Positive Psychiatry - with Rakesh Jain, MD
Positive Psychiatry with Rakesh Jain, MD explores the science and practice of fostering mental wellness, resilience, and flourishing through the lens of psychiatry. Join me as I discuss articles and opinions from expert clinicians, researchers, and thought leaders as they discuss emerging strategies to enhance well-being, purpose, and strengths—not just reduce symptoms. From gratitude and optimism to meaning and connection, this podcast brings evidence-based insights into the heart of mental healthcare.
I am additionally a proud member of the Steering Committee of Psych Congress. This year's annual meeting is September 17-21 in San Diego, California.
Positive Psychiatry - with Rakesh Jain, MD
Reframing ADHD: Beyond Deficits to Discovering Strengths
Imagine a world where ADHD isn't just viewed as a collection of deficits but as a unique neurological variation with both challenges and remarkable strengths. That's the revolutionary perspective Dr. Rakesh Jain explores in this thought-provoking episode that challenges conventional thinking about one of the most misunderstood conditions in psychiatry.
Drawing on over three decades of clinical experience, Dr. Jain proposes a fundamental shift from the traditional deficit model to a diversity model that acknowledges the full spectrum of human experience. "Differences aren't deficits—they're variations," he explains, "and every variation comes with strengths and weaknesses." While never minimizing the very real impairments that come with ADHD, this episode illuminates how positive psychiatry can complement traditional approaches by recognizing the creativity, spontaneity, and unique cognitive gifts often present in those with ADHD.
The episode takes listeners on a three-part journey, first challenging conventional thinking about ADHD, then building a positive psychiatry toolkit specifically for ADHD care, and finally exploring how to build resilience and meaning. Dr. Jain shares practical strategies for clinicians and patients alike, including character strength assessments, mindfulness techniques, and ways to identify and enhance "flow states"—those moments of deep engagement where people with ADHD often excel. He also shares a moving personal essay written by a psychiatrist married to someone with ADHD, offering rare insight into living with and loving someone with this condition.
Perhaps most powerfully, Dr. Jain encourages clinicians to help patients reframe their identity from "broken to brave," emphasizing how a genuine expression of admiration for a patient's tenacity can be "as powerful as any medication we can possibly offer." By the end, listeners will understand why the question "what's strong?" deserves as much attention as "what's wrong?" when working with ADHD patients. Whether you're a healthcare provider, educator, parent, or someone living with ADHD, this episode offers a refreshing perspective that could transform how you view neurodevelopmental differences.
www.JainUplift.com
Well, hello to another episode of Positive Psychiatry with Dr Rakesh Jain, and today's episode is one I've been long looking forward to, and it's titled Positive Psychiatry and ADHD a new lens for understanding and helping. That's right. Whether you're a parent, a clinician, a spouse, an educator or someone yourself living with ADHD, I really do hope today's conversation inspires, informs and uplifts all of us. So we're going to cover the signs. We'll also cover the limitations of the current models and how strengths-based psychiatry is transforming care. I've been a psychiatrist now for well over 30-some years, but only relatively recently have I broadened my own view of what psychiatric disorders are and what role positive psychiatry can play in our patients' lives. So this is an episode I'll organize into three parts for ease of our own discussions. So let's begin the conversation with part one, where we challenge how we traditionally think about ADHD. Let's go on this journey. So the first thing we need to do is we have to rethink ADHD and we should apply the following thinking we should go from deficit to a diversity model. Intriguing, isn't it? So the first question is what is ADHD really? Well, it's a neurodevelopmental condition and it affects people from all over the world. Around five to seven percent of children, two and a half to four percent of adults around the world have it, and this is. You know, there's some differences in different countries, but there's not a place you can go to where you can't find ADHD. But the dominant framework of seeing ADHD is only as a problem. It's a problem. It's a disorder with inattention, hyperactivity disorder with inattention, hyperactivity, impulsivity. So about 20 years ago we expanded our vision. We started calling it a disorder of executive functioning. All true, by the way. All of these things are entirely correct, and neuroimaging studies really do show a dysregulation in the circuits that are involved in all that I've shared with you so far and altered dopamine pathways. This is all true, but let's pose ourselves a different question what if this way of attending to the world isn't necessarily wrong, just different? Wrong, just different. So we're not dismissing impairment, but we're expanding the narrative.
Rakesh Jain, MD:This is entirely my goal for this particular episode of our conversation. I would like to move our conversation from a disease model, the deficit model, which is the predominant way of looking at ADHD by everybody clinicians, the world, patients themselves and move it into a way of looking at the condition that really encourages a broader look at it. So first, we need to understand what is this deficit model and what are its pitfalls. So psychiatry currently approaches everything. It zeroes in on dysfunction. It asks what's missing, what's broken, what's failing.
Rakesh Jain, MD:But this focus, this sole focus, but this focus, this sole focus on just these things and not the strengths of the individual, really unintentionally reinforces the stigma of this condition. It can also create a self-fulfilling prophecy where kids and adults internalize I am the problem, I am the challenge, there's something wrong with me, I'm broken. So this is not just sad. I in fact think it's dangerous, because it shrinks down the person's identity to nothing but a collection of symptoms. You can see why this is simply not appropriate. It's inadequate because we have to make room for the full human experience, including strengths. And this, my dear friends, is where positive psychiatry enters the room, enters the conversation. So by now, you are, you know, very familiar with positive psychiatry. But it is the science and clinical practice of promoting well-being in people with or without mental illness, and even those who might be at risk for mental illness. The Libgeste, our previous president of the American Psychiatric Association, said this in 2015. It's very true today as well.
Rakesh Jain, MD:So positive psychiatry does not replace traditional psychiatry. It in fact, enhances it. It includes concepts like optimism, resilience, gratitude, purpose, social connectedness, resilience, gratitude, purpose, social connectedness and belief in self. But you might well pose the question what exactly is so good about having ADHD? Imagine, imagine this. Instead of just asking our patients and our family members hey, how's your attention, how's your focus, how's your hyperactivity? We ask questions like what brings you joy, what gives your life meaning? What are you really good at? What are your passions? What do you do that makes a difference in your life and others' lives? See, that broadens the conversation and that is the positive psychiatry difference. One more time, let me repeat myself, because it's such a crucial point Positive psychiatry does not replace traditional psychiatry, it just enhances it.
Rakesh Jain, MD:It expands our view on what an individual is. So my thinking is that we should be looking at ADHD through a strength-based lens, because ADHD is not simply a set of challenges an individual has, no matter what age they might be, challenges an individual has, no matter what age they might be. I have met six-year-old children who clearly meet diagnostic criteria for ADHD as per DSM, but they are wonderful, creative thinkers. Same goes for people in their 60s who have ADHD, because the truth of the matter is. Adhd can also include elements of creativity and humor and spontaneity, quick thinking. They can be highly intuitive. So what about that? Should we only look at people as nothing but a collection of symptoms? That doesn't make great sense, does it? That doesn't make great sense, does it? So this neurodiversity movement that swept our country about 10 years ago has in fact taught us a lot. Differences aren't deficits, they are variations. Let's say that again and let's ponder that thoughtfully. Differences aren't deficits, they are variations, and every variation comes with strengths and weaknesses. That's the way, perhaps, to use positive psychiatry to reconceptualize what ADHD is.
Rakesh Jain, MD:Now I have so many stories I could share with you of individuals who, despite, at least on paper, horrendously bad symptoms of ADHD, have incredibly successful lives. Certainly, they've had to challenge themselves a great deal, struggle a great deal, but there's no denying in many ways these are extraordinary human beings. But it's really important. I also not glorify ADHD. No one would ever want to quote unquote have ADHD. I don't believe, because it comes with impairments. The inability to pay attention and focus comes with many challenges Academic, social, good, god. People with ADHD even have higher rates of accidents and deaths and divorces and substance misuse. These are the negatives.
Rakesh Jain, MD:Traditional psychiatry stands by to serve the needs of such individuals and I totally support that. In fact, I support it so much I'm very much part of that traditional psychiatry enterprise, traditional psychiatry enterprise. However, what we too tend to miss out is the understanding of the individual and their strengths, their ability sometimes to hyper-focus, their ability to take on challenges. So, yes, they have lots of gifts. All individuals with ADHD have difficulties, by definition, but they also have gifts. So our goal is to obviously diminish the difficulties and double down on enhancing the strengths of our patients with ADHD. The lens, the dual lens of traditional psychiatry and then the other side of positive psychiatry, allows me to reveal to the patient, reveal to the individual they are so much more than a collection of symptoms.
Rakesh Jain, MD:Let's move on to the second part of the conversation I wanted to have with you today, which is how do we build a positive psychiatry toolkit for ADHD? And the way to do that, I believe, is to assess strengths right alongside the assessment of symptoms. Let's expand on that, shall we? Let's expand on that, shall we? So we know the Conner scale, the ADHD-RS scale, the Vanderbilt scale. The best you can possibly be is have zeros on them, so no symptoms. But it completely ignores any strengths that the individual may have. It completely ignores it. Who would assess for these strengths? So you and I should do that. We might want to do a character strengths survey, as recommended by Peterson and Seligman all the way back in 2004. That can be used in clinical interviews. We can use the CliftonStrengths tool. We can in fact take this dual factor model of mental health that tells us the following Folks, really, let's really listen to this one High well-being can coexist with psychiatric symptoms.
Rakesh Jain, MD:That's right, high well-being can coexist with psychiatric symptoms. It doesn't always do so, but if there's a deficit, so there's a psychiatric symptom deficit, let's treat it. But if there is a deficit in well-being, in positive traits, psychiatry must have a stake in that conversation. It must have a role in amelioration of these symptoms. Asking relatively straightforward, curious questions hey, dear fellow human being, what lights you up? When do you feel most alive? When do you feel at your very best? What kinds of things, when you do really give meaning to your life? Those are all questions that are, I believe, really an important part of the clinical diagnostic process.
Rakesh Jain, MD:Obviously, after we've done such an evaluation, positive interventions for ADHD can be done. This is not just for major depression. I'm talking about positive psychiatry. I think in ADHD we can a thousand percent be talking about the importance of gratitude journaling, because let's also not forget that ADHD often is highly comorbid, right? So, even though we may say an individual has symptoms of ADHD, the odds are strikingly high they have other challenges. Now you see why positive interventions for ADHD have a double role, two roles. So mindfulness-based cognitive therapy, in fact, has been studied in ADHD and yep, you guessed it it helps people not just improve their symptoms of ADHD but improves the quality of their life. That is positive psychiatry and psychology in action.
Rakesh Jain, MD:We should perhaps also teach people, educate people about identifying their flow states. By now I'm very sure you're familiar with what flow states are. Those are those sweet spots in human life where an individual gets so lost, so deeply immersed in what they are doing, that literally they lose track of time and space and even themselves. This is powerful. Our dear fellow human beings who have ADHD must be made aware of, through the help of positive psychiatry, that flow states are their gift. They should find ways to further enhance it. We should empower, enable our patients, not just control their symptoms.
Rakesh Jain, MD:Let's move on to the next section, where I would like to talk about building resilience and meaning, because, you know, resilience isn't just innate Partly it is innate, partly it is, but it's also teachable and what we do know in ADHD, often resilience is in fact impaired. Part of it is biological, part of it is the tendency towards the giving upness, the tendency towards impulsivity. But with good narrative work that can be done. Someone with ADHD can be taught, and should be taught by psychiatry to reframe one's identity from broken to brave, from broken to brave. There is every reason for a clinician to sit across an individual from ADHD and, perhaps for the very first time in such an individual's life, offer admiration, admiration, that, dear patient, despite all these difficulties, here you sit, successful, sure, with difficulties and challenges, as you've just described, but yours isn't a broken life, yours is a brave life I admire. You See, that, said truthfully and believably, is powerful. It's as powerful as any medication we can possibly offer our patients and of course we can offer both. No patient should ever leave a psychiatrist, a psych NP, a psych PA, a therapist's office and not appreciate how much they are appreciated, admired for their toughness, their tenacity and their ability to deal with life's challenges and, of course, for them to know that they are understood and they are supported is what positive psychiatry is all about. What positive psychiatry is all about. So such coaching in our adult patients, our teenage patients, our kid patients helps further enhance their goal-directed action and self-efficacy One more important element of positive psychiatry.
Rakesh Jain, MD:I would like to perhaps have a discussion with you on the power of relationships. Positive psychiatry is not, you know, an esoteric tool that you can prescribe to a patient. It's deeper than that. It's obviously based on the quality of the relationship between the clinician and the patient and, of course, from the patient back to the clinician. It's very important we remember that patients with ADHD often feel misunderstood, literally from the time they have developed an understanding of life. A positive set of connections and the one that they have with their clinicians, if it's infused with elements of positive psychiatry, can actually act as a buffer for our patients. So warm, supportive relationships are protective against depression and loneliness and the sense of failure that is often a very deep wound in the hearts and minds and souls of people with ADHD. They often don't reveal it, they want to hide it, but if you really scratch under the surface, it is there, and I don't believe medications by themselves and traditional psychiatry by itself either understands it or addresses it. So I think individuals with ADHD, no matter what their age might be, may be particularly good candidates for the best we can offer them from the world of positive psychiatry.
Rakesh Jain, MD:Positive psychiatry Even parenting, even teaching parents who have children with ADHD to use positive parenting techniques, with positive reinforcement, not punishment, improves outcomes and obviously a clinician's optimism is in itself therapeutic, is in itself therapeutic. There we go Positive psychiatry in action. So perhaps we should now turn our attention to rethinking education and workplace changes if we're going to embrace positive psychiatry. I think the change, my dear colleagues, has to start with you and I. I do think we'll have to stop looking at our patients as nothing but a bag of symptoms. Our patients are not symptoms, they're people. They're people who have their own unique signature strengths and their own unique signature weaknesses, just like you and I. For you andI to understand that salient fact and to convey it with gravitas and optimism and hope and flat-out admiration for our patient's fortitude and bravery, in itself is the practice of positive psychiatry.
Rakesh Jain, MD:Throughout this series of conversations I will have with you, we will talk about individual skill sets we can develop. We'll be talking about all of that how to measure wellness, how to enhance wellness, how do we build resilience? How do we become better practitioners ourselves? How do we build resilience? How do we become better practitioners ourselves? How do we avoid burnout? But, at the moment, looking at our patients not as mere set of symptoms to be stamped out, but as people who should be admired, elevated and their abilities enhanced, that provides a setup for what psychiatry can be very good at, which is psychiatry can be a force for flourishing.
Rakesh Jain, MD:Psychiatry should not stop at symptom relief. That's not enough. That's not enough. It's got to aim for flourishing, right, it just has to. That's what you want, I want. Why would someone with ADHD be any different? And I would have to say, the single best model I've ever found in terms of understanding flourishing is Martin Seligman's model called PERMA P-E-R-M-A. He published in 2011. I will give you a citation for it so you can read it for yourself. And PERMA stands for positive emotions, engagement, relationships, meaning and accomplishment. It's pretty much a roadmap you and I can use in any patient, but I have to say we really ought to use it in the context of ADHD.
Rakesh Jain, MD:These folks really have been misunderstood by the world for the longest time and, of course, this damage, this tragedy, is further compounded by they themselves victimizing their selfhood. They start believing they are the problem. And, as clinicians, if you and I were to adopt a dual lens, which is to treat illness and promote well-being, guess who follows right along? Our patients, their family members. Now I want to be clear-eyed about all of this. There are some real-world challenges. There really are. There are time limitations, there are patients who just want their medication and get out of their consultation room, but I do think the majority of human beings who come to see us if they were only told by us, both overtly and covertly, that we see them, we see them as the full human beings they are, with joys and passions, and fears and worries, and we're here to help them fully. Using this dual lens model, I think 100% most likely of people afflicted with ADHD will be benefited. There are barriers, time billing codes, but we can start small. Even the recommendation of a five-minute gratitude exercise can be helpful. Just remember, and I will remember that right along with you small shifts lead to big impact. Small shifts lead to big impact.
Rakesh Jain, MD:Now what I want to do, if it's all right with you, is in fact read an essay to you written by a dear colleague of mine. A friend and a colleague of mine who herself is a psychiatrist, a very well-known, internationally known psychiatrist, who is married to a lovely gentleman who is himself afflicted with ADHD. And at my request, this friend of mine, this wonderful psychiatrist, wrote a great essay that's so good I think I ought to read it to you and request you reflect upon this essay. Shall we do that together? So let's do that. So the name of the essay written by my friend and colleague is Marriage and Methylphenidate A Psychiatrist's Perspective Sleeping Next to ADHD. I think the title is incredible. She is not just incredibly smart, but she is also very funny. So you will find a lot of humor mixed into this essay. So let me go ahead and read it to you.
Rakesh Jain, MD:Growing up, I never dreamed I would marry a mentally ill person, but here we are. That sounds overly dramatic, aren't we all mentally ill? To a certain extent I'm a psychiatrist. An extent I'm a psychiatrist Structured, scheduled, color-coded to the minute. My husband he largely flies by the seat of his pants has never met a calendar he liked, and frequently reminds me that walking through an art museum and actually stopping to read the signs is his idea of torture. And yet, despite our differences, or maybe because of them, we built a beautiful, chaotic and often hilarious life together. But it hasn't always been easy.
Rakesh Jain, MD:I've come to realize that his ADHD was part of what drew me to him. I was the hyper-organized type-A planner, straight-a honors student. He was my opposite in the best ways Spontaneous, hilarious, impulsive, creative, adventurous and always fun. When I craved predictability, he reminded me how to embrace surprise. His mind worked in brilliant, unpredictable ways that lit up a room. His humor, spontaneity and out-of-the-box thinking were more than charming. They were magnetic.
Rakesh Jain, MD:The diagnosis I saw coming no-transcript, relatively well-behaved, social, likable, and nobody questioned why he couldn't sit still for far too long or why his closet was always a disaster. He was successful and flew under the radar. But in college the wheels started to come off. The external structure was gone, the workload exploded and suddenly all the effort in the world did not translate to academic performance. He was studying constantly but not seeing results. I knew what I was seeing. I had already diagnosed my younger brother ADHD, predominantly inattentive type with sprinkles of hyperactivity, and my urging formal neuropsychological testing confirmed it. Once he started the stimulant medication, everything changed. He began excelling in his biology coursework and earned a spot on a Division I athletic team, eventually going to the Final Four For the first time in years. The effort he was putting in finally matched the outcome.
Rakesh Jain, MD:But when the meds run out, the benefits of treatment are undeniable, but so are the obstacles to run out. The benefits of treatment are undeniable, but so are the obstacles to accessing it. As a psychiatrist, I witness patients struggle with access issues every day. But when it's your partner, your own family, it hits differently. When he's off his meds, it affects all of us, I know. Immediately the symptoms return like a wave. Motivation plummets, concentration wanes, forgetfulness skyrockets, irritability replaces patience, tasks go undone. Oh goodness, living with ADHD and loving it too. Goodness, living with ADHD and loving it too.
Rakesh Jain, MD:Adhd doesn't just vanish with a pill. Medications help, but the deeper work is in understanding how your partner operates and how their brain sees the world. He thrives in high-energy, interactive environments. He's charismatic, loyal, wickedly smart, emotionally intelligent. He's the kind of person everyone roots for. But structure, not his strength, not his strength.
Rakesh Jain, MD:So let me offer some tips for living with a partner with ADHD. Here's what I've learned, not just as a psychiatrist, but as a wife walking this path. Keep tasks short and clear. Number two respect their rhythm. Number three prioritize exercise. Number four prioritize sleep, sleep. Number five don't micromanage, collaborate. Number six find out what motivates your partner. Number seven find the strengths. Find the strengths.
Rakesh Jain, MD:And the final thing that my colleague wrote was don't take symptoms personally. And then she ended her gorgeous essay by saying this my husband's ADHD is not a flaw to be fixed. It's part of who he is and many of his best traits stem from it. Yes, it can be challenging, yes, we've had to work at it, but I won't change him for the world. Well, maybe a teeny bit more organized. Being married to someone with ADHD has made me a better psychiatrist, a more flexible parent and a more understanding human being. It's also made life a lot more interesting and, let's be honest, a little chaos keeps you on your toes.
Rakesh Jain, MD:So, my dear colleagues, I hope you enjoyed listening to my dear friend's essay as much as I enjoyed reading it to you, but I hope you really got the point she was suggesting, which is the disorder can be challenging, but there are ways to make life thrive and flourish despite ADHD being a real fact of life in this wonderful family that also has children. And what she said is look for strengths, because everybody has them. They're uniquely different, but everybody has them. Let's do both. Let's diminish the impact of the symptoms, but let's also make sure that the positive traits, positive psychiatry, kicks into action and helps.
Rakesh Jain, MD:So finally, in the last few minutes, let me collect my thoughts as we wrap up our time together, and this is what I might want to share with you, what I might want to share with you how about we start looking at ADHD not as a tragedy. Let's look at it as diversity and differences, with the combination of strengths and weaknesses in that individual, just like everybody else? We should really start incorporating elements of positive psychiatry in our practice as it pertains to individuals and their family members, where ADHD is a real presence. May we continue to challenge the narrative. It's a strong narrative, pushed upon us by our training, by DSM, by culture, really disease-oriented culture, and you know what I in fact like that I celebrate it, but I do think it's not entirely adequate in understanding our patient or helping them to the max. Therefore, let's affirm the strengths, bring in more humanity into the way we take care of our patients and to do that.
Rakesh Jain, MD:Positive psychiatry genuinely appears to be a North Star. It really does help us. So let's do this, let's remind ourselves that our patients are genuinely to be admired. Let's ask them, let's ask ourselves not just this question, what's wrong? But perhaps even ask them and ourselves what's strong? So, not just what's wrong, but what's strong, tell me, tell me, let's talk about it, let's help you in the totality of the word treatment.
Rakesh Jain, MD:Treatment I just don't think is simply amelioration of symptoms, but I think it is the elevation of the human being symptoms, but I think it is the elevation of the human being. So I hope you will walk away not just informed but hopefully inspired to bring positive psychiatry into your practices, into your life. And most certainly, positive psychiatry can help us, you know, develop this new set of tools to guide our patients to fulfilling their lives. And let me end by one more time thanking you for your time. I wish you, of course, very well and please do stay positively curious. Goodbye for now, and thank you for joining me on Positive Psychiatry with Dr Rakesh Jain. Take care.
