Actually ADHD | Medication Strategies & Clinical Wisdom

After the Clancy deep dive I was in a bad mood, and the antidote is always nerding out. So I pulled some books, took notes, and thought out loud about why the things we look at run us more than the things around us.
Jonathan Murphy, PMHNP-BC, on Walter Lippmann's pseudo-environment, why stereotypes are cognitively necessary rather than simply bad, and what any of it has to do with a frontal lobe that isn't fully online.
This episode covers:
 ▸ Why the screen is the problem for a creator whose work is about mental health
 ▸ Medium as the thing in between, and why 99.9% of our communication is reception
 ▸ Lippmann on the feeling aroused by a mental image of an event you never experienced
 ▸ The amygdala, hippocampus, and adrenal response happening before you can think
 ▸ Why ADHD makes you a passenger on that ride
 ▸ The pseudo-environment: behavior responds to it, but acts land in the real world
 ▸ Where the contradiction develops, and what that looks like with a true crime case
 ▸ Fiction, fidelity, and why a novel doesn't mislead you but a feed can
 ▸ Being told about the world before you see it, and what preconception does to perception
 ▸ The landscape in the parlor: recognizing the sunset because you already saw the painting
 ▸ Why abandoning all stereotypes would impoverish human life rather than free us
 ▸ Bertrand Russell's code of science from The Impact of Science on Society
 ▸ Marcuse on the welfare state as a state of unfreedom
 ▸ Why the first move when you're anxious is to look at what's been going in
The book The Process: An Adult's Guide to ADHD Medication is available on Amazon: [link]
Find the YouTube channel Focus Path | PMHNP-BC for the full clinical education catalog.
For educational purposes only. Not medical advice. Consult your own provider for clinical decisions.

What is Actually ADHD | Medication Strategies & Clinical Wisdom?

Adult ADHD from the board-certified PMHNP behind the YouTube channel Focus Path and the book The Process. Clinical perspective on medication, frameworks, and the conversations the internet hasn't been having.

This is Actually ADHD.

My name is Jonathan Murphy,
psychiatric nurse practitioner.

Welcome back.

This podcast is sponsored by
the Focus Path YouTube channel.

You can go ahead and look that up.

At Focus Path Systems on YouTube So
I've been doing a lot of thinking,

especially since going into that deep
dive of the Lindsay Clancy trial.

And if you came to me because I was
talking about that, then you probably know

how I feel, which is gets in your head.

It's like all this negativity, it's left
me in a pretty bad mood, just bummed out.

That's just me.

But it does seem to be something
that affects me personally.

I always think about how I feel after or
in relation to when I'm watching certain

things and how the algorithm targets me.

I find myself watching just stuff
I shouldn't want to watch, and

I really don't, and yet it's
recommended at 3:00 in the morning.

Someone getting arrested or just…

So I'm trying not to do that,
and the antidote for me is always

some reading, some nerding out.

So I did some nerding out because I'm
thinking about scripts to write for

the next episodes or the next several
videos, on the Focus Path YouTube channel.

I do a lot of research.

I write everything myself,
do the thumbnails, do the

videos, everything team of one.

I've been thinking a lot more about media
literacy because my YouTube channel's

about mental health infotainment, and yet
it's through a screen, which is really

tricky because the screen is honestly
the problem for me, is the screen.

And being a creator and just engaging
with technology to create, it does

expose me to things on a level that
I wouldn't wanna be involved with

otherwise or wouldn't be otherwise.

And part of the problem with becoming
a creator in the beginning or creating

beyond just writing was, oh, I gotta,
to post, you gotta interface with the

technology And then you start uploading
YouTube videos and it's like a dopamine

firework show But nonetheless, if I
keep it creative, keep the spark there,

and have boundaries of these tools,
it works out But in preparation to do

some media literacy education, I was
reading a few books and I pulled some

quotes, and I just kinda wanna react to
some of the things that I highlighted.

Another good purpose for this podcast,
is to kinda nerd out and process with

you guys, think out loud one of the
things that I certainly, as someone

that grew up in front of the television

As I like to say, I was put in front
of the TV, which was my babysitter, and

then I was blamed for it nonetheless,
TV and movies, that was m- my life.

I thought in images.

My world was through glass

I never knew that it would
have such an effect on my mind,

my perception, my thinking.

In fact, growing up, you always
hear, "Oh, yeah, it's just

like, ' No, it doesn't do that.

It's just TV.'"

Of course, the things that go in
your head affect your emotions.

And in Walter Lippmann, the
other 1920s propaganda guy.

But his book, "Public Opinion," has some
really good concepts and really helpful

concepts because for people with ADHD,
we're just, like, taking the stuff in,

and the stimulation of the devices and of
media in general can just be overwhelming.

This is the counterbalance.

This is the why in it all.

This is the reason why we're gonna
wanna go, " You know what maybe

it's not such a good idea to just
be doom scrolling all day long."

Your brain smashes that electricity
against stored memory and

The next thing you know, you got an
emotional reaction, which involves the

amygdala, the hippocampus, and the adrenal
glands, other parts of the brain as well.

But it all happens so quickly.

We're just kinda along for the ride,
and if you have ADHD, your frontal

lobe isn't there, so you're just
literally just living moment to moment

So let's think about that.

And the reason why we call videos or
books or screens media is because the

word medium, being the thing in between.

So communication is the act of More
than one person sharing information.

So we individually each
communicate in two different ways.

We communicate verbally or
otherwise creating like I am now.

We can write.

You can send information and communicate,
let's say, efferently or externally.

But the reality is 99.9%

of the communication that we're
doing is receiving communication,

passive communication.

" The feeling that anyone can
have about an event he does not

experience is the feeling aroused
by his mental image of the event."

That's Walter Lippmann.

So we think in terms of images as we live,
we accumulate various images in our mind

We believe things and then we store it
as like a Polaroid in our mind or a .JPG

in our mind.

And what's happening around us doesn't
need to look any other than calm.

Could be a normal situation,
just a regular Tuesday.

But our brain can take in this
information, tag it, and suddenly

that image in our mind that the
hippocampus pulls up, that's

what the emotions react to.

So what Walter Lippmann is talking about
here is essentially the process of the

amygdala and the hippocampus reacting to
the various multi-sensory stimulation,

things we hear, see That ultimately is
something that happened early in our life

We cannot know what people think, truly.

We don't know what their
mind is literally thinking.

However, we can understand their
behaviors, other people's behaviors,

based upon what people think they know

it is the insertion between man,
the medium, and his environment

of a pseudo-environment.

Pseudo.

We react to stimulation
in our environment.

However, that stimulation activates
what we call the pseudo-environment,

according to Walter Lippmann.

The pseudo-environment, the
behavior is a response to the

pseudo-environment, but because
behavior is behavior, the consequences

of that behavior, those are acts.

Acts operate not inside
of the pseudo-environment.

Acts operate within the real environment
Where the behavior is simulated, but in

the real environment, action eventuates.

But when the stimulus of pseudo fact
results in actions on things or other

people, contradictions soon develop.

Okay, let's bring it
back to Lindsay Clancy.

We got information coming in
through the phone, all this, you

know, TikTok and all the stuff
you're doing on the phone, whoever.

And there's just Bob
walking down the street.

Bob doesn't know about all this stuff,
and this person's completely unhinged,

freaking out, losing their mind.

Well, the person losing their mind
is losing their mind not because of

stuff that's going on around them, but
because of the mental images they have.

So the environment they're acting
out this behavior, the behavior

comes from the pseudo environment,
the mixture of the environmental

stimuli mixed with the mental images.

And then Bob's walking down
the street and he's like, "This

person is completely unhinged."

There's the contradiction, the
environmental contradiction

But when the stimulus of the, pseudo
fact, so that would be like Patrick

Clancy killed those children.

The victim killed the
children, Patrick Clancy.

That's the pseudo fact

so when the stimulus of the pseudo-fact
results in actions on other things or

other people, contradiction soon develops.

For certainty at the level of social
life, what is called adjustment

Of human to his environment takes
place through the medium of fiction.

A work of fiction may have
almost any degree of fidelity.

As long as the degree of fidelity
can be taken into account,

fiction is not misleading.

So when you pick up that Harry
Potter book, you're not misled.

You know you're reading a book.

You know you're reading a
story, and you're not misled.

It's a story The alternative to the
use of fiction is direct exposure

to the ebb and flow of sensation.

So the alternative to the use
of fiction would be reality

That is not a real alternative for
however refreshing it is to see at

times with a perfectly innocent eye.

Innocence itself is not wisdom

So storytelling matters is the, is,
is the big takeaway from that one

But I did bold something from Mr.

Lipman, and then I'll move on We are
told about the world before we see it.

We imagine most things before
we experience them, and those

preconceptions, unless education
has made us acutely aware.

So that would be me, because I didn't
know any of this stuff when I was

growing up They mark out certain
objects as familiar or strange.

So symbolism, thinking about life and
making sense of our lives through the

use of symbols So that the slightly
familiar is seen as very familiar.

Slightly familiar is very familiar In
the somewhat strange is sharply alien.

They are roused by small signs, which
may vary from a true index to a vague

analogy, arouse the flood-fresh vision
with older images, and project into the

world what has been resurrected in memory
Were there no practical uniformities

in the environment, there would be no
economy and only error in the human

habit of accepting foresight for sight.

But there are uniformities sufficiently
accurate, the need of economizing

attention is so inevitable that the
abandonment of all stereotypes for a

wholly innocent approach to experience
would impoverish, impoverish human life.

So stereotypes are also a very
important concept, and I took

a lot of notes on this section

A man has rarely looked at a
landscape, let us say, except

to examine its possibilities
for division into building lots.

But he has seen a number of landscapes
hanging in the parlor, and from

them he has learned to think of
a landscape as a rosy sunset or

as a country road with a church.

Then the sun goes down looking rosy.

At once, he recognizes a landscape
and exclaims that it is beautiful.

But two days later, when he tries
to recall what he saw, the odds

are that he will remember chiefly
some landscape in the parlor.

Steeple and a silver moon.

For even without phrasing it is
to we feel intuitively that all

classification is in relation to some
purpose, not necessarily our own.

That between two human beings,
no association has final dignity

in which each does not take
the other as an end in himself.

But it's time to move on to Bertrand
Russell, The Impact of Science on

Society in 1952 And there was a,
an interesting quote here, "When

beggars die, there are no comets seen.

The heavens themself blaze forth
from the death of princes."

Charles II perceived that science could
be an ally against the fanatics, as

those who regretted Cromwell were called.

He founded the Royal Society
and made science fashionable.

Enlightenment spread gradually
downward from the court.

This is the code of science.

Statements of fact should be based on
observation, not on unsupported authority.

Two, the inanimate world is a self-acting,
self-perpetuating system in which

all changes conform to natural laws.

Three, the Earth is not the center
of the universe, and probably

man is not its purpose, if any.

Moreover, purpose is a concept that is
scientifically useless those are the rules

of the game according to Bertrand Russell.

But I really spent a lot of time
with Herbert Marcuse, and I never

read anything by this guy before.

Certainly I've heard of him
before, Frankfurt schools.

I gotta react to some of this because
it is straight up super villain stuff.

1952, "The Impact of Science on Society."

" By way of summary, the prospects
of containment of change offered

by the politics of technological
rationality depend on the

prospects of the welfare state.

I've heard the term welfare state before,
and I never really thought anything of it.

It just sounded like just some
phrase that people say to be,

"Oh, it's a welfare state."

But I never heard it defined,
and Marcuse defines it here in

The Impact of Science on Society.

" The welfare state is a state of unfreedom

because its total administration is
systemic restriction of A, technically

available, quote-unquote, free time.

B, the quantity and quality of goods
and services technically available

for vital and individual needs.

C, the intelligence, conscious
and unconscious, capable of

comprehending and realizing the
possibilities of self-determination.

And if the individuals are
preconditioned so that the satisfying

goods also include thoughts, feelings,
aspirations, why should they think,

feel, and imagine for themselves?

Not gonna lie to you.

But there's a lot to dig in here,
and I'm gonna have to read a lot, and

next time I wanna be more organized.

I'm gonna organize my thoughts.

But in the meantime, I just want
you to know that the way you think,

the way your mind works, the way you
recall emotions is based on reactions.

Reactions to your environment,
reactions to the things that you

see, you look at, you swipe on.

All those images go in your mind,
and then something happens before

you can even think about it.

So if you're anxious, if you're
worried, if you're nervous, the first

thing that we need to do is think
about the ideas that are going in our

head, the images that are conjured up.

Since we are really reacting to images
or the pseudo environment, we need to

think about the input of communication.

We're reacting to communication that's
happening from the outside world.

However, how much
communication are we doing?

You know what I mean?

So that is another
episode of Actually ADHD.

I hope you enjoyed this
super nerdy deep dive.

But until next time, my name is Jonathan
Murphy, psychiatric nurse practitioner.

Talk to you later