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

Nature vs. Nurture

Since ancient times it has been known that primary lesions of the brain caused by trauma, infection, etc. result in secondary emotional and behavioral reactions. As early as the 1870's it was observed that frontal lobe lesions of the brain were associated with problems of impulse control. By the 1930's Kahn and Cohen noted hyperactivity with brain stem lesions and proposed the concept of "organic driveness" (25). Such observations led to the conclusion that problems of impulse control were caused solely by brain lesions. Theoreticians since have argued over whether the symptom complex now called ADHD is neurological or psychological in origin. The long list of names for this disorder reflects the numerous and changing theories about its cause.

When no gross brain lesions could be demonstrated, such problems were attributed to "minimal brain damage," that is damage that could not be detected. When more sophisticated means to evaluate brain Pathology were developed, and they still failed to find any lesions, the term "minimal brain dysfunction" was employed to account for a disturbance in function without evidence of structural brain changes. The psychoanalytically-oriented second edition of the Diagnostic and Statistical Manual (DSM-II) used the term "hyperkinetic reaction of childhood." In their effort to be purely descriptive and phenomenological (rather than attribute cause to Psychological or physiological factors), the authors of this section of the DSM-III chose the diagnostic term "attention deficit disorder" (ADD). The most current term, employed in the DSM-IV, is "attention-deficit/hyperactivity disorder" (ADHD).

Mechanistic research seeks an anatomic or physiologic basis for this disorder and regards observed structural or physiological changes as its cause, attributing these to as yet undiscovered defects that are either inborn ("genetic") or have developed since birth. The orgonomic, functional (energetic) approach is quite different. It considers characterological impulsivity a biological disorder of pulsa-tion (a biopathy) that manifests primarily in the emotional realm but which has concomitant physical changes as well. These physiologic and/or structural changes result from the underlying energy disturbance (an effect of armor) which precedes and causes them to develop in the individual. [Footnote 14] For example, a recent discovery in those diagnosed with ADHD is decreased metabolic activity of the brain's frontal lobe cortex, as demonstrated by positron emission tomography (PET) (26). The frontal lobe cortex is known to be associated with impulse inhibition and such findings of alterations in neurophysiology, without demonstrable structural change, suggest this area of the brain as a primary site of armor in this disorder. [Footnote 15] The very subtlety and variability of the physiological findings associated with the diagnosis of ADHD are more consistent with a primary emotional/energetic process than a primary physiological disorder. Some of the other physiologic findings, such as signs of excess vagal (parasympathetic) tone demonstrated in studies of heart rate variability (27) as well as studies indicating resistance to thyroid hormone (a sympathetic nervous system hormone) (28) directly support the formulation of a parasympathetic predominance of the autonomic nervous system in these cases.

The mechanistic approach creates confusion when it fails to adequately differentiate the inborn physical nature and the individual's psychological development. Articles in the popular press report patients with ADHD stating that they have a high level of energy. Individuals born with a high energy level are more prone to develop problems in an armored society because of the difficulty finding acceptable outlets for their energy. Unable to fully restrain such a child's natural impulses, the parents' partially successful attempts only lead to greater impulsivity on the part of the child.

Identical twin studies that demonstrate significant genetic factors and other research that reveals a familial pattern for ADHD are cited as proof that the disorder is inborn and biological (29). In fact, it is just as likely that particular qualities present from birth are associated with a greater likelihood of developing particular emotional pathologies. J, for example, was excitable, quick to express himself and to act right from birth. Someone with these qualities will use them defensively and will be more likely than others to become impulsive.

The Underlying Bioenergetic Basis of ADHD

A year and a half of medical orgone therapy had enabled J to calm down so noticeably that a school administrator thought he had been medicated with Ritalin. Ritalin (methylphenidate), as well as other drugs used to treat ADHD, are central nervous system stimulants. Their calming effect in the disorder is considered paradoxical because they are stimulants. One would expect, thinking "logically," that such an agent would only cause greater excitability. These agents, which include amphetamines and caffeine, also have positive effects on the other symptoms associated with ADHD. They produce the same effects as an activation of the sympathetic nervous system and are there fore termed sympathomimetic. With this in mind we are now able to form an orgonomic (energetic) hypothesis as to the true mechanism that underlies ADHD and why the disorder's symptoms are (paradoxi-cally) relieved with central nervous system stimulants. ADHD has at its root an over stimulation of the parasympathetic nervous system. In such individuals the sympathetic/parasympathetic nervous systems are not in a reciprocal balance - as they are in health. Amphetamine-like drugs offset the parasympathetic over-excitement and bring about a degree of stabilization by inducing an energetic contraction. These drugs improve the more mechanical aspects of attention disturbance (i.e., test-taking) (30). Drug treatment follow-up studies show no consistent evidence that medications improve learning or have a demonstrable long-term effect on impulsive character reactions (31).

Behavioral modification modalities make up the other common traditional therapy for ADHD. One might expect this approach, which attempts to bring about an unlearning of maladaptive behaviors, to produce some restraining effect on secondary, neurotic impulses. But such behavior modification techniques are mechanical and are not designed to help individuals come into contact with their underlying repressed emotions or provide an outlet for them. A behavioral approach cannot address the root causes of the condition any more than medications can. Medical orgone therapy, however, does just that because it takes an integrated approach to the full range of manifestations of the patient's disturbed energy functioning.

The Social Problem

Dealing with inattentive, restless, impulsive children involves much more than controlling their symptoms with medications and behavioral modification. Most people instinctively want to try to stop these children from being impulsive, at least initially. What they don't know, but find out soon enough, is that this alone is ineffective. What is required is stopping the impulsivity and helping the child to face his anxiety. While a daunting task, especially for those whose patience is lacking or has worn thin, the importance of parental involvement and attention to their children cannot be overestimated (32). In order to help these children most effectively we must also understand the broader social context and see how it aids and abets impulsivity. [Footnote 16] Our modern society supports action and instant gratification, the quick thrill. Endless options excite and distract, but lack sustained emotional attention and connection. There is also a failure within our culture to hold individuals accountable for their actions.

In this regard, Breggin noted that the diagnosis of ADHD as it is currently used together with drug treatment has significant negative consequences (33). Telling a child he has a neurological condition, ADHD, that necessitates medication serves to absolve him and parents of responsibility for his behavior and undermines the principal requirements for genuine and lasting change. Parents must take responsibility for rationally handling their children's behavior and the child must be helped to take responsibility by making emotional contact with his actions.

Conclusion

There are no shortcuts or pills to cure the deep disturbances in the emotional structure of impulsive children. Medical orgone therapy has brought some success with this patient and with others, but it is not a panacea. J has been helped to live more with his deeper emotions. How he weathers the storms of adolescence, however, will put to the test how much has been accomplished. Impulsive children are a great challenge and require a tremendous commitment and effort on the part of family, teachers, and therapist. Although medical orgone therapy of individuals and families can reduce impulsivity and avoid the chronic character disorder seen in adult life, the greatest hope lies with preventing the development of the disorder as children mature from infancy through adolescence.

Footnotes

1. A recent computer search of an index of popular magazines showed entries for over one hundred articles about this disorder in the past two years alone.
2. Ritalin (methylphenidate) is a mild central nervous system stimulant related to amphetamine ("speed") that was found in the 1950's to have an apparently paradoxical calming effect on hyperactive children.
3. The character develops from the individual's experiences that grow out of the interaction between his individual nature and his environment and not from the specific historical events that occur. Orgonomic character diagnosis therefore is based upon an understanding of the patient's essential present-day defense mechanisms rather than deducing it from historical information.
4. The structure and discipline of these coached team sports also reinforced the needed changes in his behavior.
5. It was, in fact, Reich's work with impulsive characters that led to the development of character-analysis(7).
6. Konia (8) and Heimbach (9) reported on the treatment of adult impulsive characters. Crist reported on the treatment of impulsivity in a child who was probably a childhood impulsive character (10).
7. Baker identified two major types of emotional blocks, repressed and unsatisfied, in which either the inhibited or the impulsive tendency is confined to a specific stage of psychosexual development (14).
8. Reich conceptualized the "basic antithesis of vegetative life" and identified that pleasure and expansion are associated with the parasympathetic branch of the autonomic nervous system and anxiety and contraction with the sympathetic branch (15).
9. "Biopathy," a term coined by Reich, denotes those disease processes characterized by a primary disturbance of the biological function of plasmatic (energy) pulsation in the total organism (16).
10. Harman, R.A. In a personal communication.
11. Clinical observations support the idea that perception and excitation are heterogeneous functions that can transform into each other. See Myerowitz's explication of heterogeneous functions and their operations (18).
12. A number of children and adolescents meeting criteria for ADHD and treated in medical orgone therapy were not impulsive characters. Their individual character diagnoses included phallic, passive-feminine, and paranoid schizophrenia. They were all, however, significantly impulsive in their behavior.
13. "Deficit of attention" is a nonspecific term for perceptual problems that can range from subtle perceptual distortions associated with any of the character types (24) to severe disturbances with marked ocular armor such as those seen in schizophrenia.
14. The orgonomic understanding also includes the well-accepted observation that primary lesions of the brain have secondary effects on the behavior of the individual.
15. These findings also intriguingly suggest an antithetical relationship between frontal cortical activity and emotional expansion. We also know that cortical brain activity is associated with intellectual activity and that there is an antithetical relationship between this and sexually pleasurable expansion.
16. Editor's note: The increased prevalence of impulsive behavior among children and adolescents is one of the destructive social consequences of the breakdown of the authoritarian family structure during the past several decades. The social processes which underlie this rise in impulsivity in our society will be examined in depth in subsequent issues of the Journal of Orgonomy. CK.

REFERENCES

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2. Goldman, E.L. "Massive Trial to Study ADHD Management, "Clinical Psychiatry News, October, 1995, 5.
3. a. Blau, M. "A.D.D. the Scariest Letters in the Alphabet," New York Magazine, 26 (49): 44-51, December 13, 1993
b. Wallis, C. "Attention Deficit Disorder: Life in Overdrive," Time, 144(3): 43-50, July 18,1994.
c. Leavy, J. "Mother's Little Helper, with Ritalin the Son Also Rises," Newsweek, March 18, 1996, 50-56.
4. Reich, W The Impulsive Character and Other Writings, (trans. Koopman, B.G.), New York: New American Library, 1974. Also published in five parts in Journal of Orgonomy, 4:4-18,149-166, 1970; 5:5-20, 124-143, 1971; 6:4-15, 1972.
5. Crist, P.A., "The Biosocial Basis of Family and Couples Therapy," Journal of Orgonomy, 2 7:166-189, 1993
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7. Reich, W The Impulsive Character and other Writings (trans. Koopman, B.G.). Op. Cit.
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9. Heimbach, S. "An Impulsive Character: Problems of Diagnosis and Treatment," Journal of Orgonomy, 19:26-41, 1985.
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11. Reich, W The Impulsive Character and other Writings, (trans. Koopman, B.G.). Op. Cit.
12. Reich, W Function of the Orgasm (trans. Wolfe, T.P.). New York: Farrar, Straus & Giroux, 1961, 119.
13. Ibid.
14. Baker, E.F. Man in the Trap. New York: The Macmillan Co., 1967.
15. a. Reich, W "The Basic Antithesis of Vegetative Life," (Part 1) Journal of Orgonomy, 1:4-22, 1967.
b. Reich, W "The Basic Antithesis of Vegetative Life," (Part 11), Journal of Orgonomy, 2:5-23, 1968.
c. Reich, W Function of the Orgasm (trans. Wolfe, T.P.). Op. Cit., 255-265, (summary of a. and b. above.)
16. Reich, W Cancer Biopathy New York: Orgone Institute Press, 1948, 129.
17. Reich, W Character Analysis. New York: Noonday Press, 1949, 441-442.
18. Meyerowitz, J. Before the Beginning of Time. Easton, PA: rRp publishers, 43, 45-47.
19. Crist, P.A- "A'Problem'Child," Op. Cit.,199.
20. Diagnostic and Statistical Manual of Mental Disorders, 4th edition. Washington, DC: American Psychiatric Association, 1994.
21. Barkley, R. Taking Charge of ADHD: The Complete Authoritative Guide for Parents. New York: The Guilford Press, 1995, 43-54.
22. Braughman, F.A. "Fundamentally Flawed" (letter), Clinical Psychiatry News, January, 1996, 8.
23. Arnold, L.E. and Jensen, P.S. "Attention-Deficit Disorders," Comprehensive Textbook of Psychiatry. Op. Cit., 2304.
24. a. Konia, C. "The Perceptual Function in Armoring (Part 1: General Survey," Journal of Orgonomy, 18:226-237, 1984.
b. Konia, C. "The Perceptual Function in Armoring (Part Ii: General Survey," Journal of Orgonomy, 19:122-139, 1985.
25. Kahn, E., & Cohen, L.H. "Organic Driveness: A Brain Stem Syndrome and an Experience," New England Journal of Medicine, 210:748-756, 1934.
26. Arnold, L.E. and Jensen, P.S- "Attention-Deficit Disorders," Comprehensive Textbook of Psychiatry. Op. Cit., 2298.
27. Ibid., 2300.
28. Ibid., 2298.
29. Ibid., 2298.
30. Ibid., 2304.
31. Ibid., 2304.
32. Breggin, P.R. "Q: Are behavior-modifying drugs over-prescribed for America's schoolchildren? (Symposium) Yes: Drugging our children won't cure the problems in schools," Insight on the News, I 1: 18-2 1, August 14, 1995.
33. Ibid.

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