Impulsivity and Its Bioenergetic Relationship to ADHD
Peter A. Crist, M.D.
Reprinted from the Journal of Orgonomy, Vol. 29 No. 2
The American College of Orgonomy

Distractibility, restlessness, and impulsivity are often seen in children. As problems, they are the most common presenting symptoms in children brought to mental health professionals (1). Through the years this symptom constellation has been given various designations including minimal brain damage, minimal brain dysfunction, hyperkinetic syndrome, and attention deficit disorder. Many of these children are now given the diagnosis of attention-deficit/hyperactivity disorder (ADHD).

ADHD is currently receiving widespread attention from psychiatrists, neurologists, psychologists, educators, parents, and the general public. Millions of dollars are being spent on research (2). The popular press has seen numerous books and articles including several magazine cover stories in recent years [Footnote 1] (3). Yet, with all that has been written and scientifically presented, the debate continues as to the cause and most effective treatment of ADHD. Is ADHD a psychological or a physical disorder? Are these children sick or just especially lively normal youngsters? Is the problem inherent in the children or is it the result of faulty upbringing, in particular the parents failure to discipline them (nature vs. nurture)? Does the diagnosis of ADHD even represent a true disease entity? Among the numerous observations and opinions, however, it is generally accepted that impulsivity is one of the key problems in those given the label ADHD.

Before we accept new diagnostic terms such as ADHD, it would be valuable to first review well-established knowledge. Reich's landmark study of the impulsive character more than seventy years ago stands applicable today as a solid basis from which to understand the emotional dynamics of impulsivity (4). A review of Reich's later work on biopathies and the relationship between emotions and the autonomic nervous system will help further ground our understanding of a disorder that is indeed biological, a product of disturbed energy functions.

The case of a child treated with medical orgone therapy will provide a focus for a general discussion of the characterological and bioenergetic understanding of impulsivity and its relationship to ADHD. We can also see how this therapeutic approach compares to standard treatment, which almost invariably includes the medication Ritalin [Footnote 2] in combination with behavioral therapy.

Case Presentation

J was evaluated at age six and a half at the end of his kindergarten school year. His adoptive parents were concerned about a long pattern of behavior problems both at home and in school. The problems were evident even before preschool, but in kindergarten they became more noticeable. He was disruptive, restless, and inattentive in class. At home he failed to listen to his parents, was disrespectful, arrogant, and frequently lied. If he wanted something, he would just take it. He had been caught with valuable items taken from his father's locked desk and money from his mother's purse. He was quite clever at locating his parents' keys without their knowing it. He was also found with toys belonging to other children, which he claimed had been given to him at school or when he visited on play dates. Most of these explanations were revealed to be fabrications.

J was also willful. If he wanted to do something, he would just do it. For example, if he was told to wait before going outside to play, he would go out anyway. If stopped, he would sneak out the back door or get angry and yell, throw things and slam the door. He often became angry, especially when thwarted, and acted it out in spiteful, disruptive ways. As long as he got his way there were no major blow-ups, but he was always restless. His parents said he was also sweet, helpful, and affectionate at times. They did not trust this side of his nature, however, attributing his good behavior to attempts at manipulation of them. On occasion he was capable of sustained attention to activities of his own choosing. A careful review of how he behaved, and under what circumstances, revealed his willful, self-centered behavior to be related to his failure to control his impulses, especially those that were aggressive and gratification-seeking. He rarely showed genuine feeling for anyone else.

J was adopted at birth. There were no known physical problems during the pregnancy and delivery. He passed the usual milestones of physical development at or slightly ahead of time. Emotionally and temperamentally, however, his adoptive mother reported he always seemed immature, demanding, and impatient. For example, when J was an infant she made sure to have a bottle with her at all times because he would throw a tantrum or put up a great fuss if not attended to immediately. When he was a toddler and preschooler, she always carried cookies or juice for him because even as he got older he threw tantrums if hungry or thirsty.

The family consisted of father, mother, and younger adopted sister. The father was a busy, workaholic, corporate executive with serious heart disease. He was rarely at home except when his medical problems forced him to take time off. As a practical, no-nonsense businessman, he was quite skeptical about the value of therapy. The mother, an active homemaker with many other responsibilities, was very involved in the children's daily activities.

The parents were polarized in their attitudes toward J. The father imagined the worst and said that if J was acting like this now what would happen when he entered adolescence? He feared J would become involved in drugs or alcohol, and end up in jail. "If he is stealing from us and from kids at school now, what criminal behavior will he be doing later?" He found J's behavior incomprehensible because it was so different from his own hardworking, law-abiding attitude as a youngster. He just wanted J's problems fixed so that they would no longer disrupt the family and the peace and quiet he wanted in his only refuge from his hectic work life. He was inclined to be critical, harsh, and arbitrary in assigning punishments, but was often not around to enforce them. Meanwhile, the mother, trying to be understanding, often made excuses for J and was lenient with him. She usually thought he was just a lively kid who would outgrow his bad behavior.

Her disciplinary style allowed J's behavior to continue until she was provoked. She would then scream at him. She often threatened a consequence for his behavior but failed to follow through in the face of confrontation and J's angry outbursts. Contained in the parents' understanding of J's behavior and their methods of trying to cope with it were rational elements: the father wanted to stop J's neurotic behavior and the mother wanted to make emotional contact with him. To complicate matters further, as is not at all uncommon, the parents had significant unresolved marital tensions which often prevented them from cooperating with each other. Instead, they tended to argue about whose approach was right. Both acknowledged that J's behavior was better when he was alone with his father. The father cited this as evidence that he was handling J better than she. The mother cited this as evidence that J needed his father around more. (One of her own marital complaints was her husband's unavailability.) With his energy, persistence, perceptiveness and cleverness, J could play this lack of a unified approach to his advantage.

From age five to six and a half they had taken him to a number of psychologists and other mental health professionals, but felt these interventions had had little effect. Most recently he had been seen by a pediatric neurologist who diagnosed attention-deficit hyperactivity/disorder (ADHD) and recommended that he be started on Ritalin. Both parents wanted another opinion. The mother in particular was uncertain about using medications and wanted an evaluation to explore what else might be done.

On initial evaluation J was a bright, lively boy with an "in charge" attitude. He spoke to me as if he were interviewing me. He began to talk more rapidly and with pressured speech whenever I tried to pin him down on any subject or get him to tell his feelings. He was intense, engaging, and expressive but emotionally cool and aloof. He also had a glib, tough-guy, con man facade. Though not in touch with his emotions, he was driven by disturbing feelings. For the most part this was anxiety, although outwardly he showed very little discomfort. I had the impression he was constantly and acutely aware of my reactions to everything he said. His mind was quick and he spoke with great authority, but rapidly changed from subject to subject, often without clear direction. When asked about any of his emotions, his thinking became circumstantial and even tangential but with a controlled and controlling quality. His emotional expressions were lively and changeable but lacked warmth and human connection. When asked factual questions, he could pay attention, concentrate well, and remember details adequately. However, when asked about his relationship with the family or related matters, he became distracted and turned his attention elsewhere. His intelligence was estimated to be above average. He demonstrated no evidence of other cognitive function deficits. In this first evaluation session he was generally well-behaved except for his excessive tendency to take charge of the situation.

When told to lie on the treatment couch, he briefly appeared puzzled and uncomfortable. He quickly regained his composure, sat cross-legged in the middle of the couch, and began talking nonstop. With a mature manner and using adult words he told me about plans for the trees, shrubs, and gardens at their new house and of all his talks with the landscape architect. I again told him to lie down and he briefly did so while giving me a wary glance. A hint of anxiety showed momentarily in his eyes. He immediately popped back up to a seated position and began telling me about various sporting activities he liked to do. After repeated attempts to have him lie down by asking, then telling, and then demanding that he do so, I finally pushed him back gently and kept him recumbent by gentle nudges with my hand whenever he tried to sit up. Uncomfortable and fidgety, he crossed and uncrossed his arms and legs.

On biophysical examination, his eyes had a challenging expression. They were mobile when he looked about the room but when asked to track my finger as I moved it about, he had some difficulty. He was often ahead of my moving finger and tried to anticipate where it would go. His occiput was tense and tender. He had moderate armor in the muscles of his jaw. His voice had a tight, strained, somewhat hoarse quality. He held his neck stiffly with considerable tension in his sternocleidomastoid muscles. He tended to hold his chest in the inspiratory position but it moved adequately when he breathed. The intercostal muscles were very ticklish especially under his arms. He had marked tension and moderate hypertrophy of the thoracic paraspinal musculature. His abdomen was tense and ticklish. His pelvis was held rigidly His legs had normal muscle bulk but were somewhat tense and ticklish. He was agile and quick in his movements despite the extensive holding throughout his body.

Course of Therapy

Individual medical orgone therapy was begun with the goal of help-ing J make better contact with his warded-off emotions and improv-ing his ability to attend and concentrate. He also needed to become more aware of the consequences of his actions in order to rein in his impulsivity. It was quite evident that he deflected his feelings through constant motion and distraction. Treatment would require that J come to focus and discharge the deeper emotions he was avoiding but also partially relieving with his "hyperactive" behavior.

To accomplish this it was important to stop his contactless discharge of energy which manifested physically in restlessness and fidgeting, and behaviorally in the sneaky con man way he expressed himself. For example, when he was told to lie still on the treatment couch with his arms and legs relaxed and straight, he often sat up, taking charge, or would sneakily cross his legs or arms. To address this behavior, I either pointed out his acting the boss or his sneakiness. I also actively took control by telling him what to do, pushing him down, or holding him still.

On the couch, he was usually either unable or unwilling to lie still. When I physically restrained him to stop his movement, he initially became anxious and then quickly angry. I had him express the anger by giving me angry looks, hitting and kicking the couch, and punching a bolster-like device around my arm. He expressed a combination of genuine emotion and the attitude that this was just a game. I encouraged him to get out his negative feelings toward me and therapy, and he expressed them indirectly by refusing to do what I asked of him.

After several months of therapy which proceeded in this fashion, his mother reported that he avoided being alone, always wanted the light on at night, and frequently came into the parental bed. She said even though he seemed afraid of the dark and of being alone, he never said he was afraid but instead had various rationalizations for his behavior. During this time, his tough-guy, "I'm the boss" attitude in therapy intensified. He said in a provocative tone, "You can't tell me what to do." He also continued to be sneaky and with "I dare you" looks, crossed his legs, or put his hand under his head, often defying me when told to do something. When asked to breathe, he usually gave me a sly look and sometimes pumped his chest in a forced mechanical manner.

This resistance intensified in the several sessions that followed. I again held him still without allowing any movement. He struggled against my restraint, became more frustrated, looked me straight in the eye and said, "I hate you." His eyes welled up with tears and he said, "You don't care about me. You're just doing this for the money. Nobody cares about me. My real mom didn't want me. My mom now doesn't listen. My dad is too busy to spend any time with me." He cried briefly and I kept my hand on his chest where I had just restrained him. He did not struggle against me or try to take my hand away, and accepted some comforting from me. He then quickly composed himself and put his shoes on while talking about some sports event, as if nothing had happened between us. His mother reported he was more calm at home for the remainder of that evening and most of the next day.

In the course of the first year of treatment J showed some improvement in his emotional contact with me in therapy and in his behavior at school, but only limited improvement at home. After a year and a half of therapy J had calmed down enough that when his father took him to a school event where he was well-behaved, a school administrator commented, "I'm glad you finally put him on Ritalin." (Note: J was never given any medication.) The father, who had been urging a trial of Ritalin because he was not convinced of significant improvement, then was able to acknowledge that perhaps there was something to the therapy. At this point the parents began reporting he had improved at home, but also noted that improvements were soon followed by a return of the original problematic behavior.

Late in his second and early in his third year of therapy a number of family stresses occurred which in the past would have precipitated a deterioration in J's behavior. In the most stressful periods his lying, temper outbursts, and aggressive behavior with his sister increased at home, but improvements at school were maintained. Once school was out for the summer he did well at camp, but old patterns surfaced whenever he was out of the structured environment of either school or camp.

J had difficulty at the beginning of third grade. He was again in trouble for disruptive behavior, calling out in class, and pushing other pupils. Consultation with the parents and his new teacher addressed these problems promptly with a behavioral (reward/punishment) approach to which he responded quickly. Throughout the year this intervention was reasonably successful in containing disruptive behavior at school. He continued to improve overall, but intermittently had the same tendency to call out in class, be easily distracted by anyone near him or by what they were doing, and to do rushed and sloppy schoolwork. In his individual therapy sessions he discharged some anger. He was negative and stubborn much of the time, but as long as he was expressing himself emotionally, and not impulsively, I felt progress was being made. At least his behavior was more controlled at home and in school. By this time he could emotionally discharge his negativity by engaging in a "No!"/"Yes!" shouting match between us.

I met jointly with J and his mother on several occasions to have him face responsibilities. When confronted, he often responded by getting up to leave the room or kicking the chair on which he was sitting. At these times I physically restrained him. He struggled against me and became hot, sweaty, and emotional. His mother noted he was calmer after these episodes. She gained the courage to be more aggressive and held him accountable at home. Occasionally she physically restrained him and he became passionately angry and expressed it directly to her. He often said hurtful things at these times such as, "I don't have to listen to you. You're not my real mom." Although these episodes were always emotionally difficult for her, she saw clearly that he calmed down afterwards and was generally more cooperative for a few hours to a few days. In therapy he occasionally said that he knew his behavior was self-defeating. I felt we were making a more consistent emotional connection and I developed more empathy with him as he now appeared to be more a troubled boy than a con man.

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