was no pathway for ADHD and autism and that was not even 10 years ago. Less than 10 years ago there was nothing set up and we did set it up and, yes, it changed the way I work because I am I nowadays, as compared to the beginning of my career. I am already much more skilled and I see people and the presentation of patients also in a in a more narrow, diverse, narrowiverse, inclusive way. So, for example, I'm more skilled to consider with much more detail the background they are bringing, the problems they could and asking about examples in their day-to-day life when they were children and so on, and that obviously it's a big change.
Speaker 1:So do you feel neurodiversity?
Speaker 1:and I'm thinking, I'm getting the sense that a lot, there are a lot more neurodiverse people, probably in prison yes um, and it's interesting, you said that women tend to self-harm and I think, with women not to generalize but I just feel like when women are, um, anxious, women go within themselves, they hurt themselves, whereas I think with men they tend to lash out. Yeah, so it's more external, we're more internal, we'd internalize things more well as men externalize things more. So I would probably well, I don't know, I'm just making these assumptions, but I'll probably imagine in a men's prison possibly there'll be more outrage, more like external, more fighting I guess with with women it might be more internal, more harming of oneself, hurting themselves, possible suicide. I had a idealization and all those things, which is very an internal kind of thing. So that is interesting and it's kind of kind of um, making me think about how ADHD is seen in men compared to women.
Speaker 1:And just on your kind of your experience, because you work with both men and women, how do you find clients that have ADHD who are men in comparison to working with women, and what tends to turn up, what traits that tend to turn up turn up for both male and female? Now, obviously everyone's different and we don't want to generalize and we all are, you know, we all see things differently, but I know there's a generalization when we, when we look at women and how they're conditioned and how, as women, we're like made to. You know, behave yourself, don't speak up so much. But you know demure sentiment, whereas men or boys are able to be more expressive and say how they feel. So I just wanted to ask you on that, in terms of the comparison when you're treating men with ADHD in comparison to women.
Speaker 2:Yes, I guess also my clinical impression is similar to what then we see, basically very similar.
Speaker 2:It follows what we know from evidence, from research. With this I mean that males tend to have more of a hyperactive ADHD, more probably disruptive, as well as children, not necessarily as adults, but it's more frequent that children, male children, were disruptive in class rather than females. It's much more rare to find females and, um, and yes, you're right in terms of, uh, the differences also between females and males in prisons that actually that also something that uh, the difference could be that, yes, the men are out there and probably acting rather than introspectively thinking about all the thoughts that they have, rushing thoughts in their mind. I also find probably one difference that I noticed which is very, very connected to this I find that women tell me much more often that they have racing thoughts, that they never stop, that they just it's a constant, constant, never stopping, and that creates a lot of anxiety and associated symptoms. And I hear that slightly less in men, I guess, and for men it's more about, um, acting without thinking.
Speaker 2:It's more that I've done this, I've done that and I ended up in prison because, yeah, I guess from what I'm understanding, women are more anxious.
Speaker 1:Men are more impulsive in that sense.
Speaker 2:Overall. Obviously that's my impression, which I think is also in keeping with what we know from research in general. There have been quite a lot of population studies and they more or less say that. Let's say that. But also in my personal experience. I also have, obviously I've got the fortune to having worked with ADHD in different settings in the community but also in prison, which are absolutely opposite. So there is a very big difference. Probably the biggest difference I noticed is the severity of ADHD in the community it's we're talking about. So people that are outside prison, it's a much milder, so mild, moderate could be maximum ADHD version.
Speaker 2:The people that end up being in custody. If they have ADHD, it's normally very severe, like we are talking, and especially if they are women. Those women probably were. They were not able to sit down in class to stay still, to listen to study. They dropped out of school at age 10, 12 because they were kicked out and you know a picture that is extremely severe, obviously coupled also to other issues.
Speaker 2:Often we know that patients that unfortunately end up in the criminal justice system it's not just necessarily only because of their only responsibility, or it is, but there is also a background, a society. There is also society around. Maybe they didn't have a support network around, maybe they didn't have enough parents that were available to help and support and to push them or help them when they were having problems at school, them to or help them where they when they were having problems at school. And then we know that from that moment it's very easy to then get out and follow the wrong crowd, end up doing drugs and then selling drugs, and then it's a it's a step that you are in prison there's a lot of things I want to unpick here.
Speaker 1:So you talked about adhd from a mild you know form of adhd to quite extreme levels. How do you decide between what is someone who has mild adhd and who has extreme levels of adhd? And another thing that came to my mind as well is that I know a lot of people are now saying I have ADHD. You know, I think I have ADHD.
Speaker 1:Oh, I'm a little bit ADHD, or whatever that might mean you know, my, my, my concern a little bit sometimes is that sometimes people use terms like I'm a little bit ADHD or a little bit autistic, or I'm a little bit dyslexic for not doing what they're supposed to do. So it made me think about a story in the news recently about um. I don't know whether you're aware of this model called Katie Price. She's a glamour model and she missed and she said that she's been diagnosed with ADHD recently but she didn't go to her um court hearing and obviously they're now saying, like you know, you need to come to court, otherwise you'll end up in prison because she owes something like I'm not sure if that's the correct figure, but about over 700k in you know, hmrc tax debt. Well, so, um, she didn't go to her court hearing and what she did instead is she went aboard to have more surgery. She's very well known for having a lot of plastic surgery and people like saying, well, she had ADHD.
Speaker 1:But then one thing I know of ADHD people and I feel like, even though we can and I'm I'm an ADHDer. So I'm talking to my audience we all ADHDers or we have all types of neurodiverse conditions. I know for myself, as an ADHD person, I can, um, be a bit forgetful, or I can like thoughts can get rushed into my head, or I just lose my sense of time and all these things that affect me as an ADHDer. However, um, there's also this thing in me where I have a strong sense of justice. So I don't like doing things like, if I know I've done something wrong, I feel it more. And I speak to other people who have ADHD as well and they have that sense of that sense of justice, like knowing the difference between right and wrong. And I don't know if it's her ADHD necessarily stopping her from going to court, knowing that if you don't go to court you'll end up in prison, or it's just the fact that, um, maybe she's genuinely forgot, and that's sometimes we have to kind of like decipher, like this is why I was asking you about the mild and the extreme form of ADHD that is it. Is it a reason for you to misbehave or are you not taking responsibility of your action? Because I don't like the idea of using your neurodiverse and neurodiverse condition as a cop-out to do what you're supposed to do.
Speaker 1:Yeah, and this is this, is the, this is the balance I find sometimes with people. So you know I'm neurodiverse, that's why I'm like that well, you could try to be better. You know you can do better. Yeah, I understand you have challenges but you can try. I have challenges because I'm neurodiverse. I know my challenges but I try and you can. I think you can almost tell the difference between someone who is just being, you know, a bit slack and not trying hard enough to someone who really wants to, that really is genuinely struggling and they're trying to overcome that. So I just want to get your thoughts on that, because I find sometimes there is a fine line to be on to kind of balance, to use a bit of discernment to know the difference between if someone's pretending not really I wouldn't say pretending, but maybe just not really taking accountability for, you know, the action they have taken rather than planning themselves more, you know better.
Speaker 2:Well, I think that well, from an expert point of view. So there are obviously here. There are several things we need to consider this specific case, which may or we may or may don't want, we may not want to do, but also in general, in general terms, adhd, having a diagnosis of adhd, doesn't um, doesn't uh, probably uh put any shadow in your ability to distinguish what's right or wrong or to be aware of your responsibility. Yes, you can be a little bit more forgetful. Yes, you can be more distracted. Yes, it is true that you could be. You may have challenges.
Speaker 2:All of this is true and, in fact, adhd is considered a disability within the meaning of the Disability Act. So there are some adjustments that you can put in place. However, it's not a justification. So, for example, one thing that comes to my mind we need to consider that having the ADHD doesn't remove your responsibility to be responsible. For example, if driving you should, if you think that your ADHD or taking tablets for ADHD is affecting your ability to drive, you should inform the DVLA the fact that if you don't do it and then something happens, you cannot just blame it on the ADHD. That's a simple answer to be honest.
Speaker 2:Because, in reality, having ADHD doesn't remove your responsibility as a citizen, does it? Or as an honest citizen? Moreover, we also need to consider that ADHD is not a severe and enduring mental illness. It's not like having a debilitating mental illness such as, for example, schizophrenia, which is probably the most severe of the mental illnesses. It's a mental health problem, is it's a? It's a mental health problem, but for many people, it's not something that is going to completely stop them from having a life, isn't it? And probably surely didn't stop some celebrity having a life or every in a hundred thousand surgeries isn't it, so you know
Speaker 1:you cannot just pick and choose or you maintain attention on, isn't it? And that's the key. It's like you still have to be responsible for yourself and, yeah, adjustments should be made. You should be given that leniency compared to people that are neurotypical, but my gripe is that people are using it as an excuse not to do the right thing and it's not. My gripe is that people are using it as an excuse not to do the right thing and it's not. And in that case.
Speaker 2:I can tell you that if there was a situation I don't want necessarily to comment on this case, but if there was a dispute, for example in court, where a defendant was claiming oh, I did such a thing because of ADHD, it wouldn't be a person like it couldn't be the judge deciding or the jury. There would be experts deciding how possible or how realistic it is that the ADHD in that specific moment preventing that person from doing something or not doing something.
Speaker 2:So in reality, there would be an assessment. But yes, my personal opinion is that it's very unlikely that just because you have ADHD, you can be justified on any antisocial behavior. Exactly Still you end up in prison if you have ADHD, isn't it? For example, I've got many people that have got ADHD in prison.
Speaker 1:But I think we have to also take into account that that if you do have a neurodiverse condition and the fact that you've said that a lot of um prisoners that you've worked with tend to have neurodiverse conditions there is a higher chance you may end up in more than in a community that you whilst in the community you might have like that, five percent of adults have got ADHD, in the community, in prison you may have 20%, which is like a huge number.
Speaker 2:I mean a massive difference.
Speaker 1:Yeah, it doesn't surprise me if you yeah, and it's about having, I think, people that go to prison. I think I try to think of it that obviously they go to prison because they have to, but a lot of the time if you look at their history, um, there's a number of things that have happened in their life that's enabled them to end up in that position, 100% even from when they're born, like in the families they're born in and the people they've been around.
Speaker 2:it's kind of led them to prison, you know, and that's particularly true you see it's I, I it's.
Speaker 2:This is one, one of the, and I, I'm in the I'm writing, actually, an article on this um what. This is particularly true for women, and I don't want to to do a gender, obviously far from me, but but it is true that we have female prisons and male prisons, and it is true that there is research in one and the other, and what I can tell you for sure is that the amount of trauma and previous extremely traumatizing experiences that lead a woman to end up in prison, the trauma is so much higher in the female population, statistically, than in the male population. I can tell you that for sure, and that's something that, exactly the background, is something that we cannot ignore. You're right, probably prison is the only option for some people, but it is also true that it's important to consider the whole picture yeah, yeah, no, I definitely agree.
Speaker 1:Um, you said that in adhd. Um you emphasize the holistic approach in treating ADHD. Can you kind of elaborate that and why you think it's crucial that people are treated with their ADHD holistically? Rather than you know, some people say take a tablet and that will help you get better.
Speaker 2:Yes, definitely. Well, that's something that I tend to clarify the first time I meet with my patients, because some patients may have the. It depends obviously very much. It varies very much that actually everything gets resolved with taking a tablet. I'm very skeptical of this approach and I do not believe that we should put all the emphasis in only one tablet. Very often the tablet helps you if you give the tablet the way to help you and the way I see it is and it's not just for adhd, but in this case we are talking about adhd. Like many patients, or many people that have got adhd could do so much better just putting a little bit more structure in their life with simple things. Um they. The main pillars in my opinion are obviously, uh, sleep hygiene, making sure that you sleep in. They are the amount of people that sleep four hours and then they expect to be absolutely focused in the morning.
Speaker 2:It's unbelievable you're not gonna be, because if you don't sleep, you're not gonna be focused in the morning. It's just not possible. No one is with or without ADHD. It's just not possible. So sleeping enough is important, but also maintaining for people that are in the neurodiverse spectrum. It's very important also to maintain the right structure. So, for example, going to bed always at the same time, waking up always at the same time. Often this means that also during the weekends it's better and less. It's not great, I understand, but it's still better and less challenging for your body to wake up more or less at the same time, also during the weekend. And giving yourself time to to kind of, uh, remove some stress or aief after, for example, after work, going for a big walk or doing something that is relaxing, and to remove a little bit the stress before actually trying to sleep.
Speaker 2:Giving yourself time to eat and eat properly, not just on the go, Exactly because we all know nowadays without probably most of us know nowadays that there are some things that probably we should avoid, like, for example, the shoot a lot of sugars or, uh, consuming loads of alcohol or other of drugs as well, illicit drugs. You know, if you are struggling maintaining a balance in your life, all these things are something that probably shouldn't be there, because they are just going to make it much more, much harder for you. And yes, and probably it's probably the first thing that I should that should be removed or at least like a decreased as much as you can. And exercise Exercise is such an important one.
Speaker 1:Does it have to be a specific exercise? I?
Speaker 2:think that it's not the specific exercise. It's something that you like. It could be even just a brisk walk. Really, what I tend to see in people with ADHD is that people do like a crazy things, like going to the gym for a couple of hours and they do like three times a week, which is absolutely unsustainable and then they do it two weeks and they don't go anymore and they leave it. That's not what we want. What we want is, uh, 30 minutes, 40 minutes, three, four times a day, sorry, three, four times a week, and that's enough. That's enough. A little bit of a a raised, uh, your heart rate, absolutely a little bit of that, and that's enough. A little bit of a raised heart rate, a little bit of that, and that's enough. But there needs to be a routine where after work for example, before work, if you prefer you just do that as part of your daily structure and routine.
Speaker 1:So that makes me think about people who might need ADHD coaches in comparison to taking medication to manage your ADHD, but there might be people that might need a bit of both. Yes, yeah, exactly. Um, and sometimes maybe there might be times where you might be on your medication and you might want to step back and maybe, yes, do it in a more natural way. Um, because I had some time ago I had my personal coach that she came on my podcast and she was taking medication for her ADHD. She got diagnosed when she was in her late 20s, so late diagnostic test and she decided that she was going to focus on her diet and her nutrition, yes, and she eventually weaned herself off her medication.
Speaker 1:That's good, and she's now like completely not medicated and she's found structure and she's just not taking medication anymore.
Speaker 1:I mean, she's just following a structure that can help her maintain her adhd. However, she's not gonna say that if it ever got to a point where it was really bad for her, of course she may want to take the medication again. So I think, yeah, a holistic approach might be the best way, but I think some people just they don't want to try the other way because they just want their brain to switch off because of the racing thoughts and their brain going 100 miles an hour.
Speaker 2:But I think it doesn't need to be either one or the other. I personally combine them, because in most of the cases I still will prescribe medications, but medications are not going to do everything for you.
Speaker 2:So, for example, if you take medications but still you don't sleep at night or don't give yourself enough structure, the medications is not going to make you magically be attentive and switched on the day after because you're tired. Yeah's as simple as that. And there are other things. If you, exercise is important. I completely also get that. It's. It's difficult to find the structure and routine and it doesn't need either all or nothing, but a little bit, tiny little bit, just to start and keep it in your mind that it's something that we want to improve. That's important and it's enough. And again, what? What I tend to say is don't try and and do something that is a not achievable and not you cannot fit in your life. It needs to fit in your life. You cannot think of spending two hours at the gym. Who can do that nowadays? I mean, I don't know, but I cannot do it.
Speaker 1:I cannot and I wouldn't unless your personal training, your life is, your job is the gym exactly but otherwise you can.
Speaker 2:How, who can do that?
Speaker 2:most people dig there it's not realistic for most people but I think I think you know those who but the vast majority of people, though could do 45 minutes around the block like a brisk walk. Most the vast majority could do that, isn't it? It's not like so demanding and having the habit actually is a good one. Uh, also trying to maintain more or less a normal amount about seven, eight hours of sleep could be. Sometimes you have to sleep less, but it cannot be every single day that you sleep four or five hours because you're gonna be tired.
Speaker 1:It's just not. Yeah, you're gonna be. Yeah, I'm trying to get better at sleeping. I'm getting better, but it's hard obviously that's also a problem.
Speaker 2:It's such a such a big topic, sleep, isn't it?
Speaker 1:um, I wanted to ask you about you working in both the private sector and the nh. Yes, how do you approach psychiatric care within the two settings? So when you deal with your private patients in comparison to your NHS patients, I think, in terms of psychiatric care, it is the same.
Speaker 2:It's the same kind of care I don't have. Obviously same it's. It's the same kind of care I don't. I don't have a diff. Obviously.
Speaker 2:It's my mindset and my um, my, my, my set of skills yeah and uh, the same person that is, uh, speaking to you now would be the same person is speaking to the patient. So it's still me. I guess there are differences, rather than the psychiatrist, because it's, I think my work, is more or less the same in one and the other, it's more the surroundings. So, for example, obviously we are well aware that in the ADHD in the public sector at the the moment, I think it's about eight years in London, the waiting list the waiting time super long.
Speaker 2:Yeah, so that's, that's number one difference, obviously, that you don't have that sort of um waiting time in the private sector and there is probably more admin support. There is more, uh, more possibility in the private sector. You have more of a possibility to have a one-to-one with a psychiatrist and having regular follow-ups, to have more of a communication as well, which is less possible in my experience in the public sector, simply because there are no resources at the moment. So we are very stretched in the public sector simply because there are no resources at the moment. So we are very stretched in the in the public sector, which is obviously upsetting for the vast majority.
Speaker 1:Yeah, it's not and, uh, and and that's, but I think I probably am. I would do more or less the same in terms of the treatment, it's just the treatment, and also the length of assessment.
Speaker 2:It takes me about a couple of hours in the private sector, a couple of hours or slightly less in the NHS, but more or less the same often co-exist, so you tend to find someone who's ADHD may also have forms of anxiety.
Speaker 1:How do you approach treatment when patients are simultaneously dealing with their ADHD and then having this thing called anxiety, and they're navigating both of these things? So I'm anxious, I'm having palpitations, yeah, but then I can't think straight because my brain is racing like 200 miles an hour look, this is so frequent.
Speaker 2:Actually, this is probably you know what when in medicine we call them comorbidities, which means when you have a condition and another one, two conditions together so they come together well.
Speaker 2:Actually, if you think about adhd, probably anxiety is, uh, the most frequent, most frequent comorbidity and uh, yeah, probably. I guess that my role, the way I would approach it, is first of all to understand if, uh, we need to consider two things one thing anxiety could be two things. One thing. Anxiety could be to a separate issue. So this person may have two different, two different problems. So, for example, generalized and anxiety disorder and adhd, or you may have they that anxiety is actually secondary to adhd. So having continuously ADHD and being constantly overwhelmed because the ADHD mainly makes you feel overwhelmed create a lot of anxiety.
Speaker 1:I can be testimony to that.
Speaker 2:Yeah, that's the main symptom Number one is being overwhelmed.
Speaker 2:Yeah, yeah, and that could be a consequence of that. So we try to understand that and that's something that you do very much like, a like going back and establishing a good psychiatric history, medical history. And there is also a problem when you said, for example, I've got palpitations, and the problem is that adhd medications themselves can create those sort of symptoms like palpitate. They can give as a side effect, palpit heartbeat that goes fast and so on. So there are even more problems. But I think with a proper diagnosis and establishing what comes first, or if they are together, you are able as a psychologist to direct the patient to the right kind of care.
Speaker 2:In some cases you see that, uh, treating the main disorders the main disorder, which could be in many cases actually it is adhd will also help the anxiety symptoms. However, the way to distinguish is uh, normally it, it, it's, it's. This is obviously a simplistic description, but I also but I found that. I found, I find that when people are experiencing secondary anxiety, so secondary to adhd, normally when you ask them what they are anxious about is all about doing things, forgetting things or not being on top of things, the tasks, the burden. That's a typical ADHD burnout.
Speaker 2:And the anxiety is very much all related to the ADHD and that's one and I would be pretty comfortable in this case if it is all related to the ADHD. To treat the ADHD and to consider the day Anxiety symptoms little by little should treat the ADHD and to consider the day anxiety symptoms little by little should respond as well and go down. Obviously you need to monitor it. That's the role of the psychiatrist to monitor and check. You may also have people that have got a generalized anxiety disorder and ADHD. But you will see that in the generalized anxiety disorder they may have different problems problematic. So the anxiety could be about, for example, having problems or people around them disappearing, finding themselves alone, having a physical health problem, a range of other problems which are not necessarily related to the burden, the being overwhelmed and all the ADHD thematics. So that's a way simplistic.
Speaker 2:Now I'm sure that I'm just making it very simple, but you know it's an indication sometimes.
Speaker 1:No, I get that. I think I feel like I've had forms of anxiety over things and it's exacerbated my ADHD, so it's made me feel like I can't cope, I don't know what to do. And then all these thoughts go into my head and then when I have someone that's around me who maybe used to be an ADHD coach, or somebody that's a bit more grounded that sometimes is my husband, um, it kind of makes okay, I don't need to get too over, mom, it's not that bad, it's not the end of the world, the world's not crashing down. So, um, yeah, um, I wanted to ask um you mentioned enjoying and communicating and making information accessible for people with ADHD Can you share memorable experiences where your communication efforts significantly impacted someone's understanding of their mental health journey? Because sometimes you don't know what. You don't know if that makes sense. So if you're like in a position where you're having all these feelings or you're going through a lot but you don't know why you're going through this and then you're just acting like you know you're acting. Maybe this is how I'm supposed to be and you don't know if there's any help out there for you, how have you helped someone through that? Because I'm.
Speaker 1:I can give an example of my, my position. I I obviously was dealing with um, adhd and dyslexia, um, neurodivergent person, completely with two neurodiverse divergent conditions. Um, and I didn't know that I could get things like access to work. Yes, I didn't know so when I was doing the application and I was getting supported like, oh, did you don't know to do this? I'm like, well, you don't know what you don't know, like I didn't know.
Speaker 1:I just thought this is something I had to kind of manage and figure out myself, and I've always kind of figured things out myself. Um, and even when I did get the support, it's like, oh, these are some of the methodologies that I didn't realize. I had figured out myself that I was being taught um and how to manage my ADHD, but it's because you know, you just trial and error stuff and yeah, it kind of okay, this sort of works for me, but it doesn't go away. You still have it, but you've just figured out how to manage what you have. So can you give me an example of like people that have just come to you and they didn't know they had this condition and they didn't know what to do and now it's almost like now I know why I'm like the way I am you know what?
Speaker 2:actually that happens a lot with ADHD. It happens more than with other conditions. I don't even know exactly why. I have not figured it out myself, but actually I have several experiences of people that cried when they were diagnosed, but cried. Some people cried because they it finally made sense if finally everything they had been labeled. Especially women, I guess, but not only women, also men, um diagnosed in older age, um were probably labeled as lazy or uh moody or uh all sorts of things for a life, uh being compared with a brighter sibling, for example, but with the parents and um they they grew up with uh like impersonatingating the black sheep of the family role, and but still they didn't. They always felt different and they.
Speaker 2:It's a typical thing that people with ADHD that severe enough it's a typical thing that people with ADHD that are severe enough, they probably didn't achieve the results that they thought they could have achieved. If only something you know that's a typical thing that you hear they've been diagnosed because there was the validation of yes, actually, yes, all of this is absolutely indicative that you had problems with attention, with hyperactivity, and yes, there was probably more than the vast majority of people. And yes, you did try all your best strategies, but we understand that it wasn't enough and probably some extra support in place could have made a difference. So that sort of talk, but also psychoeducation, which I think it's very, very important especially, for example, psychoeducation was, uh, made a difference very much in, uh, in my, in my women in prison, where they they really had little support in life, starting from family to go on with school where they probably were coming not from a good family, and so you know what happens in school.
Speaker 2:That not necessarily you are considered unless you know you have a parent around to take care of you as well or to sponsor you in a way and sometimes your parents don't even know they might even have neurodifference conditions or they may have other problems exactly
Speaker 2:or any other problem could be and uh and yes, explaining and uh and talking about this and removing as much as possible because obviously that's not an easy thing to do, but trying and working on the shame, the shame for being that, you know, that's probably the first step. But also, I find that my role was absolutely essential in many cases to provide hope and look actually okay, okay, you've got all of this, but it's not a severe mental illness. We can improve. It's not something that you are. You know that there are some difficulties. We can help you. We can do something to help we can.
Speaker 2:There are, there is a set of things that we can do from uh, from psych education, psychotherapy, because obviously people that have lived a life with a severe adhd may also have some low self-esteem and other problems that have accumulated over time. So, starting from psychotherapy, psych education, coaching for adhd medications as well, and especially what I said also earlier this time, trying to improve structure and routine, making very, very clear actually for you it's not important, it is essential that you have a routine and you sleep enough, and so on dr alex, thank you so much for coming on the podcast before you go.
Speaker 1:Yeah, finally, where can our listeners or viewers find you and get information, to seek, potentially, a consultation or just like to find out what you do? So they can, you know, tap into what you're doing and maybe get support if they're, you know, dealing with a neurodiverse condition like adhd um work in privately.
Speaker 2:I work at Harley Therapy, so any listener could actually research my name at Harley Therapy and my Instagram page. It's mental health business with mental underscore health underscore business, so you can find me there as well. It's a new page, um, but I'm trying to develop the page as well for uh information and uh support for uh for patients as well.
Speaker 1:Thank you so much, dr alex, for coming on to vine enigma. You're really really, really, really wonderful guests and you've dropped so many gems and I'm sure a lot of value would be given to the listeners and viewers of this podcast. So thank you again.
Speaker 2:It was a pleasure and thank you so much again for inviting me. I'm very pleased that he was here and, yeah, I hope to come back again.
Speaker 1:Yes, definitely, come back again, please. To come back again. Yes, definitely come back again, please, thank you. Thank you.
Speaker 1:I just want to let our audience members know about the six-week coaching program that I'll be offering for people who are neurodivergent and who want to improve their career prospects in general or those who want to get into project management. You can also be non-neurodivergent too. I mentioned this earlier in previous episodes, but I want to make the time to offer it up to those looking for help in those areas in their life, as it's a great way to learn new skills to help you advance in your career. I'm also offering my support to people who want to pass the print to practitioner exam or other project management exams, as I've taken and failed the test a few times and I would like to help others by showing them how I passed.
Speaker 1:I also launched my membership Neuro in Eggman, in which you get supportive community career and business mentorship, monthly group coaching calls, networking opportunities, mental health well-being days and unlimited body doubling sessions and UK and very soon, international meetups. I'm also working with the British Dyslexic Association and Lexic, one of the UK's biggest neurodiversity organisations, to ensure our members get free full neurodiversity assessments accredited with an educational psychologist or doctor. So if this sounds like you're interested to learn more, please reach out to me directly to talk more about the membership. Please follow me on all platforms where you listen to podcasts. This is a safe place for project managers, professionals, side hustlers and anybody who's looking to navigate the complexity of being neurodiverse in the workplace and the corporate space. I'll see you next time.
