Why Go II

Quite often we are lost even with regard to identifying what hurts. Of all the patients who have come to me complaining of some kind of sexual problem, perhaps one out of seven or eight of them really had one. Usually we discover that in fact all their organs and sexual desires work just fine but that there are certain interpersonal situations in which other feelings -- usually anxiety or anger -- are interfering with sexual activity.

The same is true of Attention Deficit Disorder, which has become a very popular label. Again, perhaps 1 out of 8 such referrals is a true case of attention deficit. Instead the problem turns out to be an interpersonal one between the child and specific authority figures, or a case of anxiety, or any one of several other possibilities. So what hurts is not, for example, "I can’t focus", but rather "That teacher makes me nervous" or "I can’t concentrate when my parents are always fighting; it infuriates me and I’m afraid they’re going to split up".

Ironically, the most glaring case of this disorder I ever saw went undiagnosed for all 17 years of the boy's life. When he went to a psychiatrist who specializes in attention deficit, this colleague told me it was one of the clearest and easiest diagnoses he ever made. (The opposite seems to be true of adults; more often than one would expect, what appears to be an emotional problem turns out to be a problem in focusing and maintaining attention.)

Just what are "psychological problems"? What's a symptom?