Join 3,501 readers in helping fund MetaFilter (Hide)


May I have your attention please.
January 29, 2012 9:37 AM   Subscribe

Is ADHD nature or nurture? Discuss.

If you're still paying attention, here are some bonus links:
What to ask your doctor.
Essential studies.
posted by Obscure Reference (231 comments total) 33 users marked this as a favorite

 
Or is it societal/cultural?

Back "in-the-day" when we let kids roam free in their neighbourhoods, they could at least "play" themselves out... Now, constantly cooped-up, no wonder they cannot sit still...

(I am a parent of a little guy who will absolutely NOT stop moving for any reason... it is so bad we have a mini-trampoline in our living room...)

Or is it cultural - are we expecting ever more, cramming more curriculum?

I dunno. Plus - there is also evidence that ADHD can be inherited - is it again genetic or behavioural?
posted by jkaczor at 9:48 AM on January 29, 2012


This distinction is arbitrary and subjective.
posted by LogicalDash at 9:51 AM on January 29, 2012 [10 favorites]


Back "in-the-day" when we let kids roam free in their neighbourhoods, they could at least "play" themselves out...

You know, that has to be one of the biggest changes I can see in our society these days.

In my hometown, growing up, there were ALWAYS packs of kids roaming our neighborhood. We had boundaries about where we could and could not go, but it was easily many blocks of roaming time, including some vacant land near a flood control ditch where we built forts out of found wood and cardboard, etc.

When I was growing up there, the population was around 50,000, so it wasn't really a small town at all.

Here, today and now, in this town of 10,000 that I currently live in, it is SOO rare to see kids out playing free-form. Not even riding their bikes around town on residential streets, an activity which was greatly encouraged of me when I was growing up.

It'd be impossible for a movie like E.T. to even be realistic these days, because the free range those children had simply doesn't seem to be allowed anymore.
posted by hippybear at 9:57 AM on January 29, 2012 [29 favorites]


It's definitely a biomedical condition influenced by genetics. I've worked very closely with someone (a CEO) who has been diagnosed with ADHD (or one of its variants), plus dyslexia. The guy is amazing - the condition allows him to focus intensely, with the precision of a laser beam, and then suddenly lose interest and focus on something else. He's a very successful and energetic guy, and a community leader, but he is unlike anyone I have ever worked with.
posted by KokuRyu at 10:00 AM on January 29, 2012 [11 favorites]


Back "in-the-day" when we let kids roam free in their neighbourhoods, they could at least "play" themselves out... Now, constantly cooped-up, no wonder they cannot sit still...
I hear this a lot, and I think it's true but also sort of beside the point. First of all, how do we know that the ADHD-ers back then ended up ok? Maybe they were fine while they were wandering around the neighborhood but fell apart when they grew up and it was time to clock in for their 12 hour factory shifts. Maybe they ended up, as adults, self-medicating with alcohol and other drugs the same way that today's ADHD-ers do. But I also think that the contemporary economy means that there aren't a whole lot of jobs for adults who have attention problems, and having ADHD as an adult is likely to be a problem even if you were given plenty of time to roam as a kid.
posted by craichead at 10:05 AM on January 29, 2012 [18 favorites]


ADD/ADHD may have manifested very differently before television, internet, cell phones, more diffuse work days, etc. I'm not sure if letting kids roam is a direct factor, although exercise and reduced exposure to attention vortices would probably mitigate some of less desirable aspects of ADD/ADHD.
posted by Sticherbeast at 10:07 AM on January 29, 2012 [2 favorites]


As my earlier comment indicates, I believe ADHD-like conditions have always existed, but have also been under-diagnosed. In the past, before the growth the "knowledge economy" and the need for credentials to do anything in the workplace, including brew a cup of coffee, it didn't really matter as much. Go outside or go get a job in the woods or on a boat. ADHD won't help with your job at Walmart.
posted by KokuRyu at 10:08 AM on January 29, 2012 [1 favorite]


It's not arbitrary or subjective with respect to its real purpose.

The nature v. nurture "question", when phrased in that wonderful false dichotomy, is thinly veiled social conservatism. It has nothing to do with scientific inquiry, and everything to do allowing society to assign blame to parents for their children's failings. It's a modernist retread of the "sins of the fathers revisited on their children" line that lets society as a whole wash their hands of responsibility for structural problems.
posted by mhoye at 10:08 AM on January 29, 2012 [37 favorites]


I cannot help but notice that there are more explanations to why things may have been better previously --

letting kids roam is a direct factor, although exercise and reduced exposure to attention vortices would ...

There may be other factors at work. You know, maybe things are just going wrong with the way we are raising children when the main answer to "why is something more prevalent today" is "I believe it was under diagnosed... "
posted by rr at 10:12 AM on January 29, 2012 [1 favorite]


I think in most cases, depression, ADD, asperger's, etc, shouldn't really be thought of as 'disease', although they certainly are inconvenient in a modern society. They're just normal expressions of human diversity, for the most part. And it's the environment we're living in that makes them pathological.

(Which isn't to say that they shouldn't be treated, since we're kind of forced to live in the environment we live in).
posted by empath at 10:15 AM on January 29, 2012 [30 favorites]


also, i think a lot of psychiatry is kind of 'if you have a hammer, everything looks like a nail. We discover a drug that makes people more focused. Therefore, if they are less focused, they are sick. Without the drugs to 'treat' it, ADD would have never been a thing. Or it certainly wouldn't have been as profitable for drug companies to promote.
posted by empath at 10:18 AM on January 29, 2012 [7 favorites]


This shows ADHSD in numbers, % reported, % reported by parents, difference between boys and girls, numbers per state (stunning map). Since it appears from the studies mentioned in the post that the gene(s) involved are not located on a sex chromosome, the difference in numbers between boys and girls is very puzzling, even if under-reporting for girls is taken under consideration.
posted by francesca too at 10:19 AM on January 29, 2012 [8 favorites]


First of all, how do we know that the ADHD-ers back then ended up ok? Maybe they were fine while they were wandering around the neighborhood but fell apart when they grew up and it was time to clock in for their 12 hour factory shifts. Maybe they ended up, as adults, self-medicating with alcohol and other drugs the same way that today's ADHD-ers do.

My 61-year-old partner of 18+ years is a classic example of an adult with ADD.

He had developed a variety of coping mechanisms to use to help him through his daily life. He wrote a lot of notes to himself to keep himself on track and help himself cope with the details of life. He had created an environment for himself where he could have two or three attention-grabbing things going on at once that he could alternate between while keeping himself physically in one place, allowing his brain to keep finding new shiny things to focus on while he managed to make forward progress on the central thing he needed to accomplish. He had developed a habit of physical exercise which helped him burn off physical energy which allowed him to remain stationery and get his work done. He had formed rituals and habits which kept him from losing his keys and wallet all the time.

When I met him, ADD/ADHD wasn't really a diagnosis given very often, although it was starting to become popular. I was working in an elementary school, and it was vogue at the time to give school staff workshops about ADD and recognizing the signs, and it was immediately obvious to me that he had problems. I recommended that he talk to his doctor about it.

He was put on pills. Actually, several different kinds of pills over the years, from Ritalin to dexamine to anti-depressants to I-don't-even-know-what. And they helped, for a while. The side effects of various sorts always ended up building to the point where he would complain and he and his doctor would seek out another treatment.

Today, he doesn't do any of that. He just uses the habits and conditioning he had developed before I met him. And you know what? He's functional and generally okay with his life. He's still programming or reading with the television on; he's still exercising to burn off physical perpetual motion; he's still leaving post-it notes around for himself. But he's come to realize that these things are just part of the way he's built, and at least he knows he's not crazy for being the way he is.

Meanwhile, his ability to hyperfocus and his scattershot approach mean that he's constantly learning new programming languages, experimenting with different approaches and theories to the task at hand, and generally has a broader knowledge and deeper pool of experience across the spectrum of computer science than nearly anyone I've heard of. When he is faced with a new task or concept, he draws upon a giant library of possibilities and tries to find the tool best suited for the task, rather than trying to shape a narrow bit of formal schooling about the subject to accomplish something which perhaps it isn't well designed to do. And that broad base of knowledge comes directly from his need to find shiny new things to keep him interested in his subject matter.

I think there's a lot to be said for helping people like him understand that developing habits which make life work for them may be more important than finding a pill which dulls them down and makes them outwardly like everyone else. If those people are identified much younger and can be helped to realize the life-changes they need to create, then all for the better.

Overall, I'm sure that most of the adults like my partner ended up just fine. They found ways to cope with their brains, and their lives may not be perfect but they get through just fine day to day. Just like all of us.
posted by hippybear at 10:28 AM on January 29, 2012 [31 favorites]


I tend to get pretty defensive when reading excoriations of Ritalin like Sroufe's. Ritalin changed my life in fundamental ways, and if I'd gone to public school 5 years earlier when it was not available, I would have been a dropout, or worse.

Like most girls with ADHD, which the first article notes, I was pretty well-behaved in school despite the ADHD. I just forgot everything. Pencils, backpack, take-home projects, gym shoes, lunch money. I nearly failed English in the fourth grade simply because I kept forgetting my homework assignments at school, despite the fact that I was reading Jane Austen at home for fun. It was beyond exasperating how my brain simply wandered away from me no matter how badly I wanted to remember. Everyone else in my class was sick of me asking to borrow pencils, and my teachers no longer felt sorry for a kid who scored in the 99th percentile on Iowa tests and was still flunking half her classes - they were out of options for me and sick of my crap. I was sick of my crap.

Only my mom was convinced that something was actually wrong with me, that I wasn't just lazy or stupid, so she dragged me to specialists and pediatricians, and finally someone brought up this new possibility of ADHD, which we'd never heard of before. So they started me out on 10mg of Ritalin.

I am not kidding you when I say that my fourth grade teacher called my mother two days later and asked if I'd been scared straight with threats of boarding school. Overnight I began to remember those little slippery details of my life that eluded me for years. Here are my gym shoes, here is my homework, no thanks I don't need a pencil I have my own, thank you. I made straight As that quarter, and made straight As throughout high school, graduated at the top of my class, and won a full scholarship to a good college. I was once the kid who had to doodle at her desk for an entire day while the rest of her class went on a field trip because she forgot to get her mom's signature on a permission slip, and now I was the editor of student magazines in high school and college. Ritalin isn't perfect by any means, but I don't think for a second I would have been anything other than a flake and fuck-up without it.
posted by zoomorphic at 10:32 AM on January 29, 2012 [100 favorites]


ADHD is not a mental disorder from Behaviorism and Mental Health
posted by rebent at 10:35 AM on January 29, 2012 [2 favorites]


Overall, I'm sure that most of the adults like my partner ended up just fine.
Why? What makes you so sure? My family history is littered with people who didn't end up particularly fine.

I'm not convinced that ADD meds are right for everyone. I've been on and off of them over the course of my adult life. (I tend to self-medicate with caffeine when I'm off of them, though, which complicated things.) But I know that medication has helped me establish the systems that allow me to function and that I wasn't really able to do that before I went on meds. So for me, the question is not really meds vs. coping mechanisms. It's whether you need meds to establish coping mechanisms. I did, but YMMV.
posted by craichead at 10:40 AM on January 29, 2012 [12 favorites]


Maybe they ended up, as adults, self-medicating with alcohol and other drugs

That's what my dad did - he has all the classic signs of adult ADD - his brother does as well, but he manifested slightly differently.

So - when I say that I think it is genetic - I am speaking from experience, difficulty my entire school life (even with the ability to roam-free - so I guess that is a false argument) - diagnosed as an adult, I have actually come to find it a strength - now that I know what my strengthes and weaknesses are.

economy means that there aren't a whole lot of jobs for adults who have attention problems

Agreed - but then, there are also opportunities that were not there before. Personally, I feel it the computer-revolution had happened 10-15 years earlier, there would have been hope for my dad.
posted by jkaczor at 10:44 AM on January 29, 2012 [2 favorites]


I have ADD (big suprise I realize) to the point where my mother recently ran into one of my old teachers, who said "I remember jon. Bright boy but he was the poster child for ADD." I was on ritalin briefly (and this was back in the late 70's before it was sprinkled on verey kids breakfast cereal, but I developed sleeping problems, so I was taken off of it. So for most of my life my brain has been kind of like a TV with the scan button stuck down and with lousy impulse control. Like zoomorphic, I scored high on standardized tests, but by high school, I wound up in the 'problem child' category (which admittedly has given me more patience and sympathy with different kinds of people) and I've abused substances and gotten into plenty of other trouble over the years.

I'm pretty much the only one in my immediate family like this, although my sister's girls (she has two girls and a boy) are both epileptic and both have some learning disabilites. Her son has some reading problems but no seizures. So I lean toward a biological explanation, but I'm not a doctor.
posted by jonmc at 10:50 AM on January 29, 2012 [2 favorites]


rr: "You know, maybe things are just going wrong with the way we are raising children when the main answer to 'why is something more prevalent today' is 'I believe it was under diagnosed... '"

If you think about this for a moment, you might notice that, in positing that parenting styles must have changed if children are diagnosed more today, you're assuming that our society is exactly the same as it was. But it is emphatically not.

As others have noted, kids don't play outside much any more; we see it as too dangerous, and it quite often is. But even aside from that, there are a whole host of things that are exceedingly complicated in our society; as a person with ADD / ADHD, sometimes this is a bit infuriating, and even more so because you normals don't seem to notice it at all.

You don't seem to notice that, for example, even thirty years ago it was possible to have a job where you did a simple thing repeatedly and then got a pile of green stuff in exchange; you could take that green stuff and rent an apartment and buy food; and the only thing you really had to worry about was not spending the green stuff on something stupid before you got the apartment or the food.

Now, we've spent decades 'simplifying' things by making them more complicated. We wanted everybody to get to own a house, so we encouraged them all to get mortgages; anybody who's ever had one will attest to the extraordinary ways having a mortgage can complicate your life. We want people to buy more stuff, so suddenly a person is bombarded constantly by offers to loan them money via plastic cards; many of us are naturally too weak-willed to avoid giving in to the intense pressure.

Our cities are built in such a way that it's nearly impossible to have a job (and eat, and have somewhere to sleep, etc) if you don't have a car. Moreover, we reinforce the necessity of cars by constantly bombarding citizens with the notion that only car owners are worthy members of society. So, of course, you must have a car. And having a car seems simple, right? Only, first of all, we've priced cars such that almost nobody has enough money for a solid one at any given time. No problem, though - once again, we'll loan you the money! (One more complexifying payment every month.) But that's not all. We want people to be safe, and to have a safety net economically if they get in an accident; so we require them to comb through the myriad loud offers of auto insurance, select one, and give them money for said insurance, meanwhile collecting all the necessary forms and deeds along the way. Then, one has to make sure one has a driver's license, and make sure one's car is registered; all of these are very complicated tasks, and if you skip any of them, you can end up in jail.

These are just a few of the hundreds upon hundreds of ridiculously complicated tasks and utterly unnecessary forms and titles and identification cards and pieces of paperwork one is required to navigate and resolve if one is going to live in our society. It is the most complicated set of requirements for citizenship ever devised by any nation on the face of the earth. And it begins in childhood; even aside from the amount of frantic concern children inherit subconsciously from their parents, we teach them early on though numerous worksheets and exams that they will be judged throughout their lives almost solely on their ability to fill out forms correctly and diligently.

And then, as we continue to increase the amount if busy-work people are required to do, we note that more and more children (and, I would like to point out, adults too) are failing to meet our high standards for paperwork-management; the children are failing in school, and the adults are ending up on the street and sometimes in prison.

And we have the sheer obliviousness to wonder how it is that so many children end up with a deficit of attention and some uneasy squirreliness in the face of society as it is? We have the unmitigated blindness to wonder why so many among us have ended up homeless on the streets, or have apparently found that being in prison is the only way they can know they'll have food and shelter they can always rely on?

Sometimes, when people talk about the rising tide of attention deficits and wring their hands about how we're not raising our kids right or darkly imply that children now lack some innate human ability to live their lives normally, I think maybe they're somewhat confused about who really has trouble with being distracted from facts that are right in front of them.
posted by koeselitz at 10:51 AM on January 29, 2012 [99 favorites]


Short version: yes, I think "attention deficit disorder" was under-diagnosed in the past. But given our extremely high standard for necessary attention to be a member of our society, saying "ADD was under-diagnosed in the past" is like saying "lack of an automobile was under-diagnosed in ancient Greece." Well, sure. That's because you didn't need one back then.
posted by koeselitz at 10:58 AM on January 29, 2012 [13 favorites]


I agree with koeselitz's tl;dr. I have nothing to base this on, but it seems that Americans post 9/11 are characteristically more... wired, in the caffeinated sense of the word. "School school career" is the name of the game for so many wide-eyed moms and there isn't a lot of room for all the other stuffs of life. Traveling aimlessly for months? Years? And lose a competitive edge on your peers? Sure, let off steam on the weekends with booze and ultimate Frisbee if you must, as long as you're on track for that versatile college major. YOU WANT TO BE AN ARTIST?! OH FOR FUCK SAKE.
posted by Taft at 11:15 AM on January 29, 2012 [6 favorites]


I have a very close family member, my age, who has ADD. It is infuriating to be told that somehow our parents did poor jobs of "letting us run around outside," as if that would cure the fists through walls, the antsy fits, the screaming. While he was in a city, there was a yard, and a terrace, camping trips, soccer, and schools with large playgrounds and mandatory recess. The drugs and therapy were not some sort of easy way out. Years of expensive medical treatments, for fun? Years of fighting? Sure, I suspect many kids are overdiagnosed or, probably given the costs, don't get years of testing and help and therapy. And I hate-- hate-- every joking conversation about Ritalin and Adderall among college students, as if those drugs are some kind of joke and cure for late night papers. But I also hate these blithe insinuations that parents have failed their children. Seriously.
posted by jetlagaddict at 11:28 AM on January 29, 2012 [11 favorites]


I tend to think that ADD is one of our modern society's "go to" diagnoses. I think doctors, administrators and parents default to ADD when they have a kid who doesn't fit into a manageable corner. Somewhat like the way "depression" is too-often the default diagnosis for "having a bad day".

Lazy over-diagnosis diminishes the reality of those who seriously do suffer from the malady, and probably harms the ones who are simply lumped into the catch-all diagnosis.

That said, I agree with koeselitz in that ADD could very well be a symptom/diagnosis unique to (and a result of) what we expect from people in today's society.
posted by Thorzdad at 11:29 AM on January 29, 2012


I think in most cases, depression, ADD, asperger's, etc, shouldn't really be thought of as 'disease', although they certainly are inconvenient in a modern society. They're just normal expressions of human diversity, for the most part. And it's the environment we're living in that makes them pathological.

Disorders that make you unable to function aren't going to work in any environment. I imagine the hunter-gatherer who lies in bed for 18 hours a day doesn't do so well.

Being a societal outcast is literally dangerous, in every society. Disorders that cause interpersonal problems are dysfunctional, period.

These are problems that might be exacerbated (or caused) by the way we live, but to call them "normal" with the implication that the disorders would be functional in a diversity of settings, just not this one, is ridiculous.
posted by the young rope-rider at 11:31 AM on January 29, 2012 [9 favorites]


@jetlagaddict: As a college students I have to say that they let you accomplish extraordinary things. I have a couple friends who use adderall to study for finals and they really do seem like a godsend. While I agree they shouldn't be given out like candy, I'm not sure that their use is always unwarranted or unfair for those without prescriptions.
posted by Strass at 11:31 AM on January 29, 2012


Overall, I'm sure that most of the adults like my partner ended up just fine.

I guess that depends on how one defines "overall". I'm struggling very hard right now to manage my ADHD well enough to keep my job. And I feel like I'm being set up to fail: my manager knows very well that I was recently diagnosed and that I'm currently undergoing a neuropsych evaluation to get a better picture of what's happening upstairs, as ADHD and a few comorbid disorders run rampant through my family tree. But she keeps putting roadblocks in my way, like throwing fucked up new projects at me when I'm already drowning in my current workload. Or seating me in a tiny office with two other people -- one of those people demands silence in our office, so I get in trouble for blurting out a question in my office instead of saving up all my questions and asking them of someone else. That same officemate has also recently taken to watching my monitors and tattling on me to management if I do anything that she thinks is non work related. Meanwhile she's on Facebook all day. But because she's a Type A person and I'm a screw-up who has trouble completing tasks on time, everyone lauds her for her incredible work ethic and her integrity and blah blah blah, and I get told that my job is in jeopardy and I need to "clean up my act". I'm told constantly that I have to reach out for help when I get overwhelmed... I tried that this week and was totally rebuffed by everyone I reached out to. I don't know what to do, I'm trying so hard right now and I don't know that I can try any harder. I'm 90% sure I'll lose my job this week, despite some insane efforts on my part to have that not happen.

So maybe some adults like your partner end up fine. I wish I were as lucky as your partner and those other adults. But I'm not. And I don't understand what I'm doing wrong, but I feel like it's probably my fault that I'm not even as together as your partner.
posted by palomar at 11:33 AM on January 29, 2012 [17 favorites]


Overall, I'm sure that most of the adults like my partner ended up just fine.


Yeah, multiple people have/will address this pull quote, but I really have to ask--why are you sure?
posted by the young rope-rider at 11:36 AM on January 29, 2012 [5 favorites]


I'm sometimes the flake and fuck-up that Zoomorphic mentioned. I'm not sure how I graduated high-school and got into the UC system, but I didn't make it to a college degree. I'd ace one class and fail the next with no regard to the difficulty of the material or type of subject matter. It seemed like the structure of the class itself was the only element that mattered with very short 40 hour a week classes on very difficult subjects being easy, and longer spread out classes on easy subjects being completely impossible. I'm not even going to talk about my career since.

Starting two years ago I got a diagnosis, nothing changed particularly despite working very hard to try and put a structure in place for myself. A month ago I started a fairly small dose of Adderall twice daily and quit caffeine. There's been a subtle and pervasive difference in my ability to finish things I start from the trivial to the important. I'm less stressed, fitter, and much, much more hopeful. All of that could be a placebo effect, but if it is, I don't care because for the first time I feel some measure of control over my life instead of being at the mercy of reinforcing cycles of anxiety, uselessness and inattention.
posted by BrotherCaine at 11:36 AM on January 29, 2012 [7 favorites]


That said, the nature vs. nurture; I think it's a little of both. The genes pre-dispose you to it, but a very slight modification in how you are taught or nurtured might give you the means to control your life. However, I think we try and pound the square pegs in the round holes until despair or rebellion sets in. I can't blame anyone else for my failures in life. I'm the only one responsible for me. But there are certainly ways in which you can give a helping hand to the people around you sometimes. Starting with not assuming they are like you.
posted by BrotherCaine at 11:39 AM on January 29, 2012 [1 favorite]


@Strass -- the biggest problem is that those are, in fact, serious drugs. My family member eventually got off the drugs after years of therapy etc., but also because the drugs caused heart problems and other issues. They're not toys. Could a variant be developed as a much milder stimulant for students and lawyers and nurses? Maybe. But yikes, they're no joke, especially for kids who've never been evaluated for complications.
posted by jetlagaddict at 11:39 AM on January 29, 2012


@jetlagaddict Personally I don't see a problem with using one or two a year to get some really hardcore studying done, but then again I'm very pro-drugs and cognitive enhancement in general, so I admit I'm very biased.
posted by Strass at 11:46 AM on January 29, 2012


I think ADD is hard for some people to understand because it's so insidious - everybody has problems with being able to stay as focused as they'd like, everybody acts impulsively sometimes. What they don't realize is that there is a gradient, and that inability to focus at a certain point goes beyond a normal annoyance to the point that it can impact your functioning.

I do feel that medication is used too frequently, especially in children (and I use it myself) - I think counseling, working on coping mechanisms and coaching are all important parts of dealing with the disorder, instead of simply throwing medication at it. Not that medication doesn't have its place, its just that other modalities are underutilized.
posted by deliquescent at 11:48 AM on January 29, 2012 [4 favorites]


I look on medication as a temporary fix until I can put in place the habits and structure where I wont need it. I think that's the best way to approach it, because for one thing it's not certain the efficacy will continue forever, and for another I'd better be improving myself anyway to move farther towards "normative" and structure so that I'm not causing future problems for myself. In other words, the drugs are just there to give me time and space to restructure my life.
posted by BrotherCaine at 11:55 AM on January 29, 2012 [1 favorite]


Yeah, multiple people have/will address this pull quote, but I really have to ask--why are you sure?

Because if ADD/ADHD really has been historically underdiagnosed, as some have asserted in this thread, then we'd see a giant population of people in previous generations who were completely unable to cope with life due to their condition.

According to this page, by 2007 9.4% of children have been diagnoses with ADHD. That's nearly 10% of the population. It also says that the numbers have increased an average of 3% a year from 1997-2006. So we're talking well over 10% of the entire juvenile population having been diagnoses by 2012.

So either children grow out of the condition, or they don't. If they don't, then the easy projection to make is that AT LEAST 10% of the adult population across history has had ADHD or ADD or some such. Do we see 15-20 million adults in the US walking around unable to cope due to ADHD? I don't think we do. Perhaps you have different data.

The fact is, before ADD became a pill-treatable condition, we used to work hard to get students who exhibited what we now regard as symptoms to work to form better habits without medication. This wasn't always done with methods that may be acceptable in today's culture (discipline, shaming, etc). But IF (and it's a big if) ADD/ADHD has been present in the population all along in similar numbers as it is being diagnosed today, and it went untreated up until the past 20-30 years, then we'd find huge numbers of adults all across history who were incapable of coping with life.

Do we find that? Well, I haven't done any deep research on the topic, but it would be hard to miss something as giant as 10% of the population utterly unable to hold themselves together and focus attention well enough to live their lives.

I believe these adults learned to cope with their condition, developed behavior patterns which helped them keep on track, or found life partners who were capable of keeping them from falling apart.

None of this even takes into account the possibility that ADD/ADHD is increasing because of social or environmental factors, and therefore may not have been as prevalent previously as it is now. I'm just taking the assumptions about underdiagnosis already stated in this thread and working with them.

THAT is why I'm sure. Because given the current level of diagnosis of this condition, we'd have certainly seen some kind of manifestation across history that 10% or more of the population found staying on task and lack of physical movement impossible. And I don't think we see that at all.

I'd welcome having someone show me evidence to the contrary.
posted by hippybear at 11:55 AM on January 29, 2012 [5 favorites]


Personally I don't see a problem with using one or two a year to get some really hardcore studying done, but then again I'm very pro-drugs and cognitive enhancement in general, so I admit I'm very biased.

Well, the DEA isn't. And the choice to obtain them illegally is why I get treated like a drug-seeker once a month if I have to fill my Adderall XR anywhere except my usual pharmacy. And I've been fortunate enough to have access to insurance and neuropsych testing/documentation and--if you can call it luck--documented source of neurological damage that is accepted as "real" (epilepsy after a perinatal brain hemorrhage). That's a serious run of luck in and of itself. But I'm still treated like shit because

Your beliefs don't exist in an ideal world: they have practical consequences in this non-ideal one. Your friends don't Stick It To The Man when they pop illicit Adderall. They stick it to people like me, who did all of their homework and balance overwhelming paperwork and documentation requirements for work and school, and time for appointments and paid for the evaluations out of pocket and all of that.

as some have asserted in this thread, then we'd see a giant population of people in previous generations who were completely unable to cope with life due to their condition.

Although I think koeselitz makes great points about the level of complexity in modern life, please allow me to direct you to--for one thing, though it's certainly not the only possible factor--the great revolution in neonatal medicine that occurred between 1970-1980, and is still ongoing. It is indeed for the first time in human history that we have a cohort of people (starting at approximately 40 years old for the low end, and in increasing numbers as you look at younger populations) who would usually have died at birth or in infancy surviving into childhood, adolescence and adulthood.
posted by Uniformitarianism Now! at 12:06 PM on January 29, 2012 [12 favorites]



-Overall, I'm sure that most of the adults like my partner ended up just fine.

Yeah, multiple people have/will address this pull quote, but I really have to ask--why are you sure?

Because if ADD/ADHD really has been historically underdiagnosed, as some have asserted in this thread, then we'd see a giant population of people in previous generations who were completely unable to cope with life due to their condition.
Following the Peasants' Revolt, English constables were authorised under a 1383 statute to collar vagabonds and force them to show support; if they could not, the penalty was gaol.[21] Vagabonds could be sentenced to the stocks for three days and nights; in 1530, whipping was added. The presumption was that vagabonds were unlicensed beggars.[21] In 1547, a bill was passed that subjected vagrants to some of the more extreme provisions of the criminal law, namely two years servitude and branding with a "V" as the penalty for the first offense and death for the second. Large numbers of vagabonds were among the convicts transported to the American colonies in the 18th century.[22]

During the 16th century in England, the state first tried to give housing to vagrants instead of punishing them, by introducing bridewells to take vagrants and train them for a profession. In the 17th and 18th centuries, these were replaced by workhouses but these were intended to discourage too much reliance on state help.

The growing movement toward social concern sparked the development of rescue missions, such as America's first rescue mission, the New York City Rescue Mission, founded in 1872 by Jerry and Maria McAuley.[23][24]

In smaller towns, there were hobos, who temporarily lived near train tracks and hopped onto trains to various destinations. Especially following the American Civil War, a large number of homeless men formed part of a counterculture known as "hobohemia" all over America. This phenomenon re-surged in the 1930s during and after the Great Depression.[25][26]
....
In general, in most countries, many towns and cities had an area which contained the poor, transients, and afflicted, such as a "skid row". In New York City, for example, there was an area known as "the Bowery", traditionally, where alcoholics were to be found sleeping on the streets, bottle in hand.
We were far more efficient at segregating, labeling negatively, rather than to assist people, and then removing such "undesirables" from society, while simultaneously convincing the "normal" majority that they were actually "naturally" different from these "others", who had, the culture asserted, to make them feel safe, and normal, and special, and different from these "failures" by "nature", in times past... Debtors prisons will one day be magical places of study for the time traveling historians from the future studying ADD/ADHD in past societies.

A little later, a normalizing force would come along, and show how unstable the great majority was, how it was not nature, but the selective forces of culture, and social pressures, prejudice and the self-aggrandizement of those who, by luck, fortunes, or familial connectivity... "won".
The Great Depression of the 1930s caused a devastating epidemic of poverty, hunger, and homelessness. There were two million homeless people migrating across the United States.[27]
posted by infinite intimation at 12:12 PM on January 29, 2012 [16 favorites]


I'm ADHD and I'm pretty darn successful and happy, but I'm really irritating to other people :) The hyperactivity part especially. I blurt, fidget, multitask, mutter under my breath, forget things over and over and over again, and last week I saw a candid videotape of myself and nearly cried. But most of the time I don't have to see myself.

I was talking to a colleague (I'm an educator, and I was attending a conference this weekend) and she asked what she could do for an ADHD student. "Give him a bill of rights," I said. "He has the right to come back into the room to get the things he forgot. He has the right to ask questions about things you've already explained. He has the right to get up and go to the bathroom at least once a class, even if it's only to walk down the hall and back. He has the right to interrupt. He has the right to have one place for all his things, and to be reminded to put them there and only there." She said she would make him a wallet card.
posted by Peach at 12:12 PM on January 29, 2012 [16 favorites]


Illicit drug users aren't the problem. The problem is doctors, the drug companies and the government protecting an extortionate pricing scheme.
posted by empath at 12:13 PM on January 29, 2012 [14 favorites]


I have to admit that I've been interested in this kind of stuff ever since going on a reading binge of literature about alternative education and unschooling in college. In the Summerhill system, for example, there's no diagnosing of ADHD. But also they don't see, say, their students not going on to college as a necessary failure. To get behind that kind of attitude you really have to accept a wide range of acceptable professions--from labor work to creative work that looks really unacceptable to the societal eye.

But I wonder if it would have helped me, as a kid, to be in that kind of environment. I went from being labeled as "gifted" in elementary school to earning Cs and Ds in middle school, and middling grades in high school in everything except English and Art. I spent my days doodling, or writing stories, and getting in trouble for doodling, or writing stories. I was also chronically late, disorganized. Never diagnosed, but I had trouble working the system.

Mostly because I didn't care, though. I mean, I really, really didn't care about any of my public school classes except for the aforementioned English and Art and it didn't seem worth it to me to try. And it still doesn't. The life I live now is the sort that high school teachers tell you you won't ever live--where I make my own hours, where I stay up as late as I want, doing productive creative work, and then wake up late, too. I can spend all day puzzling over revisions, going for walks or whatever I need to get my creative juices flowing instead of barely awake at a job trying to sneak in a few hours of writing. I've tried the mainstream desk job way of life, and it was unsustainable and crap for my real productivity. I was a terrible office worker, just like I was a terrible high school student. I was a good writer and artist then, and I am now. But embracing this sort of life--individually or institutionally--means kind of disregarding modern American values and figuring out your values for yourself.
posted by PhoBWanKenobi at 12:17 PM on January 29, 2012 [10 favorites]


And whether that would work for the wide swathes of diagnosed ADHD adults and children, who knows?
posted by PhoBWanKenobi at 12:19 PM on January 29, 2012


hippybear, I don't have the cites in front of me, but many children DO grow out of ADHD. Currently it's estimated that 4% of the adult population has ADHD -- many of those adults, like me, have had ADHD their whole lives but went undiagnosed until adulthood.

My primary physician has made adult ADHD the focus of her practice over the past couple of years -- she has ADHD herself, but she did not receive her diagnosis until her son started having epic trouble in school and at home. Long story short, while working with a large team of people to get her son some help, she recognized herself in the case histories and the studies and the checklists.

That's how most of the adults I know with ADHD arrived at their diagnosis -- their kids started having major, MAJOR trouble in school, and in the process of getting help for their kids, they figured out that there's actually a name for the problem they themselves have had their whole lives.

That's probably contributing in a huge way to the spike in diagnoses that we're seeing in the adult population. When there's more awareness of a disorder, more people will be diagnosed. We have seen this happen with autism -- as awareness of the autism spectrum spreads throughout our communities, we see more and more kids being diagnosed who might not have gotten the treatment they needed before because their symptoms weren't recognized as an actual thing. I believe that's what's happening with ADHD.
posted by palomar at 12:20 PM on January 29, 2012 [3 favorites]


The nature v. nurture "question", when phrased in that wonderful false dichotomy, is thinly veiled social conservatism. It has nothing to do with scientific inquiry, and everything to do allowing society to assign blame to parents for their children's failings. It's a modernist retread of the "sins of the fathers revisited on their children" line that lets society as a whole wash their hands of responsibility for structural problems.

Except that it seems that it's liberals who wanted to wash parents hands of responsibility for their child's problems (e.g. "refrigerator mother" theory of autism), and wound up in a state of mindlessness - the bizarre situation where we talk about mental problems without ever talking about the mind - and letting everyone but the child's neurons and synapses wash their hands of responsibility. And it's led to a view of mental problems as something you have as a permanent affliction rather than something you are at a possibly transient phase of life
posted by crayz at 12:21 PM on January 29, 2012 [4 favorites]


infinite intimation: are you really suggesting that any and all homeless people are ADD/ADHD? Are you really saying that the homeless people during the Depression were all undiagnosed?

Anyway, in 1906, the estimated number of hobos in the US was 0.6% of the population.

I get what you're trying to say, but I don't think the figures really support your thesis, that all homeless people and beggars throughout history totaled 10% of the population, and that they all were the result of undiagnosed ADD/ADHD. Certainly some of the more extreme cases would have fallen into those numbers... But your brush is far too broad to paint the details.
posted by hippybear at 12:22 PM on January 29, 2012


Hippybear your statement was profoundly ignorant and offensive. I don't even know where to begin in trying to correct your ignorance.
posted by humanfont at 12:24 PM on January 29, 2012 [3 favorites]


Hippybear your statement was profoundly ignorant and offensive. I don't even know where to begin in trying to correct your ignorance.

Well, please try, because I've made more than one statement in this thread, and have no idea what you're taking issue with.
posted by hippybear at 12:29 PM on January 29, 2012 [5 favorites]


PhoBWanKenobi: That's exactly right. I was diagnosed with ADD when I was 19 or so after struggling all throughout high school (with grades, not with learning-- I was a National Merit Scholarship Semifinalist). I was prescribed Cylert and my GPA in college went up two points. But it didn't really make me happier, or a better person, so I stopped taking it after a year. And then found work where 'ADD', or as I like to call it "being really good at multitasking" isn't a problem -- help desk and IT work. And I learn the way I always have -- at my own pace, and following my own interests. I work with people all day long who literally can't do what I do. Their brain just isn't wired that way. They can't make logical leaps to tie two distant concepts together, they can't handle a new problem that they haven't been explicitly prepared for, they can't research a problem on their own, etc. And yet they can follow directions and do repetitive tasks all day long in ways that would make me quit my job if I were forced to do that. I can take a drug to make me do what they do, but they can't really do the same to do what I can do.

But because I can take a drug to be more like them, and that society is structured in such a way that working that way becomes vitally important, does that mean I have a disorder and they don't?
posted by empath at 12:30 PM on January 29, 2012 [6 favorites]


I seem to be one of the few ADD (actually back then it was merely 'hyperactivity') who actually agrees with his own diagnosis. What that means I don't know.
posted by jonmc at 12:34 PM on January 29, 2012


But because I can take a drug to be more like them, and that society is structured in such a way that working that way becomes vitally important, does that mean I have a disorder and they don't?

In an alternate universe where hippies won the 60s, they'd be diagnosed as creativity deficit hyperworkaholism disorder and prescribed THC
posted by crayz at 12:34 PM on January 29, 2012 [8 favorites]


yes, and if your aunt had balls she'd be your uncle.

(I agree that ADD is overdiagnosed but that dosen't mean it isn't a real thing for some)
posted by jonmc at 12:39 PM on January 29, 2012 [3 favorites]


I think the "kids used to be allowed to roam and there wasn't as much ADHD back in my day" is a spurious correlation. My husband grew up in small town Montana, had a bike, and had about as much freedom as a kid could have. I grew up in a sidewalk-less suburb, couldn't figure out how to ride a bike, and was kind of an agoraphobic introvert anyway. Yet, he has ADHD and I don't. I know lots of adults in their 30s and 40s with ADHD who grew up in the same relatively free and safe environment we did. If there is really some correlation, I'd love to see a cite.
posted by desjardins at 12:42 PM on January 29, 2012 [2 favorites]


It is interesting to me there seem to be more more people diagnosed with attention deficit and more people diagnosed with a syndrome that is characterized by obsession with minutia and increased ability to do repetitive tasks. Either all these people the have always existed, and human experience has always been this diverse or the human race has undergone some sort of radical change in recent history.

I tend to think we have changed as a society and become less flexible when it comes to encountering someone who is different. I think it is people's lack of flexibility is what causes problems For those who seem different. In the past, perhaps people with ADHD or Aspergers got along fine because the people around them we not so concerned with making them seem like everyone else.
posted by Ad hominem at 12:49 PM on January 29, 2012 [1 favorite]


The "bad parenting" argument breaks down when you meet people who "adventured" outdoors... and still suffered ADD; it is a just-so story, (and if we are engaging in "just-so" narratives, it could be argued that those people, who were USED to, and LIVED the "outdoors", roaming in packs, and adventuring actually do the worst in the hyper-structure of modern education).

crayz, it would be awesome if you could cut back on inventing sort of absurd, unrelated alternate realities where something "might have" happened, and using that to attack, or make a "point" about the real world as it exists.
Like, not everywhere, you can invent realities, or tell stories, sure, but it really sets back rational discussion of real world issues when you muddy the water that way. Analogies are great in discussion, hypothetical imaginings are less great for establishing common ground.

jonmc, there is massive stigmatization around ADD (every mefi thread has at least a few people claiming it "doesn't exist", that it is a "made up thing to sell drugs", or a "conspiracy by big-pharm". Hopefully we can work to further de-stigmatize the ADD label, so more people will feel comfortable seeking assistance with the small things, and so maybe better succeed with the bigger things.

To self-identify amidst that can be like swimming upstream. I think that once people age, and discover what it means to get assistance in dealing with such a complicated disorder (another common misunderstanding many already noted is that pernicious assertion that it is just "not being able to pay attention", and this is sort of basically a "pop-culture" joke... tv, when it portrays ADD afflicted people does so as the but of a joke, how "scatter-brained they are"... when it not so simple as "no focus", but rather hyper-focus intermingled with "poor" allocation of that focus.


suggesting that any and all homeless people are ADD/ADHD?
-opps, definitely not that, sorry hippybear. Am I suggesting that among the millions of discarded "non-normal", many were undiagnosed, dealing with either ADD/ADHD or a variant of this spectrum of disorders? Yes.

I guess more to say; we can't know (and so my quip about leaving it to (non-real) time-travelling historians to 'find out' 'the truth'... but we have singled out people as "the losers" in "the grand game" before... and many, many people have tried to pretend that it was a "natural" thing that those who "lost", had lost... To see that duplicated today is troubling (I doubt you meant your comment that way, but it came across that way; like, "your partner dealt with X, therefore everyone ought to be able to overcome X, that is not "offensive" on its own, but the idea that follows from that, is that those who don't overcome X, are failing because of their nature, or rather their failure to overcome the part of their nature (X) that your partner overcame, in order to lead a successful life).

I think I was trying to say that people who stumble, and fall under our society today are legion (see 99.9999% vs 0.0001 in wealth accumulation today [many will try to say that it was "natural", that those "hard-working" 0.0001% hold such wealth and power] and I want to say that it is not "natural")

Lots of peoples stories have been written out of "normality" in history.

Wait crayz, you are suggesting there are lots of people who refuse to acknowledge "shifting changes over time" in brain state/brain chemistry.

This would be to deny that catastrophic events can cause shifts that last for a long time, or a short time, and may never be overcome, or may be overcome by therapy and medication and a healthy environment. I don't know many people who 'deny' PTSD, and PTST is specifically that "flux" inside peoples brains, and in their experiences that you suggest is not accepted in mental health today. Flux and change are taken as givens in psychology.
posted by infinite intimation at 12:51 PM on January 29, 2012 [3 favorites]


Remember folks, the plural of 'anecdote' is not 'data'.
posted by GallonOfAlan at 12:52 PM on January 29, 2012 [3 favorites]


(I agree that ADD is overdiagnosed but that dosen't mean it isn't a real thing for some)

"ADD" is just a cluster of behaviors/symptoms. It's a heuristic. In that sense of course it's a real thing. The question is whether medical science can actually define it as anything but a heuristic - i.e. explain some underlying etiology - and whether these mind-altering drugs we give to vast numbers of people are actually an appropriate course of action to take in response to this heuristic

Anecdata in this thread notwithstanding, the evidence suggests that the drugs do not have any long-term positive effect
posted by crayz at 12:53 PM on January 29, 2012 [1 favorite]


Either all these people the have always existed, and human experience has always been this diverse or the human race has undergone some sort of radical change in recent history.

Without any real basis to back it up, I sort of believe that the rise in the prevalence of ADD/ADHD diagnosis has to do with environmental issues causing genetic pre-disposition to manifest due to chemical exposure which previously didn't activate. I think that may be the case with a lot of the lifetime syndromes of which we see increased prevalence. Impossible to track and document, but we've certainly changed the makeup of the world we live in over the past 50-60 years, and if that isn't having some kind of effect, I'd be very surprised.
posted by hippybear at 12:54 PM on January 29, 2012 [1 favorite]


i wonder how shit is gonna look once ODD really starts becoming a thing
posted by This, of course, alludes to you at 12:58 PM on January 29, 2012


Or even OPP. You down with it? (Yeah, you know me!)
posted by hippybear at 1:01 PM on January 29, 2012 [2 favorites]


Just to give you an example of how having ADHD impacts my work: I work on a team of 8 guys. This week, we were tasked to do an config change to hundreds of pieces of hardware. My boss came to me and said, look, we're going to split this up, and all of you will do these one at a time, and hopefully we'll have it done by the end of the week.

I would literally rather die than spend a week typing in the same commands over and over again. So I stopped what I was doing, spent an hour writing a script that did the whole upgrade and testing for the whole team in 3 hours.

Now why was I able to do that? I've always read a ton of books about science and computers just 'for fun, but the only programming class I've ever taken, I dropped after 3 weeks. I learned how to script because people have been asking me to do that kind of tedious shit for as long as I've been in IT and I learned how to get around it instead of just doing what I was told. I'll literally spend 3 or 4 times as long scripting something as it'll take me to just fucking do it, just because of how mentally draining it would be for me to do something over and over. And while it takes the extra time up front, it pays dividends because I'll have learned how to do something new, and I can usually re-use the same scripts later down the road.

Another example: I was asked to start updating a spreadsheet weekly on bandwidth usage on 3 dozen backbone interfaces. For over a year, a coworker had been spending 5 hours a week typing them all in by hand after looking at the Cacti graphs. Instead of doing that, I spent a couple of weeks: Learning perl (had never touched it before), learning the database schema for Cacti, figuring out how to combine data from 4 different tables (had never really done anything complicated in SQL before) to get a list of all the interfaces and speeds, and then learned the data format that Cacti used to store graph data, and extracting all of the data I needed on every single interface we were graphing (hundreds), with ones that were low on bandwidth being highlighted in red. It took me all week to do, and the first week, I ended up having to do the spreadsheet 'the hard way', but after I had everything figured out, I had a report that was way more useful than what they had before, and could be done in 10 minutes and in real time, instead of 5 hours once a week. And to me, that wasn't work at all. I loved every second of it, because it was something 'new', and I was learning something -- I even kept working on it at home and on weekends, because I couldn't stop thinking about it, once I took an interest.

Very few of my co-workers at any IT job I have ever taken the time to learn how to script, because they're getting paid either way and are just as happy doing tedious bullshit as doing anything else. And the ones that have learned to do that kind of thing? They mostly have 'ADD' also.

Now, does it also cause problems? Yes. I get in trouble all the time for forgetting meetings, for not updating tickets completely(or at all), for procrastinating on stuff that I know I need to do (I've got a ticket that's been sitting there for a week because I don't feel like dealing with walking someone through an hour of tedious crap remotely, and I know it's not going to go away, but I just can't bring myself to do it). But on balance, I think being 'the go-to guy' for hard to figure out problems and odd ball tasks makes up for my general spaciness and unreliability. I think being on the right team and having the right manager really helps a lot. When they changed managers at my last job to one who was super concerned with metrics, my life became completely miserable. I'm sure taking Ritalin would have helped me cope with it a lot more, but the end result would have been that I'd still be working a shitty job instead of the one I'm much happier at now.
posted by empath at 1:03 PM on January 29, 2012 [21 favorites]


Other Peoples Posts?
posted by jonmc at 1:04 PM on January 29, 2012 [2 favorites]


im not down with anything, you dont fucking tell me what to do
posted by This, of course, alludes to you at 1:07 PM on January 29, 2012 [1 favorite]


The "bad parenting" argument breaks down when you meet people who "adventured" outdoors... and still suffered ADD; it is a just-so story, (and if we are engaging in "just-so" narratives, it could be argued that those people, who were USED to, and LIVED the "outdoors", roaming in packs, and adventuring actually do the worst in the hyper-structure of modern education).

My belief isn't in bad parenting specifically. My belief is that our society and culture has evolved to optimize for short-term, quantifiable production - often production for its own sake - rather than human well-being, and is making people sick in various ways mentally and physically

That an "adventuring" person would quickly become dysfunctional and in need of drugs to shunt off errant thoughts when stuck in the monotonously banal, authoritarian fluorescent hell-hole that is American public education does not surprise me in the least
posted by crayz at 1:10 PM on January 29, 2012 [5 favorites]


right hippybear, but isn't that just a just-so explanation?

Like, you don't have evidence for that (totally reasonable) suggestion...
I guess what I mean is, that doesn't so much matter today, because we don't have evidence for or against that claim, so it is non-falsifiable topic. It is a purely academic (theoretical) question that has no answer today, I don't mean to say "don't look at this question, and continue to advance our understandings", but rather to say, while we keep refining our science... we need to make sure that the simple things we can do today to help people, today, should not be forgotten, or stopped simply because there are theoretical "questions", and further refinements of our science that come each day.

Meanwhile, in the day to day, people are falling apart... because of this... cluster of things.


Crayz:Anecdata in this thread notwithstanding, the evidence suggests that the drugs do not have any long-term positive effect

Can you share with the class where this evidence is? I wasn't aware that such a definitive statement had been made. When should we expect these "drugs" to be removed from shelves?

The drugs don't affect the children of people who take them.

Meanwhile, losing your job, going homeless, self-medicating, and or living as part of the social underclass have actual, material, real harm upon individuals, and any potential child of a person who "fails" in such a way.

People with mental health issues are totally at higher risk of "failing" in modern (and old, like I was trying to show) society.

If you cannot show the "harm" of the drugs used... and I can show harm in the lives of those who "fail" because they are untreated, undiagnosed, and un-assisted people facing mental health issues... I fail to see how that suggests "getting rid of the medications that exist, and have been empirically demonstrated to help real human beings, so as to not fall into the "underclass" of homeless and self-medicating "other".
posted by infinite intimation at 1:10 PM on January 29, 2012 [2 favorites]


im not down with anything, you dont fucking tell me what to do

*raised eyebrow*

I see someone has never listened to Naughty By Nature.
posted by hippybear at 1:11 PM on January 29, 2012


right hippybear, but isn't that just a just-so explanation?

Like, you don't have evidence for that (totally reasonable) suggestion...
I guess what I mean is, that doesn't so much matter today, because we don't have evidence for or against that claim, so it is non-falsifiable topic. It is a purely academic (theoretical) question that has no answer today, I don't mean to say "don't look at this question, and continue to advance our understandings", but rather to say, while we keep refining our science... we need to make sure that the simple things we can do today to help people, today, should not be forgotten, or stopped simply because there are theoretical "questions", and further refinements of our science that come each day.


Sure it is. I never said it offered any solutions. It's a personal theory of mine which, due to the complexities of testing and researching for such things, will never find an answer. If you read my statement as saying that any current research should be stopped because of my little personal theory, you read words I never wrote.
posted by hippybear at 1:12 PM on January 29, 2012


Meanwhile, losing your job, going homeless, self-medicating, and or living as part of the social underclass

Losing your job isn't a health problem. It's great that there are drugs that let you perform better at some arbitrary task, but that doesn't mean that not being able to do that task means that you are unhealthy. The fact that there are so many jobs which require people to do tasks which come completely unnaturally to them is a societal problem, not a health problem.
posted by empath at 1:14 PM on January 29, 2012 [5 favorites]


Can you share with the class where this evidence is?

The point is, where the evidence isn't. Or to quote: "To date, no study has found any long-term benefit of attention-deficit medication on academic performance, peer relationships or behavior problems"

The Illusions of Psychiatry series in the NY Review of Books last year also spends a lot of time reviewing the lack of evidence the mind-altering drugs have positive impact on mental disorders, including new studies with "active placebos" that cast a lot of doubt on past studies showing benefits

So, I'll turn your question back at you. Show me the explanation of the etiology of ADD, and the evidence that long-term ingestion of mind-altering chemicals has a long-term benefit on the patients. Because this is increasingly looking like an absurd psuedoscience
posted by crayz at 1:17 PM on January 29, 2012


sort of believe that the rise in the prevalence of ADD/ADHD diagnosis has to do with environmental issues causing genetic pre-disposition to manifest due to chemical exposure which previously didn't activate

Certainly possible. The question is then what do we do now. It seems like we medicate to ease friction with standard expectations. Are we going to medicate whole swaths of people for the rest of their lives? Can we find an alternative way to ease these frictions?

I still think a huge range of differences has existed all along. We have to remember that these diagnoseses we're created to fit a spectrum of behaviors, it isn't like we discovered a new microbe. We know there were some people with these behaviors well before the diagnosis existed. Are there really more people with these behaviors now than there were in the past? We can't really know. What I do know is we as a society have become way way more rule oriented and restrictive. We have kids being arrested for talking, we have kids being tazed in schools. Hell, people mentioned in this thread that certain activities that used to be acceptable in kids are no longer acceptable, like running wild in the streets. I think it is pretty clear being cooped up indoors by overprotective parents probably does not cause disorders, I think that the desire to do what some people have always done is now considered a disorder.
posted by Ad hominem at 1:20 PM on January 29, 2012 [1 favorite]


Relevant science.

We're basically creating a prison or a zoo or a factory farm for ourselves to live in. And pumping ourselves full of antibiotics and anti-psychotics and anti-depressants and central system stimulants to stop us from killing ourselves and each other because of it. And the ones that can't or won't be medicated, we're locking away in an out of control prison system.

But maybe the right answer isn't finding the right combination of chemicals, but finding the right way to structure society.
posted by empath at 1:26 PM on January 29, 2012 [8 favorites]


Empath:(would you not agree that losing your job in america by definition means you will become unhealthy... who is paying for doctor visits and treatments for the degenerative effects that malnutrition [taken as an assumed byproduct of of homelessness] bring).

Sorry hippybear, not meaning to come across as hostile to you, or attacking your ideas, I was sort of running with your words (I put that I agree, in principle that your suggestion is as valid as any other to explain the current situation, and is actually appealing, and seems to "make sense", but that, as we agree, we cannot determine this, with the tools of today [the bit about "continuing or not continuing research" was more to say "I (personally) don't mean to say that I have some answer, or that I think anything is done and settled").
posted by infinite intimation at 1:29 PM on January 29, 2012


When I was living in Sharon, Massachusetts, my Dad was principal of the elementary schools. He later told me that there was a little boy there who had autism, and he didn't speak.

One day, the teacher saw him next to a tree. She approached him, worried, only to hear him say, "Hello, Tree."

And that is how they found out this boy could talk. He didn't talk to human beings: he talked to trees. Maybe the rest of us are just too much stimulation.
posted by Marie Mon Dieu at 1:30 PM on January 29, 2012 [7 favorites]


would you not agree that losing your job in america by definition means you will become unhealthy... who is paying for doctor visits and treatments for the degenerative effects that malnutrition [taken as an assumed byproduct of of homelessness] bring

Yes, American society is completely fucked. But that still doesn't make getting fired a health problem.
posted by empath at 1:32 PM on January 29, 2012


I'll also add, many of the misconceptions we have about psych drugs can be traced back to our artificial distinction between recreational and prescription use of mind-altering drugs. If you said to someone "It's tough for me to be social, so when we go hang out with new people a few nights of week, I'm going to drink some alcohol to loosen up", they'd probably think that was reasonable

If you said "It's tough for me to be social, so I'm going to try to maintain a constant level of alcohol in my bloodstream 24 hours a day", they'd think you were insane

Everyone knows that we build up tolerances to mind-altering drugs, and that it's best to use them periodically/situationally to sort of push your mind's normal equilibrium into a different state temporarily. Constant use just tends to lead to a mind that slowly re-establishes the old equilibrium, except now dulled by the drug

Why this would happen with drugs you take recreationally but not (very chemically similar) drugs given to you by a doctor, is yet another of the amazing unexplained myths of psychiatry
posted by crayz at 1:34 PM on January 29, 2012 [6 favorites]



That an "adventuring" person would quickly become dysfunctional and in need of drugs to shunt off errant thoughts when stuck in the monotonously banal, authoritarian fluorescent hell-hole that is American public education does not surprise me in the least

Ok, but it seems pretty clear that you haven't had to deal with this cluster of traits... and to have to "fit in", or at least "not-completely fail"... sure, I thought everyone 'wants' to not have to live in some capitalism run-amok nightmare with fluorescent tube lighting and cubicle farms.

But we do live in the world we live in.
So... "we" are left with some "choices" either cope, shit, get off the pot, and meanwhile, being labeled, failures, lazy, pathetic... and more.

But the reality is that such positions, (perhaps "fueled", or "saved", or "driven", or "saved" by medications; these are sometimes the only hope for a chance to "fit in", or rather just to "not fall apart and fail utterly", to gather a meagre bit of money, so as to take a vacation and live that (beautiful sounding) "free-human" life, if only for a little bit.

If you are suggesting that many of the disorders of modernity could be attacked or pushed back if we all had some sort of "revolution" in thinking about how we structure and order our society... then yeah, I am with you there, on that lofty goal, or dream... but that is all it is today, a dream, a vision of a better future.

How we actually work towards that is what needs answering by people saying that it is "medication" that is at a root... many acknowledge the sick-society... so why blame the refuge, the one saving bit that helps some so called, labeled, "non-normals" fit in long enough to survive, if not to thrive.
posted by infinite intimation at 1:34 PM on January 29, 2012


The problem with this thinking is that so many disorders overlap in their symptoms. ADHD is really difficult to nail down absolutely, so, like many of us posting here, it results in a lifetime of trial and error to find a way to exist with some comfort, function and feeling of being "normal".

Just a funny aside, after 30 years of struggling with ADHD, PTSD (yea, from childhood), mild depression etc. I was finally able in my late 20s to kinda get my shit together and hold down a job. After a while I noticed my work peers starting to undermine my work and just fuck with me. My boss said that things seemed to them to happen too easily for me, that I seem too relaxed and casual. Comfortable.

I'd like to tell those folks that what they're witnessing is 30 years of developing coping mechanisms finally bearing some fruit.

FWIW, I really appreciate the person experiences posted here.
posted by snsranch at 1:40 PM on January 29, 2012 [1 favorite]


I think the Sroufe NYT article misrepresents the study that it deals with (at least, I'm pretty sure this was the one -- annoyingly, it was not linked or even cited). The study appears to have divided children diagnosed with ADD into four treatment groups (medicated, therapy, both, and "community standards of care"), maintained that division for 14 months, then continued to follow all of the children for 8 years. On average, all of the treatment groups declined in ADD symptoms over time, converging towards the end of the study, but the medicated and combined groups showed much faster improvement. So you could just as easily say that based on this study, medication is effective for ADD, in that it causes improvement to happen quickly -- in months rather than years. That is a non-trivial difference, particularly if you're one of the students affected.

It's also not even necessarily true that drugs don't provide any additional long term benefit over other types of treatment, because the randomization only lasted for 14 months but the measurements continued out to 8 years. So it may not be so surprising that you see that convergence -- some of the people in the "medication" group have stopped taking it, while others in the "community care" group have started.

It's definitely worth thinking about developing better treatments for ADD, perhaps treatments that don't involve controlled substances with not-insignificant side effects, and I'm sure the environment must play a role in the development and manifestation of ADD, but contrary to the implication in the article this study can't really speak to the question of what proportion of ADD is from the parenting environment and what proportion is intrinsic.

(I also feel like I should note that neither the article nor the study contest the existence of ADD, or mental illness in general.)
posted by en forme de poire at 1:40 PM on January 29, 2012 [6 favorites]


Hippybear go back through your comments and replace gay with your mentions of ADHD. Does that clarify how terrible your opinions sound?
posted by humanfont at 1:51 PM on January 29, 2012 [3 favorites]



Crayz:So, I'll turn your question back at you. Show me the explanation of the etiology of ADD, and the evidence that long-term ingestion of mind-altering chemicals has a long-term benefit on the patients. Because this is increasingly looking like an absurd psuedoscience

To me the most important thing to remember is that for all the fear of a diagnosis, or belief that "diagnosis= automatic pharma-solutions":

The recommended treatment of ADHD involves a combination of behavioral management and medical treatment.

This is a meta-study which asks "what is the value of Pharmaceuticals". Including evaluation of the study en forme de pore linked just above.
The MTA Cooperative Group study involved a clinical trial evaluating the relatively long term (14 months) effects of stimulants on ADHD symptoms. The authors found that the use of stimulants was superior to behavior therapy (MTA Cooperative Group, 1999). Similarly, Brown et al. (2005) reported that a review of the empirical literature suggests that nonpharmacologial interventions alone were inferior to the use of stimulant medication. The authors do report that the combined use of medication and other therapies is effective and may result in smaller doses of stimulants. Barbaresi et al. (2006) reported results from a long term observational study. These authors found that the results regarding the efficacy of stimulant medications found in clinical trials with relatively short follow-up periods were similar to the results over their longer observational period. The empirical literature has found that the use of stimulant medication has been effective at managing the core behavioral symptoms of ADHD. These included indicators of behaviors such as impulsivity and distractibility. Far less evidence was found that these medications increased academic performance (Brown et al., 2005).
....
A broader question about the total value of pharmaceuticals involves the net benefit of these medications. There is a growing debate in the literature specifically about whether new drugs are worth more than their costs. The largest debate in the literature focuses on whether spending on these new drugs lead to even larger decreases in non-prescription drug spending , whether they are cost effective (i.e., they provide enough health benefits to outweigh their costs relative to an alternative treatment method), or neither. We focus this section on existing evidence concerning the net benefits of these medications in terms of cost savings from nondrug health spending. This focus results from the fact that it is currently the most compelling area of debate between researchers regarding the value of pharmaceuticals.

Finally, we will discuss the growing body of literature focusing on the non-health benefits of pharmaceuticals. Traditionally, evaluations of medications focus on solely health benefits of prescription drugs. Increasingly, medications are intended to treat chronic conditions and therefore can generate a variety of non-health benefits. For example, the development of effective treatments for mental health conditions can result in lower crime rates and the distribution of anti-retroviral medications for HIV/AIDS patients in Africa has been shown to increase productivity and labor force participation. The studies discussed in this section provide clear evidence about the growing value of pharmaceutical medication in everyday life.
posted by infinite intimation at 1:53 PM on January 29, 2012 [2 favorites]


Hippybear go back through your comments and replace gay with your mentions of ADHD. Does that clarify how terrible your opinions sound?

No, it actually doesn't. If you feel the need to try to take me to task for unspecified things I have said in this thread but are unwilling to actually state them in the public thread, I suggest you take it to MeMail or MetaTalk. Because I have no idea what you're talking about and it obviously doesn't matter enough for you to be clear here in the thread about what has your hackles up.
posted by hippybear at 2:02 PM on January 29, 2012 [3 favorites]


Including evaluation of the study en forme de pore linked just above

Except it quotes the results of that study in the "relatively long term" of 14 whole months. The study was from the 90s, and in fact that group of people have been tracked since:
In nearly every analysis, the originally randomized treatment groups did not differ significantly on repeated measures or newly-analyzed variables (e.g., grades earned in school, arrests, psychiatric hospitalizations, or other clinically relevant outcomes).

...

Type or intensity of 14 months of treatment for ADHD in childhood (at age 7.0–9.9 years old) does not predict functioning six-to-eight years later. Rather, early ADHD symptom trajectory regardless of treatment type is prognostic. This finding implies that children with behavioral and sociodemographic advantage, with the best response to any treatment, will have the best longterm prognosis.
posted by crayz at 2:10 PM on January 29, 2012 [1 favorite]


By the way, thanks for posting the link to the Susan Smalley piece. She has a really great exposition of how people look for genes associated with ADHD and what exactly people mean when they talk about ADHD having a "heritability" of 0.76. Really recommended.

(The fact that the other arm of her research is based on meditation-based treatments also throws a wrench into the idea that modern scientists only care about drug therapies and don't care about treating individuals.)
posted by en forme de poire at 2:11 PM on January 29, 2012


"It's tough for me to be social, so I'm going to try to maintain a constant level of alcohol in my bloodstream 24 hours a day", they'd think you were insane

You also get that reaction from lots of people if you say "It's hard for me to be social, so I'm going to take some MDMA and go out clubbing tonight".
posted by empath at 2:14 PM on January 29, 2012 [2 favorites]


Hippybear go back through your comments and replace gay with your mentions of ADHD. Does that clarify how terrible your opinions sound?

If we found a drug that did to homosexuality what ritalin does for people with ADHD, do you think that it wouldn't still be a 'condition' that needs to be 'treated'?
posted by empath at 2:16 PM on January 29, 2012 [2 favorites]


Crayz, the patients were unrandomized after 14 months. Unmedicated students were free to choose medication later and vice versa, so it's not surprising the populations converged. What the study really shows is that intensive, rigorously controlled treatment over a 14 month period does not produce enduring benefits, which is not surprising since we already know amphetamines treat symptoms and do not actually cure ADHD. Also, the impact of short term benefits shouldn't be minimized (as zoomorphic's story illustrates).
posted by en forme de poire at 2:21 PM on January 29, 2012 [2 favorites]


Because if ADD/ADHD really has been historically underdiagnosed, as some have asserted in this thread, then we'd see a giant population of people in previous generations who were completely unable to cope with life due to their condition.

I don't see how this follows, since it's not like a majority of people who *are* diagnosed with ADD/ADHD are "completely unable to cope." But maybe I'm misunderstanding you.
posted by rtha at 2:22 PM on January 29, 2012 [3 favorites]


I see someone has never listened to Naughty By Nature.

Alternatively, someone was demonstrating Oppositional Defiant Disorder.
posted by MissySedai at 2:23 PM on January 29, 2012 [3 favorites]


Mhmm.

A bunch of people without ADHD trying to tell the ADHDers how to treat our ADHD.

Carry on with your ignorance. In the meantime, I'll take and keep my Ritalin, thank you.
posted by spinifex23 at 2:25 PM on January 29, 2012 [14 favorites]


And maybe none of this would be a concern if we stopped being so goddamned concerned with everyone being "normal" - as measured by a standard that does not actually exist - and started being okay with people being different from one another.
posted by mie at 2:30 PM on January 29, 2012 [2 favorites]


I agree with koeselitz's tl;dr.

Get to the point, please.
posted by y2karl at 2:33 PM on January 29, 2012


And maybe none of this would be a concern if we stopped being so goddamned concerned with everyone being "normal"
I'm truly not interested in being normal. I'm interested in not having the power turned off because I forget to pay the bill. I'm interested in not being late for work every day because I can't find my keys to lock the door behind me. It would be awesome if I could concentrate on conversations with people so that I could be an active and considerate friend. I have fucked up at work in ways that have caused other people a lot of grief because I've forgotten to do small but important things. This isn't just about me adhering to stupid social conventions. It really interferes with my life in non-trivial ways. It interferes with my life even though I happily have lots of friends who appear to find my eccentricities charming.
posted by craichead at 2:36 PM on January 29, 2012 [29 favorites]


Hippybear first you opened with some generalized based on nothing bullshit about how kids play today. As if that was the magical cure. Suppose I suggested that the reason we see so many gay kids today is because our politically correct society has somehow feminized youth. To cite your specific comment:

In my hometown, growing up, there were ALWAYS packs of kids roaming our neighborhood. We had boundaries about where we could and could not go, but it was easily many blocks of roaming time, including some vacant land near a flood control ditch where we built forts out of found wood and cardboard, etc.

Then you shared some personal anecdote about a "friend" who overcame their problems closing with, "They found ways to cope with their brains, and their lives may not be perfect but they get through just fine day to day. Just like all of us"

Suppose I provided some anecdote about some bi-curious guy who went straight and now married a woman, closing with. Then I could suggest that you find a way to cope with your gayness and marry a woman like everyone else.
posted by humanfont at 2:40 PM on January 29, 2012 [1 favorite]


I have yet to see someone address an important question:

Is medicating away behaviors/traits which reduce our chance of success bad and does it deserve social stigma?

I teach middle school and I challenge anyone who is of the (IMO idiotic) mindset that 'ADD doesn't exist' to come teach for a week at my level. Hell, I double dog dare you.

Was it always with us? Probably. Do I care? No. What I care about is this: 10-25% of the little boys I teach are more successful because of the medication they take. They learn more, they get in less trouble, they are generally happier. I do not see this specter of 'listless, overmedicated little boys who somehow fail to be little boys' that some people wave around like a boogeyman.

These little boys have as much of a right to regulate their attention issues as little girls do taking the pill to moderate irregular menstruation.

And yes, I refer to everyone under 16 as little boys and little girls.
posted by Fuka at 2:42 PM on January 29, 2012 [7 favorites]


Hippybear first you opened with some generalized based on nothing bullshit about how kids play today. As if that was the magical cure. Suppose I suggested that the reason we see so many gay kids today is because our politically correct society has somehow feminized youth. To cite your specific comment:

In my hometown, growing up, there were ALWAYS packs of kids roaming our neighborhood. We had boundaries about where we could and could not go, but it was easily many blocks of roaming time, including some vacant land near a flood control ditch where we built forts out of found wood and cardboard, etc.

Then you shared some personal anecdote about a "friend" who overcame their problems closing with, "They found ways to cope with their brains, and their lives may not be perfect but they get through just fine day to day. Just like all of us"

Suppose I provided some anecdote about some bi-curious guy who went straight and now married a woman, closing with. Then I could suggest that you find a way to cope with your gayness and marry a woman like everyone else.


Wow, seriously? I don't even...

Obviously this is a topic which you have strong feelings about.

I didn't say anything about a magical cure in my first comment. I was remarking on a change in society I have noted. At no point in that did I say it was a cure, or even link it to ADD at all.

The personal anecdote is about my partner of nearly 20 years. Your use of scare quotes and displacement of his status to being something other than my partner is pretty ugly, or shows you didn't actually read what I wrote closely at all.

And you know? He did find a way to cope with the idiosyncrasies of his brain and he works fine in the world without medication or trying to pretend he's anything he isn't. Which is pretty much the opposite of the conclusion you drew from what I wrote, but no matter. You can go on pretending that I said that people with ADD need to disguise themselves and live in some kind of closet in order to present a false face to the rest of society, and I'll live on knowing what I actually wrote was nothing of the sort.

If you want to address this misapprehension of yours further with me, my MeMail is open and functional.
posted by hippybear at 2:53 PM on January 29, 2012 [1 favorite]


I think it's fabulous that your partner is able to cope without medication, hippybear. But you seem to be assuming that since he can do it, everyone can do it. And I suspect I'm not the only person here who has had a different experience and who has found medication helpful. So what you're saying is that your expertise on ADD, which comes from knowing your partner, trumps my personal experience of having ADD. And yeah, that strikes me as a little obnoxious. Maybe me and your partner are just different people who need different things to manage our lives. Maybe both of our experiences are valid.
posted by craichead at 3:06 PM on January 29, 2012 [12 favorites]


When my dad was a kid, perhaps half his class went to high school. Of that class, maybe a couple went to college. The rest became farmers, tradesmen (almost all the women would be expected to marry and work at home), laborers and so forth. When I was a kid, everybody went to high school, and half of us went to college.

This change isn't just a shift from non-academic careers to academic ones: I can remember when physiotherapy was basically massage and it was a diploma-level subject at best. Now it takes a Bachelers' degree plus further education; I've been told that there's a strong push to make it a Masters' level qualification. In the trades, the old style of apprenticeships have disappeared: practically all tradespeople are expected to attend some sort of post-secondary education. The same goes for business: it takes a lot of focus to comply with payroll and tax law.

So consider what happens today to kids who are bright but whose ADHD means they can't focus academically. In the past they could have coped by downgrading - doing a trade rather than a profession, or going into business. This option who doesn't exist today. Their only hope of having a normal life is treating the ADHD. And I'm sure that there are behavioral tricks that help some of them, just as there are diabetics who can cope without insulin. But you know what? These tricks don't work for everyone. If they did then ADHD wouldn't be a problem, just as diabetes wouldn't be a problem if it was generally curable by exercising more and abstaining from carbohydrates. And none of us know how prevalent ADHD really is, because our circle of friends is selective. Take Hippybear, for instance. His partner copes with ADHD, and that's great, but if his partner couldn't cope then he would be a different sort of person and it's very likely that Hippybear wouldn't know him. So of course his partner was able to deal with it. Of course most of our friends were able to deal with it. But they would very likely be happier today if they had had more options; and in any event we don't know about all the people who couldn't deal with it, and are now miserable, or isolated, or dead.
posted by Joe in Australia at 3:10 PM on January 29, 2012 [9 favorites]


that strikes me as a little obnoxious

Perhaps it is a little obnoxious. But then, craichead, you aren't the one who called me out as being "profoundly ignorant and offensive", so I apologize for implying that his experience should be universalized.

The comment, was, however in the context of wondering how people with ADD coped in the world before medication was developed or became vogue, and most of it should be read in the context of the pullquote I included at the top of it.
posted by hippybear at 3:16 PM on January 29, 2012


Hippybear, ADHD is a catchall for a set of symptoms, 10% meeting the threshold for diagnosis doesn't mean that the full 10% are not going to be able to function without drugs well enough to have a place in society (however miserable the conflicts with social/workplace expectations makes them). I'm glad your partner has found a non-drug solution to his problem. My ADHD support group have been looking for non-drug solutions for a long, long time. They are all taking prescription meds despite a wide variety in perceived effectiveness from almost useless through 15% of what I need to do as therapy to manage my ADHD all the way to essential to function.

As for shaming into better habits, I seriously doubt that has ever helped anyone with really severe ADHD. There's some interesting research being done about how deficits in executive function diminish our ability to suppress traumatic memories. Given the deep sense of remembered shame I've seen in adults with ADHD who recall their childhood years in school even up to 55-60 years later, and their stories about how they rebelled more as more pressure was brought to bear, I don't think shame had efficacy for the majority of ADHD sufferers (hyperactive or inattentive). And really, if your problem is that you can't recall something, I don't understand how being shamed over it would help your recollection, as opposed to being taught some kind of structured way to manage the details you are forgetting.

Shame is actually one of the main components in the nurture element of ADHD as far as I can tell. I'm sure there are other non-normative behaviors where the response by society is similarly counter-productive or inappropriate, but with ADHD, it's amazing the degree of (defensive?) justification people bring to bear in their advocating it. I'm not saying that's the intent of your aside, but it is emotionally charged to say the least.
posted by BrotherCaine at 3:44 PM on January 29, 2012 [5 favorites]


I certainly don't advocate for shaming as a treatment or behavior modification method for any problem, so please don't put forward the idea that I have said anything of the sort.

But I do know I've read plenty of accounts, both real and fictional, about schoolchildren being subjected to shame in an official classroom capacity as a method of behavior control for those who will not or cannot, for whatever reason, sit still and be part of the desired classroom environment. I've also seen such tactics being applied myself, as recently as 15 or so years ago, so I know it's not something from ancient history.

Yes, severe ADD/ADHD cases won't be helped by behavior modification of any sort, and likely also won't be aided by structured teaching to create habits of coping. There is a reason why medication has become popular, and that is because it was seen at first to be helping the extreme cases, and has subsequently been accepted as the way to bring anyone, adult or not, extreme or mild, into line with expected norms of behavior.

Of course it was emotionally charged. But it was also said in the context of being historical, and coupled with the caveat that it isn't currently regarded as effective.
posted by hippybear at 3:52 PM on January 29, 2012 [1 favorite]


Somewhat like the way "depression" is too-often the default diagnosis for "having a bad day".

You know what the most irritating thing about mental illness is? People expressing opinions like this. If someone has a broken leg, you don't see hordes of people saying how casts are all just a conspiracy of big plaster, and you know, they had a sore leg once but it got better without all this diagnosis rubbish. Or if someone has cancer, it's because they weren't brought up properly by their parents, and they're best friends with a guy who had cancer, and he just talked to a therapist and exercised, and now he's all better, so clearly that's the real answer.

Why is when the problem is inside your skull, that most everyone thinks
1. It's not a real illness
2. They know someone who learned to cope with the symptoms, therefore everyone can without drugs
3. Drugs are good and peachy when they treat physical illnesses, but are just voodoo when used for mental ones
4. They felt sad once, or were forgetful, etc etc, so depression / adhd / bipolar / schizophrenia are just like that
5. That we all have it tough, so just buck up and take it like a man
6. That because people weren't previously diagnosed, they therefore can't have existed
7. In short, people who never experienced what it's like, have no medical training, and wouldn't know a double blind study from a hole in the ground, still feel perfectly free to pontificate on what's REALLY Wrong with mentally ill people and how to fix it.

Is life considerably more beaurocratic and driven by paperwork, achievement at higher education? Yes. Is it harder to make a living without all those bits of paper in a stressful clock driven middle management obsessed workplace where all the money goes to the people at top? Yes.

Does being unable to function in that world like other people do because your brain isn't suited to it either temporarily or permanently, make it even harder than 'normals' have it? Yes, yes it does.

Mental illnesses come in many stripes. They have different treatments, they are definitely fucking real, and they fuck with your head in ways that make surviving the day even harder than it needs to be. While drugs are not the answer for everyone, they are most definitely of great help to many.

So with the greatest of politeness, and good will to you,and this is addressed generally; if you think that such illnesses are not serious, not real, or not worthy of real treatment by qualified professionals, you can take that opinion and cram it up your bum where it belongs.
posted by ArkhanJG at 3:53 PM on January 29, 2012 [27 favorites]


The comment, was, however in the context of wondering how people with ADD coped in the world before medication was developed or became vogue
This is such a weird question to me, because I grew up hearing stories about my great-grandfather and grandfather, both of whom were brilliant men who couldn't get their acts together. What happened to them was that they scraped by on the economic margins. Sometimes they didn't scrape by and relied on charity or help from family to make do. They beat their wives. They weren't very good fathers. They weren't hobos, but I don't think anyone would count them happy or successful people. I imagine they weren't the only people like that.
posted by craichead at 3:56 PM on January 29, 2012 [11 favorites]


So with the greatest of politeness, and good will to you,and this is addressed generally; if you think that such illnesses are not serious, not real, or not worthy of real treatment by qualified professionals, you can take that opinion and cram it up your bum where it belongs.

If you're so sure of your opinion you're unwilling to listen to people who don't share it, I'm not sure why you're participating in this discussion
posted by crayz at 3:57 PM on January 29, 2012


So consider what happens today to kids who are bright but whose ADHD means they can't focus academically. In the past they could have coped by downgrading - doing a trade rather than a profession, or going into business. This option who doesn't exist today. Their only hope of having a normal life is treating the ADHD.

I think arguments like these really show how broken our society is . . . in a lot of ways. Going into the trades shouldn't be thought of a "downgrade" compared to white collar jobs (especially since there are many fields in which the pay differential behind that societal attitude just isn't there). And you know what? Most of these jobs don't need post-secondary education. Everything I've ever done in my desk jobs could have been taught on the job, from computer skills to database management. And yet they required college degrees or even graduate credits (why? I have no idea). The idea that you have to have four or more years of schooling after high school to sit at a desk and enter data (basically just so you can get health insurance) is messed up, and it's also led to high debt and unemployment in my generation. And yet we want to change people so they can fit this broken system? People aren't robots, and it disappoints me that we expect them to be in order to adapt to our really screwy world.

Fuck a "normal life." Why is this something we even value anymore?
posted by PhoBWanKenobi at 3:59 PM on January 29, 2012 [13 favorites]


I think treating ADHD as a medical disorder in isolation from social and environmental factors is an extremely dangerous and very worrying trend. It is a real illness, absolutely, but it does not follow that it does not have external causes. (Of course, it also does not follow that it has purely external causes, either.) Gabor Mate's Scattered is a good starting point; a brilliant book by a brilliant man.

Of course, if the problem is not with the individual but the system, it's much easier to medicate the individual to fit the system than it is to change the system to accommodate the individual.
posted by mek at 4:03 PM on January 29, 2012 [2 favorites]


Back "in-the-day" when we let kids roam free in their neighbourhoods, they could at least "play" themselves out... Now, constantly cooped-up, no wonder they cannot sit still...
What about adults? I suppose there were plenty of factory jobs that didn't require lots of mental energy, but it's not just a kids disease. It's not something just grow out of.

Talking about ADHD only in the context of children is completely ignoring what it actually is.
I think in most cases, depression, ADD, asperger's, etc, shouldn't really be thought of as 'disease', although they certainly are inconvenient in a modern society. They're just normal expressions of human diversity, for the most part. And it's the environment we're living in that makes them pathological.
Yeah I agree with this. Just like some people are physically weak. If we had a society where physical strength was necessary for survival, and we had steroids, people would probably need to take them. Of course some people would complain that people just need to work out harder, or whatever.
posted by delmoi at 4:07 PM on January 29, 2012 [4 favorites]


If someone has a broken leg, you don't see hordes of people saying how casts are all just a conspiracy of big plaster, and you know, they had a sore leg once but it got better without all this diagnosis rubbish.

It's interesting that your analogy breaks down at the very beginning. Yes, if you have a broken leg, we want to treat the broken leg... but we also want to know how you broke your leg so we can prevent it from happening again. Society as a whole has a shared interest in reducing the likelihood of accidental injury, so it does things like make safe crosswalks, require driver education, prosecute domestic violence, etcetera. For broken legs, car accidents, ADHD, PTSD, lung cancer, etc etc, all of these include many avoidable cases which are imposing enormous economic and social costs.

To go back to ADHD, yes, we absolutely need to treat people that are suffering from ADHD, but we also need to take a hard look at how and why ADHD diagnoses are rapidly increasing, because we want to take preventative steps to reduce them. These two things aren't mutually exclusive.
posted by mek at 4:15 PM on January 29, 2012 [5 favorites]


That said, the nature vs. nurture; I think it's a little of both. The genes pre-dispose you to it, but a very slight modification in how you are taught or nurtured might give you the means to control your life. However, I think we try and pound the square pegs in the round holes until despair or rebellion sets in. I can't blame anyone else for my failures in life. I'm the only one responsible for me. But there are certainly ways in which you can give a helping hand to the people around you sometimes. Starting with not assuming they are like you.

Well, I think nurture can affect how someone deviates from their natural predisposition, but only to an extent. If someone has a 5% case of ADHD (made up metric), then maybe with some training they can get close to average. But if someone is 50% ADHD, those same tools, if they worked at all and didn't backfire, might be enough to keep that person out of jail. But certainly not functional.

I think what is being missed here is perspective. We all knew kids in school who were oddballs, and they went on to varying levels of non-success. No matter what his parents and teachers did, he just kept failing to some degree or another. This is not a path to a happy, successful person. Now, with a greater understanding of one of the ways kids end up being not successful, we can help them be happy. Just with some medication and skills coaching. Now the kid has more control over his life and has more choices. He doesn't HAVE to do low skill, highly supervised work unless he wants to. He isn't forced into that because that's the only way he can hold a job, because he couldn't graduate high school. That seems like a win.
posted by gjc at 4:47 PM on January 29, 2012


More than 10% of the population has a prescription for corrective lenses to correct vision defects. No one extols the virtues of learning to cope with blurred vision. No one spreads panic about over prescription. Even though most people in previous centuries lived their whole lives without glasses. Also very high percentage of kids end up needing braces for their teeth, but again there seems to be no debate about correecting defects in the bite. No one talks about how much better it was when people just dealt with their mishapen maw.
posted by humanfont at 4:55 PM on January 29, 2012 [13 favorites]


Or, for instance, allergies and autoimmune diseases seem to be on the rise, and people definitely do wonder about the cause of that. But they don't tell you inspirational stories about people who learned to live with chronic hives, and they generally don't come up with wacky theories about how the uptick in allergies is caused by lack of discipline or bad, unloving mommies.
posted by craichead at 5:02 PM on January 29, 2012 [5 favorites]


Even though most people in previous centuries lived their whole lives without glasses.

Yes but they kept bumping into eachother.
posted by jonmc at 5:02 PM on January 29, 2012 [3 favorites]


I think in most cases, depression, ADD, asperger's, etc, shouldn't really be thought of as 'disease', although they certainly are inconvenient in a modern society. They're just normal expressions of human diversity, for the most part. And it's the environment we're living in that makes them pathological.

Yeah I agree with this. Just like some people are physically weak. If we had a society where physical strength was necessary for survival, and we had steroids, people would probably need to take them. Of course some people would complain that people just need to work out harder, or whatever.


I disagree with this "today's society" thing. There have always been places in society for people with ADHD, or its genetics would probably have been bred out. BUT, those jobs or situations probably weren't all that enjoyable, even compared to the average quality of life at the time.

This isn't about the variability of normal, or medicalizing the differences in people. This is about people who are much more different than that. People with the above named diseases can't just "try harder" and beat the disease. The apt comparison would be someone with an endocrine condition where their bodies didn't make their own steroids, and they take a pill to get them back somewhere close to average.

ADHD isn't about self control or procrastination. That's normal. It is about having NO control over the flights of fancy that everyone does have control over. The people who start cooking dinner and end up tearing out that wall that's been bothering them. If their minds are television sets, the channels flip and they don't even notice it.

Call me when you come home to the half-made sandwich you left on the counter and don't even remember starting it. Or finding the potato chips in the freezer.
posted by gjc at 5:03 PM on January 29, 2012 [3 favorites]


I don't have ADHD, I'm not a parent of an ADHD child, educator, or doctor. I have had friends, though, who were put on Ritalin from a young age and got addicted to it. Make no mistake, the Ritalin helped them with their schoolwork, but it was a drug that they were dependent on. One friend was on Ritalin for something like 10 years, and in college decided she wanted to quit for good. She had tried a few times, but always fell off the wagon. The next step for her was to go to Amsterdam (hey, she was a trust fund kid) and check into a detox clinic. She spent a few weeks there, suffering the tortures of the damned (her words), and I've heard anecdotally that the withdrawal from Ritalin can be along the lines of heroin withdrawal.

Maybe that was just those friends, and they are not the norm for most people taking Ritalin. And as I said, both friends claimed the Ritalin absolutely helped them with school. But damn what a price.
posted by zardoz at 5:09 PM on January 29, 2012


The apt comparison would be someone with an endocrine condition where their bodies didn't make their own steroids, and they take a pill to get them back somewhere close to average.

No, that's not an apt comparison at all, because it is assuming that ADHD is entirely genetic in nature. That's begging the question. The comparison to allergies is much more appropriate, given that both are on the rise in developed nations, are spectrum disorders, and the relevant casual links between genetics and environment remain largely undiscovered.
posted by mek at 5:20 PM on January 29, 2012 [4 favorites]


Well, I'm like hippybear's partner. I think I started developing strategies early on to beat the ol' bouncy brain. Listening to lectures while sitting still and staring at someone's mouth moving bores the shit out of me, so I took up heavy doodling in middle school, really tediously detailed drawings on graph paper in high school, crosswords in college, and nowadays, knitting. Suddenly a long talk becomes a lot more interesting if I don't ONLY have to focus on the talk! It works great except for the occasional fuckwad who yells at me to pay attention to them. Uh, if I'm staring raptly at your face as you lecture, it's because I zoned out 20 minutes ago. Thankfully, once I got out of school nobody really cares. I bounce back and forth between multiple activities at a time and work on them in chunks until the "must do something else" buildup leads me to switch. I tend to wear a lot of jewelry, which I fidget with when I can't go move around for awhile. I still get work done. I wasn't a "problem student." But then again, I'm a girl, maybe that's why. I still get things done at work. I wish during "slow season" I had more work projects to bounce back and forth between rather than only having one long, tedious one to do for weeks or months on end, because that annoys the ol' bouncy brain quite a bit, but...oh well. Could be worse.

I don't know if those strategies would work for other folks here or not, but it works for me. Also I probably don't have it all that badly compared to others either--like I can actually manage to get myself places on time without issues. The issues I have seem to be ones that can usually be defeated by giving myself multiple things to concentrate on, and I make damn sure I get my stuff together before I go to bed at night so I have as little thinking as possible to do in the morning, and I keep track of how long it takes me to do things and keep it in mind. I do think it must run in families though since some distant relatives got diagnosed with it, and god knows my mom is one of those people who can't be on time and is scatterbrained and doesn't really prioritize what she needs to be working on. She's one of those people who will drop what she's doing to focus on cleaning something or doing some other chore that isn't a priority just because it occurred to her right then to do it. I think I just lucked out compared to her, though, by not having my issues be that severe. I figured out how to focus myself in my own way (by having multiple streams of attention), and she never has. But who knows if that would work for her anyway? I multitask well and she doesn't so much most of the time.

I am not officially diagnosed and I don't ever plan on trying to get diagnosed, even though I'd probably get diagnosed in like 15 seconds once they hear that I tend to read and knit at the same time or something like that (I don't know why this shocks people so badly, most of the time I'm not exactly doing something that requires me to stare at it and only it). Why? Because not only does that put a lovely black mark on my insurance record for life and I'd rather not add any on unless I have to, they'd also immediately prescribe drugs and I don't want to take them. I don't know how everyone on drugs remembers to take them. I am a timely person, I probably don't forget shit going out the door all that much more than other folks, but I hate "daily good habit" stuff and have issues remembering to take the damn vitamins once per day every day. I usually do not manage that. On a good week I'll manage 4 out of 7 days. From what I hear, the forgetting to take the time-factor-y drugs, or not taking them on time, or forgetting a dose (multiple doses a day!) or taking it too late or whatever, is a bad thing. And I can't swallow pills whole, and I'm scared of the side effects on top of that. I don't know what the hell I'll do if I ever come down with a medical condition that absolutely requires me to take drugs consistently. Die, probably.

But that doesn't mean I'm totally against drugs. I just don't think I could manage taking them. If taking drugs works for you, then godspeed and good luck with that. You probably have less issues with meds than I do. Different strokes for different folks. I just wish ADHD wasn't one of the problems where the ONLY solution any more is "take the drugs, it's just like diabetes." And it seems to be going that way.
posted by jenfullmoon at 5:25 PM on January 29, 2012 [6 favorites]


More than 10% of the population has a prescription for corrective lenses to correct vision defects. No one extols the virtues of learning to cope with blurred vision. No one spreads panic about over prescription.

Actually, this is a thing.
Why is myopia so much more common than before?
Is it because kids read too much and don't get to run around outside?
Is it diet?
Maybe prescription glasses are causing poor vision!
You too can fix your weakened vision with exercises and proper treatment!

It actually matches the ADHD arguments almost word for word, it's just not as common yet.
posted by jacalata at 5:25 PM on January 29, 2012 [4 favorites]


Or, for instance, allergies and autoimmune diseases seem to be on the rise, and people definitely do wonder about the cause of that. But they don't tell you inspirational stories about people who learned to live with chronic hives, and they generally don't come up with wacky theories about how the uptick in allergies is caused by lack of discipline or bad, unloving mommies.

In the future people are going to be absolutely fucking amazed how little credit we gave to the effects of our own actions and the society we choose to build and live in on our well-being and mental and physical health. To hear some people on MeFi talk, everyone is morbidly obese, allergic to their entire environment and in need to stimulants, happy pills and god knows what else just to eek by, because that's the human condition

And of course anything "real" must be in our genes - that's an idea we've cargo-culted all the way to 11
posted by crayz at 5:27 PM on January 29, 2012 [2 favorites]


This is my adderal pill. There are many like it but this is mine.
My adderal is my best friend. It is my life. I must master it as I master my life.
My adderal without me is useless. Without my adderal I am useless. I must take my adderal regularly. I must not take it in greater quantities than prescribed. I must take it before I leave in the morning, I will...
My adderal and myself know that what counts are not the dreams you have, but the ones you acheive. We know that living our dreams counts, we make them real by finishing things. We will finish...
My adderal does not make me superhuman, though it helps pace my life. This I will learn it as a brother. I will learn its weaknesses it strengths and its nasty comedown in the evening. I will not share my adderal with you or sell when you need to study for an exam and I'm short of cash because it doesn't work like that, it will just make you high. Because you don't have ADHD and I'm not your doctor or a drug dealer. It is a schedule 2 substance, not a four shot Starbucks.
Before God I swear this creed. My adderal and myself are defending my executive function. We are the masters of our selves. We are the saviors of my life.
So be it until better neurotrophic substances or research based therapies are developed. Amen!
posted by humanfont at 5:45 PM on January 29, 2012 [11 favorites]


Ok, there's been a lot of weirdness about meds in the last few comments!
I've heard anecdotally that the withdrawal from Ritalin can be along the lines of heroin withdrawal.
I didn't like ritalin, because the actual process of coming off of any given dose is pretty unpleasant. But I didn't take Ritalin every day and had no problem on my days off, and I had no problem quitting altogether. I've stayed off of meds for several years at a time before deciding to start up again. I now take the extended release Adderall, which doesn't really have a noticeable crash. I take two days off every week, and I try to take an extended stimulant vacation a couple of times a year. It's not difficult for me to do that. Taking a day or week off doesn't feel like I imagine withdrawal feels. If you're taking stimulants according to your prescription, I just don't think that coming off of them should be a problem.
they'd also immediately prescribe drugs and I don't want to take them.
I've never felt pressured to take meds, and I feel like my doctors have respected my decision not to take them at times when I've decided not to.
I don't know how everyone on drugs remembers to take them.
This is a challenge for me. (And it's not just about my Adderall, because I have a couple of other prescriptions that I need to take every day.) I put my pills next to the coffee machine, because I won't forget to drink coffee in the morning. I also have my morning routine really ritualized in general. If I stray from my routine, I often do forget to take my pills, so I don't stray from my routine.
From what I hear, the forgetting to take the time-factor-y drugs, or not taking them on time, or forgetting a dose (multiple doses a day!) or taking it too late or whatever, is a bad thing
It's ok to miss a dose altogether. They're not like birth control pills, where they don't work unless you take them every day. If I forget to take my Adderall, I just can't concentrate for that particular day. It is true, though, that I don't want to take it too late in the day, because I need it to wear off by bed time. My rule is that if I haven't taken it by 8:00 AM, then I'm not going to take it that day. I'm on the time-release formula, so I only need to take one dose a day.

I think there may be some other ADHD drugs where it's more of a problem to miss a dose.

Any other things anyone wants cleared up?
posted by craichead at 6:02 PM on January 29, 2012 [2 favorites]


This is such a weird question to me, because I grew up hearing stories about my great-grandfather and grandfather, both of whom were brilliant men who couldn't get their acts together. What happened to them was that they scraped by on the economic margins. Sometimes they didn't scrape by and relied on charity or help from family to make do. They beat their wives. They weren't very good fathers. They weren't hobos, but I don't think anyone would count them happy or successful people. I imagine they weren't the only people like that.

Along the same lines, I wonder about the old trope that goes "So-and-so was pretty wild when he was a kid, but then he joined the army and they straightened him out."

I dunno. I take Adderall and I don't see a problem with it; it works for me. But man, if there weren't amphetamines and I had to find a purely behavioral solution to ADD, peacetime military service would be one of the first things I'd try. Seems like all the habits they try to drill into you (at least, the ones that aren't about killing people more efficiently) are basically right out of the ADD-coping-skills playbook.
posted by nebulawindphone at 6:02 PM on January 29, 2012


No, that's not an apt comparison at all, because it is assuming that ADHD is entirely genetic in nature. That's begging the question. The comparison to allergies is much more appropriate, given that both are on the rise in developed nations, are spectrum disorders, and the relevant casual links between genetics and environment remain largely undiscovered.

You are talking about the cause of the disorder, where I was talking about the effects. Doesn't matter where it comes from, it's still a real thing that is, finally, more readily recognized and treatable.
posted by gjc at 6:19 PM on January 29, 2012


I'm a big fan of my medication: A quadruple espresso first thing. Ping! Everything comes into focus and I can think. It's too bad I can't drink coffee in the afternoon too (it messes up my sleep).

I'm with jenfullmoon on the doing-things-while-in-meetings habit. I used to knit up a storm. Or doodle. In college, I melted plastic spoons in the boiling snack bar coffee and then drew pictures of them, to the outrage of my seminar instructor. I learned in grad school that if I took copious notes (by hand or with a keyboard), I got less grief from my classmates. I never look at the notes again, mind you.

None of it keeps me from blurting out if it's a discussion class. Or from doing a kind of call-and-response pattern where I echo the speaker: Mm-hm. Yes, it's true. Yes, indeedy. You got that right.
posted by Peach at 6:20 PM on January 29, 2012 [3 favorites]


If you're so sure of your opinion you're unwilling to listen to people who don't share it, I'm not sure why you're participating in this discussion

Oh, I dunno. I'm with him. If you don't ACTUALLY know - really KNOW - what it's like to deal with mental illness, what makes you think your opinion on the topic is worth anything?

I spent 20 years trying to get my mental illness treated. I'm really grateful for the doctor who finally paid attention and handed me the roll of duct tape - in my case, a scrip for Lexapro - to help me hold my live together. I like being functional and productive, and every single person who thinks my illness should be treated by yanking up my bootstraps, or whatever the fashionable Doubting Thomas phrase is these days, can stuff it.
posted by MissySedai at 6:25 PM on January 29, 2012 [4 favorites]


I agree with craichead:
If you're taking stimulants according to your prescription, I just don't think that coming off of them should be a problem.

I have been taking Adderall and then Vyvanse, and yeah, the only "withdrawal" is tiredness for me.

I just tried Ritalin, and I did NOT like it. I can't believe they give that stuff to kids. It barely touched my symptoms, I felt like a zombie (like being on Benadryl, but can't sleep), and I wanted to murder people come about 3pm. I suspect it's one of those deals where it's different for everyone.
posted by gjc at 6:28 PM on January 29, 2012 [3 favorites]


jenfullmoon I'm sorry to hear that you would be so afraid of some stigma from a doctors consult about a possible medical problem that you'd avoid diagnosis. However I'm also skeptical of your self diagnosis. You seem able to prioritize and shift between tasks. You describe knitting and reading at the same time, which isn't symptomatic (though if you never finished a knitting project or the book that would be). You describe having lots of energy and multi-tasking. That also isn't an indication of ADHD. ADHD is not so much multi-tasking as it is continuously shifting between priorities and tasks in a disorder and unstructured way with an inability to complete ones which would be objectively or subjectively more important. Doodling and not paying attention when bored is also a normal human behavior; not really a symptom of ADHD.
posted by humanfont at 6:42 PM on January 29, 2012 [3 favorites]


Because if ADD/ADHD really has been historically underdiagnosed, as some have asserted in this thread, then we'd see a giant population of people in previous generations who were completely unable to cope with life due to their condition.

Your assumption is that people with ADD/ADHD are unable to cope with life in a way that is readily apparent to you, a non-historian, non-psychologist.

[...]

So either children grow out of the condition, or they don't. If they don't, then the easy projection to make is that AT LEAST 10% of the adult population across history has had ADHD or ADD or some such. Do we see 15-20 million adults in the US walking around unable to cope due to ADHD? I don't think we do. Perhaps you have different data.


You don't know whether or not children grow out of the condition? This is a basic fact about ADHD. Your assumption that people do not grow out of the condition is faulty. Another implied assumption, that everyone who is diagnosed grows out of it OR no one grows out of it is also faulty. I don't have different data as much as I have a basic understanding of the disorder on a population level. You also make the faulty assumption that I (or you) are able to effectively "see" ADHD and gauge its prevalence in adults based on...a whole lot of nothing.

The fact is, before ADD became a pill-treatable condition, we used to work hard to get students who exhibited what we now regard as symptoms to work to form better habits without medication. This wasn't always done with methods that may be acceptable in today's culture (discipline, shaming, etc). But IF (and it's a big if) ADD/ADHD has been present in the population all along in similar numbers as it is being diagnosed today, and it went untreated up until the past 20-30 years, then we'd find huge numbers of adults all across history who were incapable of coping with life.

Your statement that "we" used to have to try to get people to "form better habits" actually supports the argument that there was ADHD in the past and that it was simply under- or un-treated. I already addressed your assumption that you are any kind of expert on historical diagnosis of a disease you don't completely understand.

Do we find that? Well, I haven't done any deep research on the topic, but it would be hard to miss something as giant as 10% of the population utterly unable to hold themselves together and focus attention well enough to live their lives.

Finally, we find something to agree about.

I believe these adults learned to cope with their condition, developed behavior patterns which helped them keep on track, or found life partners who were capable of keeping them from falling apart.

This actually contradicts your argument that ADHD didn't exist in the past. You're now arguing that it does exist but the majority of people are able to cope with it, which is different. That is arguable as well but you've provided no support for it besides an anecdote (and I find the bit about a partner keeping the ADHDer on track to be darkly ironic considering the havoc untreated ADHD can wreak on partnerships.)

[...]
THAT is why I'm sure. Because given the current level of diagnosis of this condition, we'd have certainly seen some kind of manifestation across history that 10% or more of the population found staying on task and lack of physical movement impossible. And I don't think we see that at all.

The criteria for ADHD do not say that staying on task and not moving are "impossible". This is a definition of ADHD that does not match the current accepted definition, which does not even necessarily include hyperactivity.

I'd welcome having someone show me evidence to the contrary.

The DSM or any basic text about ADHD will invalidate your argument for the reasons stated above.
posted by the young rope-rider at 6:42 PM on January 29, 2012 [10 favorites]


More anecdata for medication withdrawal and such:

After cycling through several different meds last summer in order to find one that works well for me, I've been on Vyvanse since August (70mg daily), and am supplementing it with instant-release Adderall as needed. A couple of weeks ago I ran out of Vyvanse during the middle of a snowstorm -- I had to go without for three days, during which I didn't take any medication at all. (I save the instant-release Adderall for work days, when I actually need to be more focused. Besides, with the current shortages, it behooves one to be prudent with one's rationing.) I experienced no withdrawal symptoms while off the medication. When I went back on meds, I had a day or two of heightened side effects (that weird tight feeling in the hands from rising BP, and super awesome gastrointestinal distress that made my officemates unhappy).

Out of all the drugs I tried -- Ritalin, Focalin, Adderall, Adderall XR, and finally Vyvanse -- only Focalin and Adderall XR made me feel kind of icky: jittery, aggressive, lots of difficulty sleeping. I experienced withdrawal symptoms on exactly none of them. Once I stopped taking the medication, that was the end of it. If anything, the only "withdrawal" I experienced was a return to my typical state: scattered as fuck. That's not withdrawal, though. That's an expected result of someone with ADHD taking an ADHD medication.

jenfullmoon, the fact that you get things done at work, that you're able to knit AND watch TV at the same time, that you're able to easily figure out how long it takes to do things, and that you're able to hold that information in your mind, indicates to me that you probably DON'T have ADHD. Because I do have it, and I cannot do what you are able to do AT ALL.
posted by palomar at 6:52 PM on January 29, 2012 [2 favorites]


What about adults? I suppose there were plenty of factory jobs that didn't require lots of mental energy, but it's not just a kids disease. It's not something just grow out of.

Um - if you read a little further down the thread - where I negate this, then talk about my adult ADD diagnosis (hyperactivity was never a problem for me personally), plus pretty darn certain from behaviour patterns that my dad also has it (and his brother) - and most likely my kids as well... I am pretty comfortable with it being a physical disorder, probably genetically inherited, which affects adults as well - that's why I am medicated.

Sigh - after seeing all the back'n'forth about what was essentially a throw-away opinion I made early-on and negated later in the thread, I feel guilty.

Perhaps it was easier previously for people with mental disorders to fit in, perhaps not. Definately societal expectations were very different 20, 30, 40 or 50 years ago - there were a greater number of roles for people in general.
posted by jkaczor at 6:53 PM on January 29, 2012


I don't have ADHD, I'm not a parent of an ADHD child, educator, or doctor. I have had friends, though, who were put on Ritalin from a young age and got addicted to it. Make no mistake, the Ritalin helped them with their schoolwork, but it was a drug that they were dependent on. One friend was on Ritalin for something like 10 years, and in college decided she wanted to quit for good. She had tried a few times, but always fell off the wagon. The next step for her was to go to Amsterdam (hey, she was a trust fund kid) and check into a detox clinic. She spent a few weeks there, suffering the tortures of the damned (her words), and I've heard anecdotally that the withdrawal from Ritalin can be along the lines of heroin withdrawal.

Maybe that was just those friends, and they are not the norm for most people taking Ritalin. And as I said, both friends claimed the Ritalin absolutely helped them with school. But damn what a price.


This confuses addiction and dependence. Addiction is compulsive use of a substance *despite* negative consequences; if the drug makes life better and you rely on it, it's NOT AN ADDICTION. So basically, your friends bought into the idea that the drug is evil and then they had a hard time functioning without it because it was useful to them and they stopped using it!!!

There's absolutely no evidence that stimulants produce a withdrawal syndrome anything like that seen with opioids—indeed, it would be bizarre if they did given that stimulants and depressants basically have opposite effects on wakefulness. Kick heroin and you'll puke, shake, have diarrhea and be unable to sleep— kick cocaine or ritalin and you'll be tired and cranky. No vomiting, shaking, sleeplessness, diarrhea— or physical symptoms of any type that can be identified, just mental ones like distress.

However, if you're kicking Ritalin and it's *helpful to your functioning* you'll probably feel extremely lousy because you are no longer being helped by it and don't have strategies to deal with the stuff it helped with.

The problem here is what someone I know labeled metabolic chauvinism: the idea that everyone's response to a disease, condition, drug, recovery or experience is the same. It isn't.

And the other part of the problem is that PTSD in children is very difficult to distinguish from ADHD. Doesn't mean all ADHD is bad parenting or all PTSD is "biological ADHD." We don't have good ways of defining mental illness because many different brain conditions produce similar symptoms. Until this heterogeneity is dealt with, we'll have these dumb fights like the blind men and the elephant.
posted by Maias at 6:53 PM on January 29, 2012 [3 favorites]


Also, I'm about to scream here--not all of us with ADHD want to work on a fucking boat or be carpenters, okay? I know the intention is good but really, some of us love to write or research or learn about music...

Shunting everyone with ADHD into a trade strikes me as very sad and even wasteful thing to do.
posted by the young rope-rider at 6:53 PM on January 29, 2012 [27 favorites]


Also, I'm about to scream here--not all of us with ADHD want to work on a fucking boat or be carpenters, okay? I know the intention is good but really, some of us love to write or research or learn about music...

Shunting everyone with ADHD into a trade strikes me as very sad and even wasteful thing to do.


Concur. I think that attitude comes from not understanding ADHD.

Elder Monster has ADHD. It made school difficult and no fun for him...until he discovered music and cooking. So he took the culinary program at school (and now cooks for a living and loves it), and got involved in both the school orchestra and the local drum circle, in spite of his counselor trying to push him towards building trades. She just didn't know what to do with a kid who not only had ADHD, but had the aspirations of "normal" students.
posted by MissySedai at 7:00 PM on January 29, 2012 [2 favorites]


humanfont, the knitting and doodling and melting of spoons are not symptoms. They are ways of coping with the symptoms. Just like having one iPod earbud in, and jiggling a foot, and even rocking in place when things get really tough.
posted by Peach at 7:03 PM on January 29, 2012


Also, everyone should watch this documentary. http://www.addrc.org/add-and-loving-it/
posted by gjc at 7:03 PM on January 29, 2012 [2 favorites]


Shunting everyone with ADHD into a trade strikes me as very sad and even wasteful thing to do.

Actually - I think most people with ADHD would do worse in a trade - the whole "hands-on" thing never worked for my dad - and he tried many, many, many, many different jobs/trades over the years. Turns out - what does he do well? Write, tell stories and be an "activist" - heck, the internet, blogging, YouTube have given him the soap-box he always wanted.

Basically, un-treated people with ADHD need to find work that stimulates their brains in ways that work with their ADHD - at their own pace, with their own schedule.

Heck - I still did well for the first 15 years of my working career - because IT, software development is a dynamic, fast-paced field that changes frequently. I did find though, that certain roles were not for me... Others, I excelled at... Things are much better now that I am being treated - but even if I were not, there would still be a place for me and my quirks - companies love people who can get from A to solution E without slogging through B,C & D over the course of months...
posted by jkaczor at 7:05 PM on January 29, 2012


I also think that the "just work in a trade" thing is kind of insulting to the trades. Do you really want a plumber or electrician who tends to zone out and not finish things? It seems to me that being a carpenter probably actually takes a fair degree of focus, and if you don't measure twice and cut once, then the whole thing doesn't work. I'd be a crappy carpenter, for many reasons. The world of carpentry deserves people who want to be carpenters, not people who are being shunted into some second-class occupation for the people who can't make it in anything important.
posted by craichead at 7:06 PM on January 29, 2012 [6 favorites]


And of course anything "real" must be in our genes - that's an idea we've cargo-culted all the way to 11

If this is meant as a criticism of scientific inquiry I think you're aiming at a straw man. Here's what the scientist in the above article actually has to say:
We understand that the predisposition to getting a diagnosis of A.D.H.D. has a lot to do with what kind of genetic complement you’re born with, and then how that genetic complement interacts with the environment throughout early development. Prenatal exposure to cigarettes, for example, may impact the genes differently when you have a genetic predisposition to A.D.H.D.. Several studies have shown that maternal smoking in pregnancy increases risk for hyperactivity-impulsivity later in life, and a recent study suggests that that effect may be greater if the fetus has a certain genotype.

Postnatally, there may be differences in childhood as well. We have interesting research showing that in families where there’s a lot of conflict in the home, a lot of arguing, that has a very negative impact on kids with A.D.H.D. in terms of leading to greater impairment, greater problems.
(my emphasis)
posted by en forme de poire at 7:08 PM on January 29, 2012


Elder Monster has ADHD. It made school difficult and no fun for him...until he discovered music and cooking. So he took the culinary program at school (and now cooks for a living and loves it), and got involved in both the school orchestra and the local drum circle, in spite of his counselor trying to push him towards building trades. She just didn't know what to do with a kid who not only had ADHD, but had the aspirations of "normal" students.

That's the double edge of ADHD. The absent-minded professor thing. The inability to accomplish relatively simple things, but when the mind is turned on to something, the ability to focus comes on like gangbusters. That's why people with moderate cases cope by falling into high stress professions. The stress fires the adrenalin which focuses the mind, and the job gets done. But god help them if they have to fill out a report afterwards. Or remember to show up.

The insidious thing that happens in these cases is that leveraging stress that way leads to a highly volatile personal life and much unhappiness. "How is it that I can fail at marriage and parenting when I can save people's lives like it's easy?"
posted by gjc at 7:10 PM on January 29, 2012 [9 favorites]


Wait, it seems that the second article says that meds worked over short periods but did not improve long term outcomes. Did any one get that out of it as well?
posted by xarnop at 7:30 PM on January 29, 2012


did not improve long term outcomes

Well - I have many questions. Was the dosage altered over time? When effectiveness of one medication was noticably reduced, did the patient try an alternative? Did the patients "self-medicate" (i.e. high-dosage caffeine product/energy drinks?) more over time? Did the patients change careers? Finish school and start a career? Have a major life-style change? What type of careers did the patients end-up in? Where did they start?

Did they use their time on medication to develop coping mechanisms that may have assisted them once medication was removed?
posted by jkaczor at 7:35 PM on January 29, 2012 [2 favorites]


I hope nobody took away the impression from my post that I'm against taking drugs to cope with attention deficit problems. I love drugs. For work or play. They're amazing. Everyone should be able to use them to improve their lives however they want. And they should be able to do it whether or not a doctor says you should be able to, and even if you aren't 'sick'.

I just don't get why there is this need to define chemicals as either 'good' or bad depending on whether they're 'medicine' or not.

Amphetamines are either the worst scourge the country faces, or a vital medicine that people depend on, and there is absolutely no way to distinguish, objectively, who is who. Except the people with better insurance get better drugs.

By all means, use chemicals to improve your productivity. Everyone should be able to.
posted by empath at 7:44 PM on January 29, 2012 [4 favorites]


I'm still not convinced that ADD/ADHD exist as distinct disorders (or diseases if that's what they go by today). It's hardly surprising that people are driven to distraction by their surroundings any more than it is to see increased productivity by taking small amounts of speed.
posted by onesidys at 7:55 PM on January 29, 2012 [1 favorite]


Hey, that's cool, discount the lived experiences of those of us that have posted in this thread, simply because you're "not convinced". I'm not convinced Jesus is our lord and savior but I sure as shit don't march into a group of Christians to tell them that.
posted by palomar at 8:12 PM on January 29, 2012 [12 favorites]


As for being driven to distraction by one's surroundings... that happens to me in an empty room with blank white walls. It's not my surroundings, pal. It's my goddamned BRAIN. FFS, how hard is it to do some simple reading on the subject before you post?!
posted by palomar at 8:13 PM on January 29, 2012 [5 favorites]


Heh - actually, one of the best books on the subject is titled: driven to distraction

I'm curious - on what basis are you not convinced? This has even been covered up-thread (have you read the thread?) - if one were to substitute "homosexuality" for "ADD/ADHD" in your statement, would it be less offensive? Are you a practicing medical professional? Do you know anyone who has been diagnosed - not children, but adults?
posted by jkaczor at 8:20 PM on January 29, 2012


By all means, use chemicals to improve your productivity. Everyone should be able to.

Heh - well, there you have hit on both my dad's self-medication strategy - and his choice of activism - while I don't share complete enthusiasm on the subject (growing up with him and the results of his self-medication was not easy), I do think there is alot of stigmatism with many forms of medication, prescribed or not...
posted by jkaczor at 8:24 PM on January 29, 2012


xarnop, the study doesn't really say that, because the non-medicated groups also improved; the medicated groups just improved faster. But even saying that is overreaching a bit because the only controlled part was the first 14 months; after that individuals could choose their own treatment options, which includes either going on or going off medication -- so it makes some sense that all groups got better over time.
posted by en forme de poire at 8:24 PM on January 29, 2012


If this is meant as a criticism of scientific inquiry I think you're aiming at a straw man

No, I'm not. I'm talking about the way mental disorders are framed in modern discourse, and the way finding genetic components validates people's feelings that a disorder is right there in those broken genes, and definitely not in a society that needs to be fixed, and so here's some chemicals that will fix it

Look, political thought actually is genetic:
Appearing in the latest edition of The Journal of Politics published by Cambridge University Press, the research focused on 2,000 subjects from The National Longitudinal Study of Adolescent Health. By matching genetic information with maps of the subjects' social networks, the researchers were able to show that people with a specific variant of the DRD4 gene were more likely to be liberal as adults, but only if they had an active social life in adolescence.
Finding statistical links on frequencies of random genes - not an actual full explanatory "x -> y -> z -> ADHD" theory, does zero damage to the idea that this should be better understood as maladaption to a broken society/environment, which is what needs fixing

...

As for being driven to distraction by one's surroundings... that happens to me in an empty room with blank white walls

You might want to reconsider the notion that a an empty room with white walls would be a suitable habitat for a sentient being. Or whether much of America is
posted by crayz at 8:25 PM on January 29, 2012 [4 favorites]


More anecdotes, as I'm exhausted but want to contribute but really don't have the energy for a trawl for good journal articles (I'll do better next time, really):

AD(H)D is about control. More specifically, it's about the lack of it. How many 10 year old boys do you know who you can get to start crying at the drop of a hat? Who have violent outbursts and have even had "red outs"? Who are the smartest kids in the class but only remember their homework because their parents make sure it is packed every morning?

Looking back, Ritalin probably kept me out of jail. It gave me the space that I needed to develop the coping skills that most people have naturally. I had the space not to immediately react to everything, to keep myself calm and not burst into tears at the slightest insult or misunderstanding (I say that I have trouble crying as an adult because I used up all my tears as a child). I was able to keep myself from flying into rages that almost had me expelled (and these days would have me expelled). I now have more patience than anyone else I know. Which is part of why this comment isn't simply me swearing at some of the commenters and trying to find a way to make them feel like horrible human beings.

This was after 3 years of trying everything but medication. By age 6, they knew I had ADD. The doctor told my parents the best they could try to do was keep me out of jail, to forget about college. That was the message people were receiving about ADD back in the mid 80's. The idea that it is so treatable that people can succeed with it is relatively new.

Reading the criticism and attacks (and make no mistake, they are attacks) direct at people with ADD or other metal issues made me realize where I've seen this attitude before. Its the same attitude that is shown towards suffers of chronic pain. We've all banged our shin into a table in the dark, so you really don't need to constantly take something for the slipped disc or that rheumatoid arthritis. I was going to write about how depression can manifest itself as pain, but I realized that the contempt shown is the same for chronic pain. So, please, next time simply go to a cancer clinic and tell the people there that their pain is all in their head.

I fully support figuring out what causes ADD/depression/autism/whatever else. Please do. Please find out what causes this and find a solution to prevent another kid suffering through a childhood like mine. If this research can make it so that there is one less person who considers 6 years old the worst time of their life, this is worth it. But don't belittle it in the process. Find solutions and preventions, yes. But do it with respect and remembering that you are talking about people.

(Two relatives of mine made it through college by self medicating. One did it with speed. The other with a combination of pot and coffee that I never quite understood.)
posted by Hactar at 8:41 PM on January 29, 2012 [8 favorites]


I'm seeing a lot of my childhood and adulthood reflected in others' comments. Just wanted to chime in that yes, it's real, yes, meds can help, and yes there do need to be coping mechanisms that you put in place to use with or without the meds.

I'm also reliving the decades I spent trying to convince my parents that it was real and I needed help, goddammit. I'm really too mad to say anything else.

(Hectar, I suspect the coffee helped the focus while the pot mitigated the side effects. I do something similar with espresso and Xanax)
posted by lysdexic at 8:47 PM on January 29, 2012 [3 favorites]


I've pointed this out before (and yeah, my tongue is slightly in cheek here, but only slightly) ADD is a low level superpower. Hang out with an ADD person sometime and try to see what they see and consider the things that they consider.

Like empath, I had a reputation at my last job for being incredibly observant and solving complex problems. I also found myself spending huge amounts or time explaining things to people because I'd tend to chunk huge pieces of complexity, while they'd want things spelled out step by step. And like empath, I started to really hate my job when they kept replacing real live thinking with "workstreams", a process of solving problems that seems to be based on the belief that a fourteen page flowchart (of which six pages were boilerplate intro) could pass a Turing test and the scientist was just an apparatus to move chemicals around.

ADD is becoming more of a problem because we've become a society that doesn't much care if you can handle sensory overload, or even if you notice the jackals by the waterhole or not. Now we're a bunch of middle managers and grade school teachers who are obsessed with the most tedious of metrics, and who are stymied by systems with more than a handful of moving parts.
posted by Kid Charlemagne at 8:57 PM on January 29, 2012 [8 favorites]


Finding statistical links on frequencies of random genes - not an actual full explanatory "x -> y -> z -> ADHD" theory, does zero damage to the idea that this should be better understood as maladaption to a broken society/environment, which is what needs fixing

If your argument is that genetic contributions are irrelevant because the only real problem is with contemporary society, I don't see how having a detailed molecular mechanism of how ADHD arises would make a difference to you. But if you're going to make this claim convincingly, then I think you're going to have to be way, way more specific about what you mean by "better," "understood," "broken," and "fixing," the last two especially.

I'm talking about the way mental disorders are framed in modern discourse, and the way finding genetic components validates people's feelings that a disorder is right there in those broken genes, and definitely not in a society that needs to be fixed, and so here's some chemicals that will fix it

Is this the impression you get from the passage I quoted above? That's coming from a person who actually works on statistical linkage between "random genes" and ADHD - I don't think what you're saying here really characterizes the discourse.
posted by en forme de poire at 8:59 PM on January 29, 2012


Check out this one hour video documentary about living with adult ADHD. It was made in September 2009 by CW Media. [Ed. note: Actually, the full documentary isn't there anymore. That link goes to a description page ABOUT the documentary. A new site has a new version of the documentary in smaller bites. Makes it a bit easier to watch.]

Oh, god, that's awesome. I can't stop laughing. I needed that.
posted by lysdexic at 9:11 PM on January 29, 2012 [4 favorites]


Why are you so obsessed with other people using so called "mind altering drugs" (like do you sit at the local starbucks clucking your tongue?

Do you stand at the corner store and slap chocolate bars out of customers hands? No? I'd please request that you stop fertilizing my lawn then.

Crayz, so you are pissed that some scientists might be making a "correlation/causation" assumption?

"genes" just don't "break" (it is comments like that one that lead people to say "hey, you are invoking "science" and your grasp of such seems to be pretty limited, or coming from some really unique, narrow perspective.

They may activate, or not, express or not, mutate or not... but what do you think "break" means?

Are you a follower of scientology? I ask honestly, and don't mean offense, really, I don't, reading about 20 of your comments over the last few days; from what I know of the group's views, your comments follow a lot of the ideas they promote. Your expression of a deep fear and mistrust of Psychology and "psychiatrists" for example (I mean, if you had a bad experience with either... right, anger is justified, and cool, if misplaced, and over-broad, but you seem to be expanding this, and generalizing your critiques, to the point of glittering generalities, about a "sick america". Which can be made without denying the existence of millions of people, as exemplified by multiple people speaking directly to you of their lived life experiences.

The study from '99, yeah, that's 'the '90s', sure, the end of them, but what? Not sure why that matters, Was medicine wrong then, and right, now?

I would suggest you would accomplish more by promoting your new vision of an advancing society (like it sounds so far like you are pretty hostile to a lot of things... I, for one wouldn't want to live in your "psychologist free", modern medicine free Anti-american little tin pot despot nation; rather than assuming that the lived experiences of others "don't exist" or are somehow making America worse.

Sorry, what area of neurology, or psychology, or health care provision do you study again, so-as to form such an objective, brilliant and insightful critique of modern medicine?

See, it is comments like that which cause me worry that the simple (external) accommodations (non-medical, social accommodations) I relied on for several years before considering other options (and a life of "learned adaptations and little tricks to get by"), was able to get 20 years too late (extra time so I can think through, read, and process questions for an exam, or the ability to write it in a quiet, dull room (yes, tiny things like this correlated with 30% grade variation [for me]), because to process a question I have to talk it out (spent a long time knowing I could give a great response, but FUCK THAT, I'm not about to talk to myself in a room with 600 people. THATS NOT NORMAL. And Y'all are ALL about (some invented, ill defined, moralistic, looking to some greater yesterday) normal.

It is opinions based on guts like that which make me just not speak to a teacher to describe the accommodations that were recommended after weeks of testing, because well, hey, chances are that maybe they are ignorant, self-aggrandizing pseudo-philosophic sophists JUST LIKE Y'ALL, so, even though using the "acceptable" accommodation could allow me to actually perform to my ability, I'd "rather" fight it out and get a fail writing it in class, and just take the lower grade because, really, if a lot of people had their way, any sort of "lack of strict and universal rules", any "accommodation" for something that they don't even "believe in" could be "unfair".

hippybear, I think part of the visceral reaction (and I don't mean to pile on, or to intend anything that seems "hurt", or "angry" to be taken as directed anywhere close to you, I fully believe that your comments are intended with no "judgement, or attack, or cruelty" [I think it is good to note BrotherCaine's note of a massive role of "shame" [both self-created, and culturally created] in situations of ADD/ADHD [like it can feel like people who talk about the "medicated mindless society" are accusing people with ADD who choose, or are fortunate enough to find safety in medication and literally only trying to cope with a world that is REALLY confusing, and seemingly built and designed to "force" some formulaic, or arbitrary set of "normal behaviors" that people with ADD have great difficulty with, and don't seem to be "advantageous" to wider societal development anyway, but are expected as normal behavior nonetheless) it was just that it seemed like you might think you would be saying something "new" to people dealing with ADD/ADHD; it is important to note the "seemed" part, and to be aware of the context, which is that people who have ADD/ADHD Absolutely both "have", and "constantly seek out" methods of coping, techniques, exercises, routines, any, and everything (so that leads us to be a little bit sensitive when someone seems to be attacking another, equally valid facet of coping; medications. Which help human people live in the human society that they exist in.

People with ADD/ADHD diagnosis severe, or mild have been berated, been sneered at, felt the shame of getting a prescription that allows them to function in our pretty complex world, and to know that many people think of them ignorantly as simple "addicts"... there are plenty of pharmacists (who do not do empirical drug trials, or studies, but are simply trained to "deal out" medicines, treating people as thought they are drug dealers...

Have you ever had your blood pressure meds "split" into 20 "orders" because "somewhere out there" people are abusing them? Even though this leads to running out sooner, and having to deal with even MORE arbitrary "return visits", and interactions, a purely symbolic attack on access to care. This moralistic "rule-set" has, multiple times led to "forgetting to refill" (because again, not "heroin like addiction" [wtf moral panic FTW]), during a particularly difficult day, or time, an important time, crunch time... and so, thanks moralism, you screwed my performance... but hey, who cares, you are saving the world from the soon to come brave new world.

Women have access to an appropriate amount of birth control medication, why must someone with ADD be treated like they are abusers of "bad drugs", when it is delivered in quantified, measured, limited doses. Like every other medication.

Do people getting Viagra have to listen to the pharmacist berate them, or sneer at them, and imply, suggest and hint that their customers are addicts, or dependent, or part of a "drug abuse culture"?

Why?

My experience suggests that anyone expressing a belief that a person might possibly "do only one or only the other", with a stigmatizing and problematizing of medications, haven't had to personally deal with the issue. "Coping mechanisms" absolutely are used, taught, developed, adapted, and adopted by people... as a first line of defense by us who augment these (incomplete, limited) methods, with medication. It is only "psychology disbelievers, or Psych-deniers" who are making this out to be an "either or" equation.
For people living this, it is absolutely not "this or that", neither is a "solution", neither is complete, and even with both coping and medication, people can collapse.

I dunno, we can demand people "please the idiosyncratic demands of some random person" who doesn't believe the empirical examinations of modern medicine, or... we can work to eliminate stigma, and find ways of assisting with those vaunted "coping mechanisms".

Um, how about, Nature via nurture? Discuss. Was this not established well over a decade ago that anyone trying to get you to buy either as "the whole picture" was yanking your chain, and hiding some argumentative, axe-griding, socio-political agenda?

This always bugs me (the false dichotomy question of "nature or nurture" choose one and it must be your religion henceforth).

I am ashamed at how many elementary school courses I nearly failed, not because I didn't understand the topics, or couldn't engage in thought, discourse, and recitation of idiotic atomized context free factoids on the topic; but because I forgot about, and was late handing TITLE PAGES FOR UNITS.

This continued into high-school. How messed up is that? I came to find such assignments increasingly absurd.

Like the practice of exams, where it boiled down not to what someone knew of a subject, but how fast one could write, within an absolutely arbitrary "time period", regardless of physicality, I mean, I was allowed to wear my glasses into an exam... that is "cheating" my pathetic nature.

Why is some asshole now trying to otherize me, and claim that I should be limited by my pathetic thinking nature?

Even the playing field, no glasses, no hearing aids, no wheelchairs, no use of Kurzweil software, no exemptions for people who have wrist issues, and cannot "write" properly, but can SHOOT YOUR BRAIN WITH LAZERS when they type... heck, why do we let Hawking use a computer to talk?

That is evil, right, breaking his human nature, by using nurture?

Y'know, those things where you DRAW little pictures, coloring projects, basically, and some words relating to the unit, and then to put it in your preciously organized little binder?

Yeah, failing because of missed title pages, while learning about the actual issues, and learning the actual material... that about sums up what is wrong with the bliss of ignorance that people who assert that they not only know what "normal" means, but that some fucked up limited group of people fits into that "category" of normal, while others, they say, do not.

It was precisely because of the sort of stigmatizing, axe-grinding, pseudo-religious positions that said that "bad parts of society" were promoting ritalin, and treatment of ADD/ADHD as some sort of business, that was rampant, and ruining society... which scared me from getting assistance, and led to more failures, and spiraling failure modes being the default expectation that I developed of myself.

I didn't want to exist, saw it as pointless to 'be', when teachers would claim "needs to try harder", and I had poured everything I had into an attempt, into "not drifting during the day", or not daydreaming, that was after training myself just for something so simple as to not be a disruption, and yet it all fell apart at some "critical juncture" (how critical is any given juncture in "school", and yet, lines were lines, and rules rules, anyone noticed that "across all the classes everything comes due in the same two weeks?). Literally, why exist, if even the most well intended, close to well performed, but missing some element attempt would never be good enough.

And the harder I tried, the worse it gets. The more prone to forget details, to be afraid to talk about the problem to a teacher, to fail to cut the failure off at a pass.

Like if you ever talk to someone with body-image concerns, and telling people to "just try a better diet", or someone saying to a person with chronic severe depression that "you get it, you were sad before too!", "just smile a little" and the depression will go away... more sun, or any of that... unsolicited, from a stranger, when you know nothing of what is going on, it is just patronizing, and fear mongering to invoke the "brave new world" nightmare fiction.

To paint those people as "Bringing on some sort of 'Brave New world' medicated underclass... is pure fiction, and a large part of the stigmatization that leads to less of that "good ol" coping method assistance is stigmatizing. It puts the bullshit demands for "normality" as prime (which many have noted is a fiction, a generalization; there is no such thing as a 10o% "normal" person [what would that even be?]).

Medicine is great, but so is a smaller room to take an exam in, with fewer, or no other people, sweating, breathing, rummaging, getting up and leaving, finishing early, etc., or say, extra-time, so as to complete thoughts on an exam, as opposed to leaving many unfinished thoughts.

But with a lot of the biases and blindness about this, assumptions, accusations, and flat out moral panic level of hyperbole (seriously? Now people with add are responsible for turning our society into a cargo cult of genetic determinism? Come on.

Remembering where keys were left, or what to say in a conversation, or remembering not to let my eyes go all "shifty" (how many teachers who called it "disrespectful" that, when processing information, I cant just look at them, or the board, looking around the room, but also, not to stare into the eyes for too long, and then to have that whole conversation going on over-top of the conversation being had...

I was born this way. With an umbilical cord around my neck that is. Maybe I will change. Maybe not. Get the fuck out of my life, in the meantime, quite using the power of "normal" (and fear based pseudoscience myths to demand I justify every minute element of my own life to you, a random stranger, initiating a discourse that I essentially have to take part in (like seriously, you are proclaiming I literally don't exist, how can walk by, knowing that you are gathering allies who are perfectly fine with telling people what is and is not ok, or "right", who is repeatedly displaying ignorance of the issues involved, and simplifying complexities, while mistaking precision for accuracy, and quit fucking with my available life choices based on some ignorant, moralistic, "imagine some imaginary future where we all have something I just made up that sounds pretty scare, and cribbed from brave new world, pseudoscientific fear that "society will lament the loss of something, and something scary psychology something else -something inappropriate invocation in incorrect context of cargo cult analogy with some like joke like in Spinal Tap". Thanks.
posted by infinite intimation at 9:27 PM on January 29, 2012 [11 favorites]


hippybear, I think part of the visceral reaction (and I don't mean to pile on, or to intend anything that seems "hurt", or "angry" to be taken as directed anywhere close to you, I fully believe that your comments are intended with no "judgement, or attack, or cruelty" [I think it is good to note BrotherCaine's note of a massive role of "shame" [both self-created, and culturally created] in situations of ADD/ADHD [like it can feel like people who talk about the "medicated mindless society" are accusing people with ADD who choose, or are fortunate enough to find safety in medication and literally only trying to cope with a world that is REALLY confusing, and seemingly built and designed to "force" some formulaic, or arbitrary set of "normal behaviors" that people with ADD have great difficulty with, and don't seem to be "advantageous" to wider societal development anyway, but are expected as normal behavior nonetheless) it was just that it seemed like you might think you would be saying something "new" to people dealing with ADD/ADHD; it is important to note the "seemed" part, and to be aware of the context, which is that people who have ADD/ADHD Absolutely both "have", and "constantly seek out" methods of coping, techniques, exercises, routines, any, and everything (so that leads us to be a little bit sensitive when someone seems to be attacking another, equally valid facet of coping; medications.

I completely understand what you're saying here, but I'm going to need to find a hyperfocussed ADHD grammer nerd in order to diagram this sentence to fully grok it in its intensity and complexity. :P
posted by hippybear at 10:02 PM on January 29, 2012 [2 favorites]


Hippybear, I apologize if I implied you were an advocate of shaming. Not sure if that was the quality of my writing, reading comprehension or both, but mea culpa.
posted by BrotherCaine at 11:31 PM on January 29, 2012


the ear infection theory fits me pretty neatly. I was quiet, observant, well-behaved & very empathetic until ear infection; all the ADHD symptoms ever after.
posted by lastobelus at 11:51 PM on January 29, 2012 [1 favorite]


Hippybear, I don't mean to pile on, or to intend anything that seems "hurt", or "angry" to be taken as directed anywhere close to you. I fully believe that your comments are intended with no "judgement, or attack, or cruelty".

I think part of the visceral reaction in situations of ADD/ADHD ---> unfinished.

I think it is good to note what BrotherCaine says about the massive role that "shame" [both self-created, and culturally created] ---> unfinished. plays in the development of ADHD'ers coping mechanisms ???

It can feel like people who talk about the "medicated mindless society" are accusing people with ADD. These people choose, or are fortunate enough to find safety in medication, and are literally only trying to cope with a world that is REALLY confusing, and seemingly built and designed to "force" some formulaic and arbitrary set of "normal behaviors". These are often the behaviours that people with ADD have great difficulty with.

It is important to note the "seemed" part, and to be aware of the context, which is that people who have ADD/ADHD absolutely both "have", and "constantly seek out" methods of coping, techniques, exercises, routines, any, and everything. This leads us to be a little bit sensitive when someone seems to be attacking another, equally valid facet of coping; medications.

-------------------------------------------------------------------

With sincerest apologies to Infinite Intimations. Infinite: I hope that this reworking conveys what you wanted to express; it is probably my error if it does not.

Hippybear: I know you were joking in your post, but Infinite's unbalanced parenthesis got me started automatically, and then why stop?

For what it's worth, I personally did not come to the same conclusion as Infinite as to your opinion w.r.t. medication and/or its usefulness. However, my wife has frequently accused me of having too thick a skin (often w.r.t. her feelings); possibly others are picking up on things that I was oblivious to. Or maybe I just skimmed the wrong posting.

Either way, medication is clearly just one tool that can be used to treat was is definitely a condition. All of it works for some people. For some people, medication is all that works.

Regards,
Hyper-focused ADHD grammar nerd.
posted by Arandia at 1:05 AM on January 30, 2012 [1 favorite]


"Give him a bill of rights," I said. "He has the right to come back into the room to get the things he forgot. He has the right to ask questions about things you've already explained. He has the right to get up and go to the bathroom at least once a class, even if it's only to walk down the hall and back. He has the right to interrupt. He has the right to have one place for all his things, and to be reminded to put them there and only there." She said she would make him a wallet card.

This is what the whole IEP process is about. I'm shocked that a teacher asked you this. Kids with any sort of disability can get all kinds of accommodations to ease their way. They also get "scaffolding" where they get support and slowly but surely get that support taken away so the kid can use those coping skills by themselves.

I have ADD and BPD. My 16 year old son has ADD and Aspergers. We both take medication, do counseling and work hard as hell to keep it all together. We were both free range children, and he was even homeschooled for 8 years. Still, something is broken in our brains, so we do the best we can to patch them up. I won't speak for him, but I know I'd rather take a handful of pills every day than be that manic, scattered, shamed and then depressed person I used to be.
posted by Biblio at 5:06 AM on January 30, 2012 [1 favorite]


There's three sides to this argument. Taken from a historical perspective, they are:

1. There's no such thing as ADHD. People who "have" it were just brought up incorrectly. It is the parents fault.

2. There is such a thing as ADHD. It is a chemical imbalance / disorder of the mind / we can fix it with drugs. It's nobody's fault, and if you'll just take these drugs, you too can be a functioning member of society.

3. ADHD is not a "Thing" that "Exists," but rather how many people function due to some combination of genetics or upbringing. While having ADHD may make it more difficult for someone to function in today's cubicle world, it is just the natural product of natural inputs.


I myself see value in the second and third view. The first is pigheaded and prescriptive. The second point is really important, I think, in that it is a reaction to the first point. For too long, people who could not function in our constructed society were labeled "broken." The the Pharmaceutical Industry helped us to realize is that *everyone* is equally human, and no one must settle for seconds just because of who they are. If someone's willing to seek out the right cure, they can combat whatever disease that is attacking their life. This view is very important to me, even though I disapprove of the pharmaceutics themselves.

The third view is the one I hold. No, I am not a Scientologist, but rather I have a degree in Behavioral Psychology. I hate how those silly nut jobs have turned true areas of doubt and concern into a laughingstock.

I have learned that the medical model of disease that psychiatrists use to back up their prescription of medications is incorrect. I have learned that many behavioral problems can be solved through training - and in many cases, it's too late to undo the early-childhood learning that has already happened. I have learned that many of the side effects to drugs are worse for the patient than the effects of the disorder they are trying to solve. I have learned that psychiatrists mix drugs that have not been tested together, because if drug A gives someone anxiety, then surely an anti-anxiety drug will fix that. I have learned that pharmaceuticals spend more money on advertising their drugs than they do on researching them. I have learned a great many things that have made me completely doubt the validity of the psychiatrists and pharmaceutical corporations.

In the end, it all comes down to the question of "What will it take for you to change your mind." For many people in this thread, they will never change their minds, because they have personally experienced the life saving effects of the drugs. Others might be swayed by arguments or facts (sadly, few facts have been shown in this thread, and I have few to show myself).
posted by rebent at 6:44 AM on January 30, 2012 [2 favorites]


I'd put my self in the third category.

I think that it's not something inherent to the person -- it's not a disease or a sickness, like say "the flu" or "cancer" or even sickle sell anemia, but the result of a complex interaction between the persons genetic predispositions, their upbringing and the society they live in -- the most important aspect of adhd is an 'inability to cope', and that is a real problem, and not something that should be ignored, whether that's a result of society not being suited to the person or the person not being suited to society doesn't really matter. I'm just very hesitant to think that to focus on the individual is the right thing to do, rather than creating a space in society where those people's contributions can be better used, and with more ways to help them cope 'as they are', rather than trying to change them with drugs, which to me, is not much better than a lobotomy -- it's such a blunt instrument for such a complex, delicate problem.
posted by empath at 6:59 AM on January 30, 2012 [1 favorite]


How's my grammar? She's in the kitchen. ;)


hippybear, I think part of the visceral reaction it was just that it seemed like you might think you would be saying something "new" to people dealing with ADD/ADHD. It is important to note the "seemed" part, and to be aware of the context, which is that people who have ADD/ADHD Absolutely both "have", and "constantly seek out" methods of coping, techniques, exercises, routines, any, and everything

so that leads us to be a little bit sensitive when someone seems to be attacking another, equally valid facet of coping; medications.


That's the meat. There's more to unpack, but when you're trying to get it ALL out, the run on sentences can really just build themselves. I'm always having to watch for that in myself.
posted by lysdexic at 7:08 AM on January 30, 2012


Yeah, only I wasn't attacking medication at all.

I was responding to the thought of "what did people do before there was medication", using the example of my partner who lived with ADD for years without it, and has gone back to living without it after having tried it. That's all. There was no attack, there was nothing of the sort.

I'm sorry my comment about people finding life habits instead of taking a pill was taken as an attack, but it was never intended that way. In the context of the comment, it meant to be more of an aside about his specific coping with his condition. I phrased it poorly.
posted by hippybear at 7:18 AM on January 30, 2012


Yes, if you have a broken leg, we want to treat the broken leg... but we also want to know how you broke your leg so we can prevent it from happening again.
Which is what science is for. But the people complaining about ADHD are nonscientists who are just bitching about what they see as the problems of modern society in general.
For broken legs, car accidents, ADHD, PTSD, lung cancer, etc etc, all of these include many avoidable cases which are imposing enormous economic and social costs.
No, there is a difference between worrying about people breaking their legs and worrying about broken bones being 'over diagnosed'. There are lots of little breaks that might have gone unnoticed without x-rays and CAT scans and so on, but now we can find them and prevent them from getting worse. That's not a problem, that's a good thing.

We should be worrying about whether bones are actually broken or not, not whether they're being 'overdiagnosed'.

The other thing - the cognitive stuff that people supposedly want people to do is really difficult and really hard work for the people are even capable of dealing with it that way.

Going back to steroids - it's like telling someone with a hormone imbalance that in order to be normal, they need to spend 3 hours a day working out, while a normal person only needs to do 15 minutes every other day. (obviously everyone needs at least some exercise). Is it really fair to tell people they should just 'suck it up' and expend 20x the effort of a normal person?

Obviously like I said with strength, modern society doesn't need that much strength. But it does need a lot of focused attention, so why not give people a tool that helps them focus?

I certainly do think we should try to make society less mentally demanding for people, though.

Maybe it is like Myopia where environment plays a roll. And certainly we should be looking for environmental factors. But, like Myopia, it's probably something that happens in childhood. Ditching my glasses is not going to fix my vision.
Do people getting Viagra have to listen to the pharmacist berate them, or sneer at them, and imply, suggest and hint that their customers are addicts, or dependent, or part of a "drug abuse culture"?
It's more like talking about how people who take viagra just aren't man enough to get it up.
I am ashamed at how many elementary school courses I nearly failed, not because I didn't understand the topics, or couldn't engage in thought, discourse, and recitation of idiotic atomized context free factoids on the topic; but because I forgot about, and was late handing TITLE PAGES FOR UNITS.
that remind me of one of the most enraging moments of my k-12 academic life. It wasn't even for points, it was just a contest.

Anyway, in my 8th grade science class we were going to have a competition to make a cooler that could keep an icecube frozen for the longest. I had a paper rout, and noticed that newspapers in bundles could stay cold for days. So I came up with a brilliant plan to make a cooler out of newspapers.

I spent hours working on the damn thing. Cutting up tons and tons of papers, taping them together. My hands were friggin raw from all the work. Of course, in order to work the papers need to be cool to start with, so I put my thing in my mom's big chest freezer.

The next day I got up and went to school, leaving the cooler in the freezer. I didn't remember it until half-way through the day, but the teacher wouldn't let me bring it in late. Like I said, it wasn't an assignment for points, so I didn't lose anything other then the fact that all the work I did was for naught.
posted by delmoi at 7:28 AM on January 30, 2012 [3 favorites]


As a side note, Jesus, what the fuck is wrong with school teachers? All of these stories about title pages and pencil-shaming make me want to start slapping people.
posted by en forme de poire at 7:36 AM on January 30, 2012 [2 favorites]


When I was in 1st grade, my teacher (Sister Linda, I still hate that bitch to this day) dumped out the entire contents of my desk on the floor and made me clean it up because it was so messy inside.
posted by empath at 7:39 AM on January 30, 2012 [3 favorites]


3. ADHD is not a "Thing" that "Exists," but rather how many people function due to some combination of genetics or upbringing. While having ADHD may make it more difficult for someone to function in today's cubicle world, it is just the natural product of natural inputs.

The problem here is that many people with untreated ADHD can not function adequately in any society you choose to drop them in. That doesn't have to mean that they instantly die or get thrown in jail, but it does mean much unhappiness. And more importantly, loss of potential. How many lives have been wasted because some genius with ADHD couldn't sit still (literally or figuratively) long enough to get his ideas into some concrete form? How many lives are or will be wasted because people "disapprove" of pharmaceuticals?

I'm just very hesitant to think that to focus on the individual is the right thing to do, rather than creating a space in society where those people's contributions can be better used, and with more ways to help them cope 'as they are', rather than trying to change them with drugs, which to me, is not much better than a lobotomy -- it's such a blunt instrument for such a complex, delicate problem.

What space would you create for people who can't finish what they start and can't keep their minds quiet long enough to do the things THEY WANT to do? It isn't about hammering square pegs into round holes, it is about people who are round but can't find their way to their round hole.

Stimulants, when used as intended, do not change people. They allow people with ADHD to harness the potential that is already inside them. Viewing this as a blunt instrument that lobotomizes people is really unhelpful.
posted by gjc at 7:42 AM on January 30, 2012 [3 favorites]


Oh god, Catholic school. Sister Jean-Marie gave me detention once for picking up my pencil at the wrong time. Looking back, I can't even.
posted by en forme de poire at 7:43 AM on January 30, 2012


Stimulants, when used as intended, do not change people.

Don't be ridiculous. Of course they do. That's the whole point of using them. If they didn't change people, they'd be useless.
posted by empath at 7:48 AM on January 30, 2012 [3 favorites]


Viewing this as a blunt instrument that lobotomizes people is really unhelpful.

I didn't say it lobotomizes people.

The way your mind works, is in a real way, who you are. A lifetime of using psychoactive medication changes you, fundamentally. This is not like 'putting on glasses'. ADD is not a deficiency in the sense that near sightedness is. It's a difference. People should be able to choose to change themselves, of course, but putting it in the context of disease and medicine removes a little bit of agency and freedom, doesn't it? If you're choose not to medicate yourself, you're being 'irresponsible', right? I mean who doesn't want to be healthy?
posted by empath at 7:51 AM on January 30, 2012 [1 favorite]


FWIW, hippybear, I really liked your comments, and your responses to folks who didn't.

And yeah, there are some damned toxic teachers out there. Some are just not willing to see beyond their own noses.

Most of the teachers I've encountered just don't have any experience dealing with out of the ordinary students. I think some Ed. degrees really don't cover it well, and it's a tough thing to be able to observe kids under the right conditions. We got lucky that there was a "teaching" day care center near work. Since my son had special needs, he got placed higher on the wait-list. He got help, they got experience. That's one place, maybe 100 kids, in a 200,000 person city. There just isn't enough knowledge to go around.

Add to that the fact that the special needs kids need individualized help - there's no real formula - just practices that tend to help. Add to that, classroom sizes are getting bigger because of state and local budget cuts. It's not helping anyone.

At least in our case, the district had a library that had oodles of information on how to help our kid, and the teachers were allowed time to study them.
posted by lysdexic at 8:06 AM on January 30, 2012


These conversations frequently go poorly on MetaFilter. They occupy the ticklish area at the meeting point of medicine, culture, stigma, redemption, public health, public policy, profit, and personal responsibility. You’ll note that other topics, like obesity, that occupy the same area are similarly difficult to discuss civilly or well. On the one hand people with well-treated ADHD feel understandably strongly about how important that treatment has been to them. They see in comments that seem to question the veracity of the problem a dismissal of their lived experience and the suggestion that what’s really wrong with folks who claim to have ADHD is simply a lack of good, old-fashioned will. On the other hand, people are trying to understand how and why ADHD is defined and treated as it is, and what that says about society.

zoomorphic’s* early (and much favorited) comment is a great illustration of at least one of the recurrent threads. She starts by saying, “I tend to get pretty defensive when reading excoriations of Ritalin like Sroufe's,” and then goes on to explain how essential Ritalin has been to her functioning. Her explanation is persuasive and poignant, and it certainly answers the question of whether or not Ritalin has been a help to her. It almost makes one forget that Sroufe’s column has nothing excoriating about it, regarding Ritalin or anything else, and that zoomorphic’s experience is only one bit of data among many. It’s the most important piece of data for her, and belongs in any good conversation about the issue, but may not weigh as much from a medical, public policy, or epidemiological perspective.

The tragedy of these threads, to me, as someone who works as both a clinician and in public mental health policy, is that the high level of emotion in these discussions leads to a very narrow view of what’s acceptable discourse. Sroufe’s article and zoomorphic’s response are great examples of this. Sroufe has three main points in his piece: 1) stimulants work well to help kids with ADHD (and everyone else) focus, at least in the short term, but may lose efficacy over time; 2) the fact that stimulants work well tells us nothing about the cause of the disorder they treat; and, 3) we need more comprehensive strategies for understanding and treating ADHD in the long term. None of these can be remotely understood to be dismissive of ADHD as a “real” disorder, or as suggesting that folks with ADHD are simply lazy or otherwise malingerers. Indeed, the piece is entirely positive from the standpoint of someone wanting increased ADHD treatment. Sroufe is explicitly and rationally arguing for a broader array of treatment modalities for kids with ADHD. Not only does he recognize the disease, he suggests that we haven’t done enough to take it seriously. In contrast, zoomorphic reads his position as excoriating Ritalin, and, and this is very important, by extension, calling into question whether ADHD is real and should be taken seriously. Many other comments in the thread do likewise. I’m not trying to pick on zoomorphic here, I understand some of the social and political pressures that lead to that position, but it’s an unfortunate one. To redeploy the beloved biological comparison: can one imagine a cardiologist who said that stents don’t work being accused of not taking blocked coronary arteries seriously?

The fact is we don’t know what causes ADHD, and we have a pretty narrow means for treating it right now.** We know behavioral interventions work, but we, as a culture, seem to prefer medications. That’s ok, medications work well for a lot of people, but there is a legitimate question about how well they work, how long they remain effective, and whether or not there are other interventions that would be as or more effective. People with ADHD should welcome that conversation. It’s a conversation about expanding, not limiting, treatment. It’s a conversation premised on taking ADHD seriously. There are always going to be assholes who dismiss illness as made up or a problem of individual will (although I haven’t really seen that in this thread), no matter the illness (people do it with cancer, for fuck’s sake), but if that conversation dominates every time someone suggests the need for a broader array of treatments for mental disorders (as it mostly does), we aren't likely to advance a treatment positive agenda very far.

* I'm really not trying to pick on zoomorphic. I understand how exhausting it can be to counter ignorance repeatedly, and it certainly sucks to feel like your own experience is being dismissed.

**Sroufe does suggest that environmental factors might predominate in the cause of ADHD, but this does not equate to blaming "bad parenting." We know that living in poverty as a child has broad potential psychological and physical sequelae. Primarily psychological trauma can have wide-ranging adverse physical effects. Felitti, et al., have correlated childhood abuse and household dysfunction to a wide range of health problems in later life:
RESULTS:
More than half of respondents reported at least one, and one-fourth reported > or = 2 categories of childhood exposures. We found a graded relationship between the number of categories of childhood exposure and each of the adult health risk behaviors and diseases that were studied (P < .001). Persons who had experienced four or more categories of childhood exposure, compared to those who had experienced none, had 4- to 12-fold increased health risks for alcoholism, drug abuse, depression, and suicide attempt; a 2- to 4-fold increase in smoking, poor self-rated health, > or = 50 sexual intercourse partners, and sexually transmitted disease; and 1.4- to 1.6-fold increase in physical inactivity and severe obesity. The number of categories of adverse childhood exposures showed a graded relationship to the presence of adult diseases including ischemic heart disease, cancer, chronic lung disease, skeletal fractures, and liver disease. The seven categories of adverse childhood experiences were strongly interrelated and persons with multiple categories of childhood exposure were likely to have multiple health risk factors later in life.
posted by OmieWise at 8:08 AM on January 30, 2012 [7 favorites]


I'm a Ritalin failure. In the late seventies, when they were still arguing with what "disorder" to pin on me in the hazy realm of hyperactivity, dyslexic, dysgraphic, attention deficit hoopajoob nonsense that people of my age and class went through as cliques of psychiatrists fought turf wars for terms, one of the attempts to calm the monkey was a stretch on Ritalin, and it did not save my life, bring me clarity, or restore my natural order—it gave me a strange feeling of being psychologically air-conditioned, like my thermostat had been set artificially low. In my case, my response to the change was to eventually start tucking the damned little poison pills under my tongue so they could be spat out as soon as the supervision left.

I did and do self-medicate from time to time, though I dislike the term "medicate," which furthers the obnoxious disorder model of whatever it is people are calling this thing now. When I need the idea machine to stop so I can do some bookkeeping, a bit of caffeine works just fine. The rest of the time, I surrender to absolute, unwavering fascism, and it's a solution I find pretty effective for being a hunter in a farmer's world. Every morning, I get up, ring a bell, light a candle, print out a pocketmod for the day, carefully transferring unfinished tasks into it from the previous one. For my bills, I use an app called Todo, in which I've set up repeating tasks for all the bills and regular chores that get lost in the chaos.

I have to keep my desk perfectly clean, as uncluttered as a zen rock garden, or it manifests in the back of my head as a panicky sensation that I'm forgetting something important, and my working files, both digital and paper, have to stay completely organized. When these things slip, I get bogged down and start spinning my wheels very, very quickly.

I'm right now recovering from one of those slips, where everything just got out of control and became overwhelming, but I do it by turning out all the parts of my psyche that don't work well on their own into externalized systems of producing order.

When I run wild, though, and when it's something I've allowed myself by virtue of having sustained my productivity through rituals and rules, it's glorious. In my job, I'm caught between paperwork and the physical, maintaining a pair of aged, crumbling arts facilities both bureaucratically and literally, and I'm lucky in that, when I reach the limit of my focus in the numbing reality of the spreadsheet, I can pack it in for a while, climb into the machine room of the clock tower, and put in some time in the clockworks, carefully cleaning, lubricating, and adjusting the mechanism of the clock, or smoothing the contacts of the elevator control board with a square of emery paper.

The powers-that-be said of me, back in my wayward youth, that I just couldn't pay attention, but that's their own bullshit, because I've always had a well of attention that's so deep that I can dive in and swim for hours. I'm supposed to be in the wrong for being unable to sit still and watch some uninspired, underpaid, lifeless teacher counting down the decades to retirement and droning out her millionth rendition of the same old lecture she gave on diagramming sentences back in '62, even though I wrote flawlessly at ten, to the point that I was accused of plagiarism fairly often. We're supposed to be the ones with a problem when we've produced a culture so flat and dead and lifeless that we feel jumpy when we're stuck crunching numbers for some middle management nobody who's asking for them so they can crunch numbers for their upper middle management nobody boss.

Meanwhile, the streets are empty, and everyone's clutching their pearls about how fat we all are. I go for a walk at night, and every house on every street is an aquarium of drowned desires, lit by the ghastly blue flicker of larger and larger televisions, with the upper windows glowing in the light of the immortal, unavoidable web, where we're all supposed to be getting smarter and more connected. I go for a walk in the daylight, or climb on my spindly old three-speed, and I am the only person on the road, barring the newer immigrants and the recovering drunks on their liquorcycles. I live in a compact town with sidewalks everywhere, parks, libraries, and places to go, but on bright, sunny, lovely days, it's so rare to see a kid on a bicycle anymore that it fills me with both joy and despair on the rare occasion when one comes zinging by.

I'm lucky, in that when I finally decided I couldn't take life in a sea of cubicles anymore, I had the skills and the opportunities to use them, but our species spent two hundred thousand years evolving, and suddenly, almost instantaneously, we've invented this sort of lifeless life where the movement of little green pieces of paper dictate how we live and whether we're okay or whether we have a "disorder," and those of us who still feel the bristle and fire of that old instinct to hunt and explore and experiment are destined for diminishment. Maybe the drugs help, and maybe that's okay, since very few of us have a way out of the intellectual widget factories. My caffeine comes in handy when I need it, and sets me jittering to a night of grinding teeth when I don't, but I'm always going to be skeptical about the notion that there's not a better way for those who aren't at the far end of the spectrum, where the monkey mind can never find a moment of tranquility.

I don't know what to tell people, sometimes, because the suggestion that maybe, just maybe, we can downshift in our lives into lines that suit us, even when that means less money, less prestige, and less acceptance, always gets the pod people stare.

"Well, Joe, that's easy for you to say," they say, "but not everyone can live like you think we should live. Some of us have kids and mortgages and retirement plans."

And that's true, and depressing, too. I don't know how to forge any kind of consensus or share the means by which I manage my compatibility issues with the modern world with parents whose kids are bouncing off the walls. Everyone's always got a perfect counterpoint to every suggestion, a perfect reason why I'm just so very impractical. It's nice in theory, they say, but you have to live in this world.

Neither of my nieces, who live a block away, owns a bicycle. The instinct that fed the hearts of my friends and I back in the seventies, and that longing for the crisp, crunching, tramping trails through the shallow, scrubby woods, and the wonder about what's just around the bend either isn't there or exists in some virtualized way I just can't understand. It's just heartbreaking, because they've had most of the opportunities that I have, but they're going against the mass of history, which doesn't celebrate ragged victories anymore.

In the meantime, I have my clockworks, turning quietly fifteen stories overhead, and when I get through the mundane paperwork for the day, I can put in my time there with a little brash brush, tools, and an oil can. There is always an endless list of things to do on that front, and despite my "disorder," when the focus comes, the gears that seem unmoving all turn fluid and churn in great interlocking patterns like the planets in orbit and electrons buzzing in shells of indeterminate action and it's all there, lit up and dynamic and filled with the unbearable potential for awe and wonder.

It's just...well, we're lousy as a species at anything but the one true answer and the one true philosophy and the one true solution to everything that impedes us, and so we're stuck when we're not like you and you and you out there—the ones who don't have trouble adapting to a way of life established in just a tenth of a tenth of a twentieth of all the time we've lived on this planet, just the merest sliver of deep history. Every day, someone wants to define us, to constrain us, and to tell us what's best, but when we're very, very lucky, and very, very loved, people along the way might point out that we may already know how to get by, or that we may be able to learn ways around our obstacles.

It's a thing, this life—isn't it?
posted by sonascope at 8:17 AM on January 30, 2012 [10 favorites]


If you're choose not to medicate yourself, you're being 'irresponsible', right? I mean who doesn't want to be healthy?

I don't think so, and I don't think anyone here is saying that. If you can find a way to manage your life without meds, and you're happy and feel productive, then yay! But if you can't - if you are unhappy because no matter how hard you try, you can't do things you want to do because your ADD/ADHD symptoms interfere, then why should you be crapped on as a lobotomized robot, or a tool of Big Pharma, because you find that drugs help you be the way you want to be and do the things you want to do?
posted by rtha at 8:32 AM on January 30, 2012 [3 favorites]


OmieWise, I remain a little skeptical of Sroufe's column not because he's arguing that behavioral interventions may be effective for ADHD, but because what he's saying doesn't really seem to be borne out by the study he references. I also think he downplays the benefits of a fast treatment like drugs; I think seeing changes fast has a lot of value for many people, and the behavioral treatments for ADHD I'm familiar with (like mindfulness training -- are there others that work as well/better?) are much more slow and difficult to adhere to. And the things he says at the end about ADHD being potentially caused by parents picking their child up too often seem totally, bizarrely speculative to me -- is there really any evidence for that?
posted by en forme de poire at 8:43 AM on January 30, 2012 [1 favorite]


Oh saw this in slate the other day (yeah, I know, slate) and thought it was interesting

My romance with ADD medication -- he took adderal:
If stimulants worked for those writers, why not for me? Who wouldn't want to think faster, be less distracted, write more pages? I asked half a dozen psychiatrists about the safety of using nonprescribed Adderall for performance-enhanced journalism. Most of them told me the same thing: Theoretically, if used responsibly at a low dosage by someone who isn't schizophrenic, doesn't have high blood pressure, isn't on other medications, and doesn't have some other medical condition, the occasional use of Adderall is probably harmless. Doctors have been prescribing the drug for long enough to know that, unlike steroids, it has no long-term health consequences. Provided Adderall isn't snorted, injected, or taken in excessive amounts, it's not highly addictive—though without doctor oversight, it's hard to know whether you're in the minority of people for whom the drug may be dangerous.

As an experiment, I decided to take Adderall for a week. The results were miraculous. On a recent Tuesday, after whipping my brother in two out of three games of pingpong—a triumph that has occurred exactly once before in the history of our rivalry—I proceeded to best my previous high score by almost 10 percent in the online anagrams game that has been my recent procrastination tool of choice. Then I sat down and read 175 pages of Stephen Jay Gould's impenetrably dense book The Structure of Evolutionary Theory. It was like I'd been bitten by a radioactive spider.
posted by delmoi at 8:53 AM on January 30, 2012 [1 favorite]


But if you can't - if you are unhappy because no matter how hard you try, you can't do things you want to do because your ADD/ADHD symptoms interfere, then why should you be crapped on as a lobotomized robot, or a tool of Big Pharma, because you find that drugs help you be the way you want to be and do the things you want to do?

Yeah, but that's not how they're treating children. They're just giving them Ritalin, and there is tremendous pressure on parents to medicate their children by teachers and school staff who can't or don't want to cope with whatever behavior problems they have.
posted by empath at 8:54 AM on January 30, 2012 [1 favorite]


As a side note, Jesus, what the fuck is wrong with school teachers? All of these stories about title pages and pencil-shaming make me want to start slapping people.
I'm guessing a lot of this was in the 70s/80s? Probably trying to prepare people for a world where computers wouldn't catch and correct any mistakes they made. Think about the corporate world without computers, or even calculators -- no computerized spreadsheets: all the math needed to be done by hand and at the same time there could be no errors. So obviously math and with no errors. So we all learned a way of doing math that was tedious and unenlightening, required a pencil and paper, but was unlikely to produce errors. And they drilled it into people so it would become routine (and boring as hell)

But in the age of calculators, making sure people have a 'number sense' and can do math pretty well in their mind although perhaps with errors is more important then what was needed in the past – the ability to sit at a desk and do pencil and paper arithmetic without error all day. Even if you were going to do higher math, you'd still need to have a mastery of arithmetic on a day to day basis.

I guess a lot of the other tedious bullshit was the same - prepareing people to be desk drones in the corporate world, or something. But now most of that work is just entering data, or maybe talking and coordinating with people over email or on the phone (I guess)

I read an interesting essay once about how the education of 'middle class' children is very much about not screwing up, getting everything right, no second chances, etc. State schools are the same way. On the other hand, rich kids go to schools that coddle and help them fix mistakes, including in Ivy League schools. -- And that does a good job of preparing them for the lives they are going to lead after school.

But I think that the structure of society is changing with respect to middle class jobs (i.e. they're going away. Even Thomas Friedman can tell so it must be pretty obvious. So who knows what this will do to the need to prep people for middle class jobs?
These conversations frequently go poorly on MetaFilter. They occupy the ticklish area at the meeting point of medicine, culture, stigma, redemption, public health, public policy, profit, and personal responsibility.
People disagreeing with each other does not make a conversation bad, it makes it good. The problem is when people get too emotional over a topic and can't discuss it at all. But I don't see that here.
posted by delmoi at 8:54 AM on January 30, 2012 [1 favorite]


Well, I don't think that he's misrepresented the study, so much as used the conclusions that he found the most helpful. In a short newspaper piece. To argue for expanded treatment options. I don't think everything about his piece is great, and certainly there's plenty of more room for discussion, but that discussion ain't gonna happen if we condemn him for taking a position he hasn't taken. I don't think he's suggesting, for instance, that one shouldn't use meds in the short term for their quick benefits. I think reading his piece that way is symptomatic of what I'm talking about.

As to this part: "and, especially, patterns of parental intrusiveness that involve stimulation for which the baby is not prepared. For example, a 6-month-old baby is playing, and the parent picks it up quickly from behind and plunges it in the bath. Or a 3-year-old is becoming frustrated in solving a problem, and a parent taunts or ridicules. Such practices excessively stimulate and also compromise the child’s developing capacity for self-regulation."

That does read as speculative, but it makes perfect sense that a pattern of intrusiveness of that kind would have an effect like he posits. I happen to be teaching tonight (MSW students) about infant and toddler development, and the bulk of the lecture will be about the importance of infant self-regulation and how parental attachments either help or hinder that. There's a boatload of evidence that trouble self-regulating as an infant and toddler leads to problems with self-regulation later in life. Sroufe is describing a pattern of disruptions to the developmental tasks associated with self-regulation, his individual examples are simply illustrative. As I read his paragraph there I am assuming two things: 1) he's not making that up out of whole cloth. He doesn't qualify the statement, which leads me to believe that it's grounded in at least some amount of research. 2) he was not able to write ad infinitum, and so left out the citations for that paragraph. But those two assumptions are predicated on already giving him the benefit of the doubt about his overall position, which is what some folks here (for reasons I previously explored a bit) are having trouble with doing.
posted by OmieWise at 8:58 AM on January 30, 2012 [2 favorites]


People disagreeing with each other does not make a conversation bad, it makes it good. The problem is when people get too emotional over a topic and can't discuss it at all. But I don't see that here.

We agree on the former, and disagree about the latter.
posted by OmieWise at 8:59 AM on January 30, 2012 [1 favorite]


Yeah, but that's not how they're treating children. They're just giving them Ritalin, and there is tremendous pressure on parents to medicate their children by teachers and school staff who can't or don't want to cope with whatever behavior problems they have.

I think this is a little reductive, although I only have anecdata: all the parents I know whose kids are diagnosed ADD/ADHD (and some are on the autism spectrum as well) put gigantic amounts of time into behavioral therapies as well. They don't just give the kid a pill and that's it.
posted by rtha at 9:16 AM on January 30, 2012


I put people who deny the existence of ADHD or who call it a parenting issue in the same category as the anti-vaccination people. they're well meaning, have a knowledge of the subject from some trendy articles and dodgy studies, and are perfectly willing to screw up people completely in order to prove their world view. So as far as I'm concerned, they can all go to hell.

As for Sonascope, and the others who say that it's simply a maladaption to modern society, well, sure. If we only went back to a pre-industrial society where 95% of the people were peasant farmers, then we wouldn't have any trouble at all. Sonascope and company could have the of getting up at daybreak every day, having a bowl of cold pottage, and then spend the day pulling a plow. At least until they die of some disease we can prevent with a shot. Or we could go for early industrial revolution, as long as we had a frontier we could send our maladjusted people to. Sonoscope and friends could have the joy of dying from an infected cut somewhere in the mountains.

Personally, I like modern medicine, and I like a variety of cooked foods, and I like having easy entertainment available. I like having a car and being able to travel more than ten miles away from home in my life, and all the other benefits of modern civilization, that are brought about by pushing green pieces of paper around from cubicles. If having to deal with a society that's imperfectly organized for my neurochemistry is the price I have to pay for these comforts, so be it. I'll happily pay a fraction of my income for meds that allow me to participate in society better, rather than whine about how the culture isn't built around my needs.
posted by happyroach at 9:18 AM on January 30, 2012 [4 favorites]


I don't know anything about psychology, psychiatry, or neurology. I don't know what the diagnostic criteria are for ADD. I don't know what drugs are actually prescribed for ADD in the year 2012, or how often they are prescribed, or under what conditions and/or restrictions, and I don't know what non-drug therapies are used alongside or instead of medication. I don't know what it's actually like for someone with ADD, and I've never read that AskMe thread where people shared their experiences.

But I do know that it's overdiagnosed, that doctors hand out Adderall and Ritalin to any kid who looks a little dreamy, and that it's caused by "modern society", whatever the fuck that means. I know that college students who use illicit Adderall as a study aid are definitely on-topic when it comes to discussing the supervised medical treatment of elementary-school kids, and this one time I totally knew a girl who overdosed on prescription stimulants, so, like, people who believe they have ADD just need to try a little harder, am I right?
posted by Zozo at 9:22 AM on January 30, 2012 [2 favorites]


all the parents I know whose kids are diagnosed ADD/ADHD (and some are on the autism spectrum as well) put gigantic amounts of time into behavioral therapies as well. They don't just give the kid a pill and that's it.

*raises hand*

Yep. All the behavioral interventions happened first, then we got a scrip. The behavioral interventions continue.

I spent weeks just furious that I needed to drug my son into compliance. On the other hand, remembering my struggle with my parents, I would have killed for that kind of help growing up.

Getting evaluated for your out of the ordinary kid is terribly invasive. It's invasive to the kid as well. "Did you have a normal pregnancy? Was it planned? Does this thing happen? How often? What is your discipline style? Does your child have a normal appetite?" And that's just the school.

Then you have other parents getting upset because their [expletive redacted] children are "suffering" exposure to your precious snowflake. It makes for some crazy stress. But hey, there's pills for that too. she muttered bitterly
posted by lysdexic at 9:26 AM on January 30, 2012 [1 favorite]


Uh, was there a point, there, Zozo?
posted by lysdexic at 9:27 AM on January 30, 2012


As for Sonascope, and the others who say that it's simply a maladaption to modern society, well, sure.

Actually, I don't think it's "simply" anything. I think these things are varied and complex, but the fact is that we've built a culture that works to thwart our natural instincts, drives, and humanity at every turn, and recognizing that has nothing to do with rejecting the tools available to us. It's a ridiculous dichotomy to propose that we either embrace all modernity or reject all modernity—are you actually saying that the only alternative to drugging every single mode of learning that's different from the cultural norm is to "[go] back to a pre-industrial society where 95% of the people were peasant farmers?"

That's the problem, alas. When it comes down to it, particularly for children, it's drugs or nothing. No education about using your distinctions and working with your distractions, just "Ritalin changed my life" over and over. For the people for whom that works, that's fine. For those for whom it doesn't, that should be fine, too.

When I write, I prefer to do my first drafts on a manual typewriter, then mark up the document with a red pencil. Is that a wholesale rejection of modernity, particularly when I do all my editing on a computer? That's what gets me—the absolute tone-deafness to nuance out there. There's no reason why we can't have both drugs for problems for which they can help and a cultural consensus to live lives more in tune with the way our bodies evolved to work. I can eat cooked food and keep a garden, and I can drive a car and walk. I can use a bit of caffeine, Ritalin, or whatever if I need it and I can recognize that a big part of the problem comes from forcing humans to meet the needs of institutions.

Our solutions are choked with a plague of "or" and a paucity of "and," by and large because all the decisions being made are being made by accountants. Why shouldn't a parent have access to reasonable resources and accomodation for a kid who's got the monkey mind than what's available to a parent who's got a happy little soldier, sitting patiently in the ranks? The thing is, if we only ever work to treat the symptoms while we let the overall way we live fester like a metastasizing cancer, are we really better off? I say no, so I must be a luddite or an anti-vaccination groupie, right?

I'll have both modernity and history, thank you very much, because I can.

Making that choice available to others is a person goal for me. Getting people to listen rather than go off on kneejerk snorting sessions is the first hurdle, alas.
posted by sonascope at 10:57 AM on January 30, 2012 [3 favorites]


A "personal goal,' that is.
posted by sonascope at 10:58 AM on January 30, 2012


lysdexic, I think there was an implied "hamburger" there

OmieWise, thanks for putting that into context. I think part of my problem with the Sroufe article is that he seems to be taking a hard-line "environment only" stance by saying things like "there is little to no evidence to support [the genetic/inborn] theory." I understand this is a reaction against what he perceives as an inappropriate focus on molecular mechanism, but I think it ultimately weakens his case because twin/adoption studies have shown that ADHD is strongly heritable beyond just parental influence. That's very hard to reconcile with the "environment only" model he proposes. Gene/environment interactions I can totally get behind, but ignoring or dismissing the effects of genetic background entirely seems without basis to me.
posted by en forme de poire at 11:42 AM on January 30, 2012


When I was in 1st grade, my teacher (Sister Linda, I still hate that bitch to this day) dumped out the entire contents of my desk on the floor and made me clean it up because it was so messy inside.

Me too. This was a regular occurrence and I'd have to miss recess and sometimes part of lunch to clean it up. Which was really helpful, as you can imagine.
posted by the young rope-rider at 12:05 PM on January 30, 2012 [2 favorites]


So - for those trying to grasp what life is like with untreated ADD/ADHD, you might try the begining of the movie: Limitless. (First 30-40 minutes or so, before it goes off the deep-end)

Ok - Hollywood has had their way with things - but that first transition from unfocussed, unable to concentrate failed writer to productivity is what life can be like for someone being treated appropriately.
posted by jkaczor at 12:30 PM on January 30, 2012 [1 favorite]


it's drugs or nothing. No education about using your distinctions and working with your distractions, just "Ritalin changed my life" over and over.

Are you deliberately ignoring the people telling you that this is not the case? That kids get behavioural therapy, Individual Education Programs, etc., as well as Ritalin? Because in light of, say, lysdexic's post immediately above yours describing exactly this, that's how it looks.
posted by jacalata at 12:50 PM on January 30, 2012


In my son's case it turned out we were good parents after all, the meds just made him able to concentrate and follow through on the stuff we'd been doing all along. A medicated brat is still a brat. Children are just easier to educate and discipline when they aren't hanging from the chandeliers.
posted by Biblio at 1:30 PM on January 30, 2012


Are you deliberately ignoring the people telling you that this is not the case?

Nope. Was eating my lunch and very slowly writing a response to happyroach's comment, and those follow-ups hadn't appeared yet. Then, got a phone call and didn't finish and post until well after I started. The perils of trying to keep up with an extracurricular interest in working hours, alas.

That said, the drug thing isn't really what my comment is about.
posted by sonascope at 1:51 PM on January 30, 2012


palomar Hey, that's cool, discount the lived experiences of those of us that have posted in this thread, simply because you're "not convinced".

I don’t (and didn’t) “discount” your lived experiences. I do think that the disorder might better be classified as a “syndrome” since it’s represented by a constellation of symptoms and behaviors unrelated to a specific identified origin. It’s also diagnosed through exclusion of other diagnoses, making it a sort of last resort diagnosis. I apologize if you find this offensive.

palomar As for being driven to distraction by one's surroundings... that happens to me in an empty room with blank white walls. It's not my surroundings, pal. It's my goddamned BRAIN. FFS, how hard is it to do some simple reading on the subject before you post?!

I've read plenty on the topic, thanks. I was referring to the fact that many live in a over-stimulated environment (in the US anyway). I'm sorry to hear that you have any difficulties and wish you no ill-will but my statements don't belittle anyone's condition, but rather question the accuracy of the DSM. Coincidentally, here's an article published today that examines the efficacy of pharmaceuticals.

jkaczor I'm curious - on what basis are you not convinced? This has even been covered up-thread (have you read the thread?) - if one were to substitute "homosexuality" for "ADD/ADHD" in your statement, would it be less offensive? Are you a practicing medical professional? Do you know anyone who has been diagnosed - not children, but adults?

Well, at the risk of reiterating others above, I’m unconvinced (but not unconvinceble) for several reasons. 1) It’s mostly diagnosed on the basis of a constellation of behaviors – and lacks a well-defined etiology. 2) Being diagnosed on the basis of exclusion suggests that it’s not well understood as a distinct disorder, 3) It seems to be frequently (perhaps most often) comorbid with one or more other more well-defined conditions, 4) recent environmental health studies have begun to identify other environmental factors that contribute to many diseases, often intergenerationally , and 5) the classification difference between ICD and DSM, and the corresponding differences in prevalence of the disorder(s) suggests that one of these paradigms is less accurate.
Yes, I’ve read the thread and am still unconvinced.

Re homosexuality – it’s your position that homosexuality is a clinical disorder?! And you’re suggesting that I’m being offensive? Whatever…...

No, not a practicing medical professional but I think I’m qualified enough to discuss it intelligently and rationally. Seriously, what level of academic credentials qualifies me for having an opinion? What are your medical credentials?

How do you know that I don’t suffer from ADHD/ADD?

Note: Help maintain a healthy, respectful discussion by focusing comments on the
issues, topics, and facts at hand—not at other members of the site.

posted by onesidys at 3:28 PM on January 30, 2012


My anecdote time. Two years ago I sat my best friend down for a serious talk about his depression. I told him that he needed to speak to a mental health professional, and after some badgering he did.

Six months later he was (apparently) diagnosed with ADHD and a host of other disorders, and was taking 4-6 meds a day, including Lexapro, Seroquel, Xanax, and Ritalin. He went from a depressed but bright, creative person to.. well, I compare it to hanging out with a store mannequin, and not in the fun Kim Cattrall way. Maybe he's happier now, but it's hard for me to tell any more. Encouraging him to seek out a mental health professional is something I now deeply, deeply regret.

You know, I'm very glad that some people found medication improved their lives and I am not discounting that, but if you think ADHD is not being diagnosed where it does not exist and that medications are not being handed out where they are not necessary then you are fooling yourself.
posted by jess at 3:41 PM on January 30, 2012


Encouraging him to seek out a mental health professional is something I now deeply, deeply regret.

Please don't. People die from depression. A lot.

That he may be on the wrong/too many drugs is something that can be addressed, and if you're up for it, you can help him put together a plan to do that. Being dead from depression is not something that can be fixed.

I have been clinically depressed. I worked it through purely with talk therapy - the drugs available were fewer and blunter then, and I was lucky to have a therapist who didn't see the need to start me off right away on them, but to see how the just-talk side of things went. Not everyone gets to have their clinical depression helped solely by talk therapy.
posted by rtha at 3:53 PM on January 30, 2012 [5 favorites]


I recently got a Neurosky headset. This device purports to do EEG measurement and sex the data to your computer. They have a number of biofeedback video games designed to help you measure as improve attention and executive function.

I'm not sure how valid its measurements are, but I have read positive accounts of biofeedback as a supplement or replacement for medication.
posted by humanfont at 3:55 PM on January 30, 2012 [1 favorite]


Given that he's on multiple anti-depressant and anti-anxiety drugs, some of which are pretty heavy hitting, it seems odd that you should lay your friends issues at ADHD treatment.

Whether or not ADD/ADHD has anything to do with his issues is another matter. I was on a tiny little dose of Xanax for a while (PTSD) and I think it's safe to say I was less fun during that period than I am normally.
posted by Kid Charlemagne at 3:56 PM on January 30, 2012 [1 favorite]


I played with one of those (or something like it) at MakeFaire two years ago Humanfont. OK, the one I played with was using a low grade flame thrower as a readout but same basic thing. My experience - got it on my head, the lady running things set the switch to concentrations, I thought about the things I'd been puzzling over at work for the past year or so and about five seconds later, WOOF!

Then something else started happening right behind me and try as I might, I couldn't get it to go off again. Too much of my brain was saying to me, "Uh, dude, are you sure there aren't leopards back there - something's back there - you should check it out. It might be leopards. Or Jackals. You never know. You should really look and make sure!"

Then she switched it over to meditation mode. A few seconds later...WOOF!

Of course, from talking to the people who built the thing, the EEG thing is all off the shelf, so they have no real idea of what it's looking for - some kind of wave form or another I'd guess, but it certainly seemed, from my n of 3, that it could tell focused contemplation from distracted contemplation and a non-contemplative state (or as non-contemplative as I ever get) from those.
posted by Kid Charlemagne at 4:14 PM on January 30, 2012


The process of finding the right long term medication for anxiety or depression takes a while. As a short term solution doctors often prescribe a benzodiazepine such as Xanax. They are fast acting but not the long term solution as they tend to make people into a bit of a zombie / mannequin. Eventually the doctors get the dosage and SSRI medication right. This is usually after months of trying different doses and medicines such as Prozac, Lexapro, Zoloft, etc. Then they can cut out the Xanax and start trusting the patients brain to give a shit about things again without getting overly morose or anxious. Be patient, the alternative of suicide or continued depression / anxiety is much worse. It gets better.

ADHD seems much easier to treat by comparison. The medications mostly leave people feeling better and more active in the short term. They are called uppers for a reason after all. The drugs also show a pretty rapid impact on organization and executive function.
posted by humanfont at 7:05 PM on January 30, 2012


Was it always with us? Probably. Do I care? No. What I care about is this: 10-25% of the little boys I teach are more successful because of the medication they take. They learn more, they get in less trouble, they are generally happier. I do not see this specter of 'listless, overmedicated little boys who somehow fail to be little boys' that some people wave around like a boogeyman.

And yet they seem to be falling behind in college more and more every year.
posted by furiousxgeorge at 11:07 PM on January 30, 2012


en forme de poire: I think part of my problem with the Sroufe article is that he seems to be taking a hard-line "environment only" stance by saying things like "there is little to no evidence to support [the genetic/inborn] theory." I understand this is a reaction against what he perceives as an inappropriate focus on molecular mechanism, but I think it ultimately weakens his case because twin/adoption studies have shown that ADHD is strongly heritable beyond just parental influence. That's very hard to reconcile with the "environment only" model he proposes. Gene/environment interactions I can totally get behind, but ignoring or dismissing the effects of genetic background entirely seems without basis to me.

Fair enough. Again, I tend to grant him the benefit of the doubt here, because I know that you just don't get to lay out your most complex arguments and citations in a short newspaper piece. (There are no citations in the Smalley piece asserting heritability, eg.) This does not excuse his positions, but I do think they are likely more nuanced than they appear in print. Previous to this I didn't really know anything about Sroufe, but he's got a lengthy publication history as listed in PubMed, and his work seems clearly centered around child development and developmental psychopathology. His work actually seems quite interesting. Of note for this discussion is a prospective longitudinal study on intergenerational parenting behaviors, as well as a developmental investigation of inattentiveness and hyperactivity. The abstract for the latter seems to show that it's the source of his position on development v. genetics with respect to ADHD:
Abstract
The development of inattentiveness and hyperactivity in middle childhood was investigated using a prospective longitudinal approach. Endogenous and exogenous predictors measured in infancy and in early and middle childhood were examined independently and in combination. In early childhood, quality of caregiving more powerfully predicted distractibility, an early precursor of hyperactivity, than did early biological or temperament factors. Caregiving and contextual factors together with early distractibility significantly predicted hyperactivity in middle childhood. While environmental variables also predicted hyperactivity in later elementary years, these factors did not improve the prediction beyond the influence of hyperactivity in early elementary years. The findings support a developmental view of the origins and course of hyperactivity in childhood, that is, that the emergence and persistence of AD/HD symptoms depend on developmental history along with current circumstances.
Note that this is not the same thing as saying that there are not biological factors, just that other factors are more important. One of the issues with biology as explanation, as it's currently used, is that it's mostly not nuanced very well, and biology is just kind of assumed to trump everything else.

He also has a full text paper available that bears on this discussion: The Concept of Development in Developmental Psychopathology, where he more fully lays out his thinking about what genetic and biological studies have to tell us:
It would be easy to extend this list of accomplishments, as both the effort and the output in this field have been extraordinary. Despite this progress, however, a counter-trend has occasionally arisen that at times erodes a developmental perspective: the tendency to treat biological correlates of functioning, and even characteristic child behavior, as somehow lying outside of the domain of development—of simply being endogenous givens. Reflecting this, the vast majority of current studies in the psychiatric literature simply compare those who do and do not qualify for some disorder on some biological variable (see, for example, the review of fMRI studies of ADHD by Dickstein, Bannon, Castellanos, & Milham, 2006). Given the integrated nature of development, it is impossible to avoid discovering large numbers of such differences. Seriously disturbed functioning will doubtless manifest in brain/body just as in interpersonal relationships and daily functioning.

However, studies that reveal some difference in brain physiology between two groups, even those that use children, cannot answer the basic developmental questions of origins and course, but can only stimulate developmental inquiry. We can spend $21 million on the neurophysiological correlates of anorexia, as Chavez and Insel (2007) describe, and learn almost nothing about how individuals develop this problem. This is not because genes and neurophysiology are unimportant, but because they derive their importance within complex developmental analysis. Only developmental studies can reveal whether obtained associates are true antecedents, markers, or consequences of a disordered process. Experience influences physiology just as physiology influences experience (Grossman et al., 2003). Only developmental studies can reveal how genetic or physiological features interplay with the other features of a developing problem.
This is clearly a guy who has done a lot of work in this area, has well-developed and nuanced views, and is prepared to discuss them.

Which brings me back to my initial point, which is that reducing his intervention in the debate into a "bad parents cause ADHD and Ritalin sucks" position not only does Sroufe a disservice, but limits the discussion in drastic ways. If we can only discuss the causes and treatments of ADHD within a narrow orthodoxy without accusing each other of acting in bad faith, the likely losers will be kids with ADHD. It is not without consequence that the present orthodoxy also has a substantial profit motive.
posted by OmieWise at 5:19 AM on January 31, 2012 [3 favorites]


empath: "also, i think a lot of psychiatry is kind of 'if you have a hammer, everything looks like a nail. We discover a drug that makes people more focused. Therefore, if they are less focused, they are sick. Without the drugs to 'treat' it, ADD would have never been a thing. Or it certainly wouldn't have been as profitable for drug companies to promote."

For the first decade and a half of my life, I had a thing. Although ADHD already existed as a diagnosis, it wasn't widely known. All that was certain was that I had deep, fundamental problems interacting with the world and the people around me.

Mostly because of how I struggled, you can count me among those who think it is probably overdiagnosed, and that it doesn't make sense to medicate children who are maybe 8 or 9 years old and just enjoy running around and find class boring. Because I didn't just run around; I found sitting still impossible. I didn't just find class boring (heck I wasn't bored at all; I actually usually found the class interesting, when I was "there"), I just wasn't there at all.

True story: when I was in 3rd and 4th grades, my teacher (this was a private school, so he taught us in both 3rd and then the 4th grade) would manage, while I was spacing out, to marshall the entire class to join him in yelling "1....2....3.... JORDAN!" as loud as they could to draw my attention back to the class when I spaced. I barely remember those days (or even much of my childhood; I'm fairly sure I've blocked it out as a defense mechanism, which is why Umberto Eco earned my enmity forever when he said that the point of life was "to remember your childhood") but I remember this happening multiple times and I feel like it must have been a shaming thing although at the time I was probably not self-aware enough to realize that it ought to have been embarassing.

My point is, when the drugs to treat ADHD arrived my thing changed from being the trait that pretty much determined my entire self to a problem that I could work on. So, there's that.
posted by Deathalicious at 7:03 AM on January 31, 2012


francesca too: "the difference in numbers between boys and girls is very puzzling, even if under-reporting for girls is taken under consideration."

I'm going to say that at least half of the difference comes from under-reporting.

ADHD behavior, like the behavior of those with Tourettes, is contextual. So, for example, in certain cases even without medication I can make myself be quiet, still and calm (although granted it is also easier now that I'm an adut anyways) but this was always true even when I was a young child and unmedicated. I could also make myself be on time or be organized for certain purposes.

But it goes the other way too: in environments or contexts where it was more permissive to be loud or active, I would go crazy. And so naturally in a culture where boys are grudgingly expected to be more rambunctious and noisy, of course boys with ADHD are going to feel freer to act on their urges, while girls will feel less able to do so.

Seems to me that correlates well with a tendency for girls to be more depressed than boys. I wonder how many of them are suffering from ADHD and instead of releasing the tension through hyperactivity are internalizing it.

Also, let's not kid ourselves. Aside from a few extreme cases of inattentiveness/impulsivity, most people focus exclusively on the hyperactivity when it comes to diagnosing ADHD. If I'd been one of the unlucky ones who only hyperfocused or found it hard to pay attention all the time in class, my ADHD might have remained undiagnosed for years or even a decade, until I started out in the working world and wondered why I could never get anything done.
posted by Deathalicious at 7:14 AM on January 31, 2012


That's what my son is going through right now, Deathalicious. He still has to work on controlling himself, but the major difference is that he's acting out of little boy mischief instead of a human tornado.

I had the "quiet" type. I was also in a private school, and the curriculum was ridiculously easy, so I could get my work done and then read. Some teachers didn't care for it and would confiscate the books, others called me lazy and wouldn't let me do the advanced stuff until I'd done the boring shit I already knew.

But yeah, I had a "thing", and nobody did shit, even denied it. I'll take a wee bit too much over too fucking little.
posted by lysdexic at 7:23 AM on January 31, 2012


Well, at the risk of reiterating others above, I’m unconvinced (but not unconvinceble) for several reasons. 1) It’s mostly diagnosed on the basis of a constellation of behaviors – and lacks a well-defined etiology. 2) Being diagnosed on the basis of exclusion suggests that it’s not well understood as a distinct disorder, 3) It seems to be frequently (perhaps most often) comorbid with one or more other more well-defined conditions, 4) recent environmental health studies have begun to identify other environmental factors that contribute to many diseases, often intergenerationally , and 5) the classification difference between ICD and DSM, and the corresponding differences in prevalence of the disorder(s) suggests that one of these paradigms is less accurate.

It is so strange to think that lacking a firm etiology is evidence that something isn't a "real" condition. Many perfectly real conditions have more complicated and mysterious etiologies than ADD/ADHD. I don't suppose we'll be floating the idea of lupus denialism any time soon.

Being diagnosed on the basis of exclusion does not mean that a condition is not real, nor even that it is not well-understood. Where did you get the idea that this was the case?

It's also strange to think that frequent comorbidity with other disorders is somehow evidence that a condition is not a "real" condition. Many, many perfectly real conditions are frequently comorbid with many other conditions.

Whether ADD/ADHD has a stronger environmental or genetic component has nothing to do with ADD/ADHD's "reality" as a condition. In the course of a single list, you've changed from asserting that ADD/ADHD lacks a firm etiology, to apparently asserting that what we call ADD/ADHD may be the result of as-yet-unknown environmental factors. So, the condition lacks reality because there's no firm etiology, but at the same time, it lacks reality because it may be a result of environmental factors? This is not consistent.

Classification differences for ADD/ADHD between different manuals and organizations are no more divergent than that of less controversial diagnoses, especially when it comes to psychiatric disorders, but even when it comes to physical disorders. Science evolves, conditions are social defined, and so on. This is not news to those who regularly encounter this kind of stuff.

Where this gets more interesting is when you examine where and when these definitions differ, and why. We may be evolving towards a more unified definition of ADD/ADHD, or our understanding of the condition could splinter it into more refined subdefinitions.

It also does not affect the "reality" of ADD/ADHD to notice that it appears to only exist in the West. Not only is the amount of sensory stimulation at an unprecedented level in the West, but it is very old news that mental conditions are part of our social reality. It doesn't mean that these conditions aren't "real," at least no more so than fiat money isn't "real," or that the legal system isn't "real."

...

Re homosexuality – it’s your position that homosexuality is a clinical disorder?! And you’re suggesting that I’m being offensive?

The reason homosexuality is being (validly) brought up is because it is a condition which would appear to be equally unreal, when we apply the same level of skepticism that we would apply to ADD/ADHD. After all, homosexuality has a very unclear etiology, its definition varies highly across time and culture, etc.

That said, many cultural/queer/etc. theorists might argue that this is skepticism perfectly fine - that "homosexuality" isn't really a thing at all, at least not as Westerners conceive of it, but this would require a radical redefinition of human sexuality. (Which is not to say that radical things are automatically wrong.)

At any rate, you could substitute in any number of other positive, neutral, or negative conditions for "homosexuality" in order to make a similar point.

To move more in the direction of comparing clinical disorders to ADD, you could just as easily throw in depression, schizophrenia, autism, or lupus, and that's just off the top of my head.
posted by Sticherbeast at 7:42 AM on January 31, 2012 [4 favorites]


That’s ok, medications work well for a lot of people, but there is a legitimate question about how well they work, how long they remain effective, and whether or not there are other interventions that would be as or more effective. People with ADHD should welcome that conversation. It’s a conversation about expanding, not limiting, treatment. It’s a conversation premised on taking ADHD seriously. There are always going to be assholes who dismiss illness as made up or a problem of individual will (although I haven’t really seen that in this thread), no matter the illness (people do it with cancer, for fuck’s sake), but if that conversation dominates every time someone suggests the need for a broader array of treatments for mental disorders (as it mostly does), we aren't likely to advance a treatment positive agenda very far.

Well there always needs to be more tools for the job. I'm on meds and know a lot of ADHD people on meds, and I've always had the impression that ADHD meds lose effectiveness over time. Then at some point you change medication or dosage; rinse repeat until nothing works. Kind of similar to how chronic pain was managed very early on. From an academic perspective I can appreciate that, and I look forward to going through pubmed to read up on Sroufe's papers when I have time. But from an advocacy perspective in a forum for lay readers, I'm very nervous about the same statements being made. Especially in the puritanical USA where mental health is stigmatized and personal responsibility is endlessly spouted as a mantra by the perpetually clueless. We have advocates lobbying to ban OxyContin for abuse, and most of the ADHD meds are abused by somebody. I don't want to stockpile my meds, but at the same time, being suddenly cut off from them by some kind of regulatory or policy change could drastically screw up my life for a short but critical window of time. Although I appreciate behavioral therapy too, there are issues of equity and access that affect people's ability to pursue it; have you looked at how mental health treatment is covered by insurance? Personally, I almost need the ADD meds to deal with getting the insurance company to cover ADD meds. I suspect a lot of the ADD people I know were only able to get ADHD treatment covered by their insurance with the help of their spouses or parents.

But I've been through the behavioral approach, and I can already see that even if I'm successful in building the right habits a hell of a lot of careers and jobs are going to be effectively closed off for me without figuring out how to radically restructure how I'm expected to go about them. This means that I need to acquire a skill set where I'm attractive enough to employers that I can negotiate some concessions at date of hire and not be considered the last candidate they want because I have special circumstances. The only way to acquire some of those skills is a short term treatment right now. I hope to figure out a structure where I can do better, but right now if my drugs were taken away I would lose all hope, and probably seriously start considering how I could live out of my car and the contents of dumpsters in back of grocery stores because that's where I'm headed eventually if I can't control my attention... or dead from mismanaging my Type I diabetes due to inattentiveness. I sometimes feel like that is the worst possible disease for someone with issues focusing, but I'm sure there are worse. But back to the job thing, while unmedicated for ADD I can hold down a lot of jobs for a while that don't require much in the way of attention, but the lack of intellectual stimulation bores me to tears, and they usually don't pay enough to cover my rent, food, and diabetes medication.

I'm truly happy that others have carved out little niches that work for them, and that's one of my goals, but understand that ADHD works differently for different personalities. I know one other guy besides myself that works in accounting/finance, and all the other ADHD people think we are crazy. But to me it's like playing a strategy game, or multidimensional minesweeper. There's a lot of analysis and a score at the end to reward you. I can actually be happy at it when I'm not forced into a rigid 9 to 5 approach. It can be a distraction instead of the sort of thing to yearn to be distracted from, at least for now and maybe a year or two more. I can't picture a job, other than maybe the one Mike Rowe has, that doesn't force me to deal with my weaknesses from time to time. And I include pre-modern jobs in that list. I'm 40, and I know what I am and am not good at at this point in my life.
posted by BrotherCaine at 10:00 AM on January 31, 2012 [2 favorites]


other than maybe the one Mike Rowe has Scratch that, I couldn't do his job either.
posted by BrotherCaine at 10:04 AM on January 31, 2012


The reason homosexuality is being (validly) brought up is because it is a condition which would appear to be equally unreal, when we apply the same level of skepticism that we would apply to ADD/ADHD.

You know, that's BS. Homosexuality is being brought up to play gotcha. The questions about it are begging. "When did you stop beating your wife?" The comparison is meant to highlight the supposed moral failings of the person asking questions about ADHD. At least be honest about the rhetorical strategy.

(The comparison is problematic and not germane for all kinds of reasons, not least because homosexuality used to be recognized as a psychological disorder until justice prevailed. The example tends to confirm that our diagnostic nosology for mental illnesses is imperfect.*)

*I'm suggesting anything about the ADHD diagnostic rubric, although I have some technical quibbles with it, I'm just pointing out why the moralizing example chosen to embarrass the interlocutors here is misguided.
posted by OmieWise at 10:04 AM on January 31, 2012


I thought that the fact that homosexuality used to be recognized in the DSM was why it was brought up in the first place. Personally I agree that it was bullshit rhetoric and probably counter-productive as well.

The example tends to confirm that our diagnostic nosology for mental illnesses is imperfect

It's not so much that it's imperfect, as that it mandates normative behavior as a goal and hence a virtue. In some senses non-normative behavior can be treated at the individual level, or by changing social norms. In either case if untreated there will be suffering for the non-normative individual. I have some sympathy for people who think that society can't change and it's better to change the 'patient' to alleviate their suffering — as long as they don't stomp all over people's autonomy in the process. At the same time, I'd feel anger at someone who said don't you just want to be normal? Because I've tried that and it's not ever going to happen without some kind of treatment we can't even imagine right now.
posted by BrotherCaine at 10:14 AM on January 31, 2012 [1 favorite]


In the context that it (homosexuality) was brought up it wasn't with regard to people asking questions about ADHD. It was in the context of people making uninformed judgements about ADHD and the people with ADHD. We have people suggesting that perhaps we'd be better off if people with ADHD could just go in to the trades. I don't think the moral outrage is misplaced.
posted by humanfont at 10:55 AM on January 31, 2012 [1 favorite]


(The comparison is problematic and not germane for all kinds of reasons, not least because homosexuality used to be recognized as a psychological disorder until justice prevailed. The example tends to confirm that our diagnostic nosology for mental illnesses is imperfect.*)

But the question isn't over the perfection of diagnostic nosology for mental illnesses. The question is over showing how thin the "well, in my opinion ADD/ADHD doesn't exist" argument really is, because many conditions, including something as completely common and neutral as homosexuality, would completely fail such an exaggerated display of "skepticism".

Also, homosexuality didn't stop being classified as a psychological disorder because people stopped thinking it existed. People learned more about it and made new judgments about what we, as a society, should tolerate. Straight people gained new perspectives on those with same-sex attraction because they took "homosexuals" seriously and decided to actually learn more about it, as opposed to just continuing to glibly classify homosexuality as a disorder.
posted by Sticherbeast at 11:13 AM on January 31, 2012 [5 favorites]


Yes, I'm aware of the history of homosexuality as a disorder, and of the revision of the diagnosis. My point, which I think still stands, is that there was an obvious error in the diagnostic criteria such that homosexuality was classified as a disorder. The criteria were changed as our understanding changed. This is not a good example to use to try to show that questions about the usefulness of a diagnosis are misplaced. Further, it isn't deployed here because it's "completely common and neutral," it's deployed because it would be monstrous to say that gays and lesbians should be discounted in some way.

Look, I think you're willfully misreading the "well, in my opinion ADD/ADHD doesn't exist" argument in way that assumes the worst about your interlocutor. If you read the argument it is, indeed, about the diagnostic rubric. The argument is not "these people don't suffer," the argument is "the suffering these people experience is being classified in a bad way." You can certainly disagree with the latter, and you do a good job of explaining why you do, but when you bring homosexuality into it as you have you are essentially saying that there is no room to do anything other than accept the diagnosis as written, and to not do so would be a monstrosity on par with being blatantly homophobic. That seems like a much more extreme position than the one you're arguing against, and, as I've argued elsewhere in the thread, seems to be ultimately likely to harm folks with ADHD.
posted by OmieWise at 1:49 PM on January 31, 2012


Cancer has all kinds of confusing etiologies that have nothing to do with one another. I think it makes a better example.
posted by LogicalDash at 2:41 PM on January 31, 2012


OmieWise, I was not responding to your more fine-grained concerns. I was specifically responding to someone who was claiming ADD/ADHD was probably not a distinct condition, and who cited a list of IMHO very unconvincing reasons why this was so.

This is not a good example to use to try to show that questions about the usefulness of a diagnosis are misplaced.

No, but it is still a fine example of how artificially exaggerated "skepticism", if taken to its logical conclusion, would cause us to regard many obviously real conditions as "not real." Many of the same concerns leveled at ADD/ADHD would also cause us to conclude that there was no such thing as gayness as a condition unto itself.

At no point did I ever say or imply that there could be no questions about the usefulness of ADD/ADHD as a diagnosis, as the diagnoses currently stand. Indeed, I expressed hope that the differences in diagnoses across time, bodies, and culture would help us determine better understanding and treatments for the conditions.

Further, it isn't deployed here because it's "completely common and neutral," it's deployed because it would be monstrous to say that gays and lesbians should be discounted in some way.

I don't know about the others who had brought it up, but I bring it up not because it's evidence of monstrosity, but evidence of silliness. To blunder into a thread on gay experiences and to say that gayness had no existence as a distinct condition, as we don't really know what causes gayness and as different people have had different perspectives on what gayness is, would strike me as being very silly.

Yes, definitions change and societal perceptions change and many of our conditions are mediated into a social reality, but ultimately, things like gayness and ADD and left-handedness and lupus are at least as real as money or the rules of baseball, despite the fact that they could all theoretically be deconstructed to one extent or another as having some irreal, ambiguous, confusing, vague, socially constructed, or otherwise unknown qualities.

Look, I think you're willfully misreading the "well, in my opinion ADD/ADHD doesn't exist" argument in way that assumes the worst about your interlocutor.

No, I'm taking "I don't think ADD/ADHD exists as a distinct disorder" at its face value. I haven't taken the time to respond to any of your concerns, which seem mature, detailed, and basically out of my league.

Either way, I'm happy to drop homosexuality as a comparison, because it does have a lot of red flag attachment to it. I had liked the homosexuality comparison specifically because it is not a disease, but rather a fundamental part of who people are, but that's neither here nor there, and I've probably been too confusing when bringing it up.

I will instead stand by comparisons to depression, schizophrenia, lupus, and left-handedness, as well as comparisons to dyslexia and stammering. All of these conditions have very confusing etiologies; they are all, to one extent or another, mediated through social reality; but, they also all undeniably "exist" to us. Further, attempts to classify ADD/ADHD as being not-real would also, if taken to their logical conclusions, cause us to conclude that those conditions were not conditions unto themselves.
posted by Sticherbeast at 3:56 PM on January 31, 2012 [1 favorite]


Dr. Hallowell, the author of Driven to Distraction replies to Dr. Sroufe.
posted by Obscure Reference at 4:47 PM on January 31, 2012 [2 favorites]


You can certainly disagree with the latter, and you do a good job of explaining why you do, but when you bring homosexuality into it as you have you are essentially saying that there is no room to do anything other than accept the diagnosis as written, and to not do so would be a monstrosity on par with being blatantly homophobic

People with ADHD endure senseless beatings, being flunked out, flagged for failure and berated by regular folks. The same attackers drive people to away from effective therapies by creating a false moral panic about medicating our youth. The homophobic people don't think they are doing anything wrong either.
posted by humanfont at 4:49 PM on January 31, 2012


And all this time I thought homosexuality had been brought up in order to try to make me feel bad about saying things which the person who brought it up didn't like, agree with, or had misinterpreted altogether.
posted by hippybear at 5:42 PM on January 31, 2012


Hippybear you said your partner had ADHD, when they have never been clinically diagnosed. You used this example of your partners condition to claim expertise, and deflect criticism. You seem to think that attempts to enlighten you to your own ignorance and prejudice are attempts to make you feel bad.
posted by humanfont at 6:30 PM on January 31, 2012 [1 favorite]


Hippybear you said your partner had ADHD, when they have never been clinically diagnosed.

This is false. I recognized symptoms based on workshops I had been in as staff in the public schools, and he consulted his doctor and received a diagnosis and subsequent treatment.
posted by hippybear at 6:34 PM on January 31, 2012


I will instead stand by comparisons to depression, schizophrenia, lupus, and left-handedness, as well as comparisons to dyslexia and stammering. All of these conditions have very confusing etiologies; they are all, to one extent or another, mediated through social reality; but, they also all undeniably "exist" to us. Further, attempts to classify ADD/ADHD as being not-real would also, if taken to their logical conclusions, cause us to conclude that those conditions were not conditions unto themselves.

Fair enough. And while I don't want to spend time defending anyone's comments but my own (where appropriate), I do think it's worth considering that our diagnostic nosology for mental disorders is mixed up enough that asking whether a particular disorder exists as a distinct condition is well within the bounds of acceptable discourse, and is not on par with calling the disorder "not real."* Things can be real but improperly classified, or improperly understood, or improperly labeled, or any of a host of other possibilities. This is important because we aren't at the end of history with mental disorders, despite what biological psychiatrists would have us believe. We still experience psychiatric "epidemics" (we had one for multiple personality disorder in the 80s and 90s, we had one for ADHD in the 90s, we are in the midst of one for childhood bipolar disorder now), that have to do with the interaction of social concerns, the looseness of our diagnostic rubrics, and the constructed expression of mental distress. Ian Hacking, who has written with balance and sympathy about these types of surges in particular diagnoses, suggests that real mental distress is expressed within an "environmental niche," predicated on some of those things I listed. This is not the same thing as saying that these mental illnesses are not real, that the sufferers are not suffering, or are somehow faking it, it's a recognition that we diagnose mental illness based on subjective symptoms whose expression appears to be influenced strongly by cultural and social factors (including how psychiatry is currently talking about the problems under consideration). Psychiatry has no blood tests, no brain scans, no assays to use in diagnosis; there are no identified physical markers for the mental disorders we're talking about here, even the "biggies" like schizophrenia.

In other words, it's entirely plausible to suggest that ADHD as we currently understand it didn't exist when our world was substantially different, that the mental disorder we now know as ADHD was expressed differently when the concerns of our social world were different. We know this has happened with other disorders: we still see a little bit of conversion disorder (the modern name for hysteria) around (it's still in the DSM), but hysteria isn't the defining medical and psychiatric disease it was at the turn of the 20th century. Instead we see depression, anxiety, and expressions of complex trauma like Borderline Personality Disorder and PTSD. Similarly, to use Hacking's example, dissociative fugues are still sometimes diagnosed, but we don't see any Mad Traveler's Disease anymore. It was a mental disorder of the 19th century. Now we see other dissociative disorders, including, in the 80s, a lot of multiple personality disorder. This is not a naive argument for social construction akin to suggesting that no one could have died from ovarian cancer in Jane Austen's time because no one had identified cancer yet, it's a more complex argument about the inherent sociality of mental disorders, no matter the etiology. Women who had hysteria in Charcot's Paris were suffering, that suffering was very real, that suffering was expressed in a way particular to the context in which they lived. Suffering in the same way now is expressed differently not because it is somehow not real, but because the context has changed, and mental disorders are subjective and social disorders. Even if we find organic causes to a host of mental disorders, history suggests that our understanding of them and how they are expressed will change over time. Discussing these things does not in any way suggest that people suffering with ADHD aren't suffering from something real, but it does help to explain why well-meaning people might have questions about the expression and the rise of diagnoses in a changing world.

*I'm not saying you're incorrect to read onesidys' comments as you have, I don't know what his/her motives are.
posted by OmieWise at 5:42 AM on February 1, 2012 [3 favorites]


I think that's all very interesting from a philosophical or historical perspective, but I have to live my life right now, with the best tools available to me now. And I'm not sure exactly how that perspective helps me do that.

But also, you have a lot more to say about hysteria than about, say, "refrigerator mothers" and other cruel examples of psychiatry falsely blaming bad mothers for their children's mental illness. You're truly not conscious of that risk here?
posted by craichead at 6:50 AM on February 1, 2012 [1 favorite]


I think that's all very interesting from a philosophical or historical perspective, but I have to live my life right now, with the best tools available to me now. And I'm not sure exactly how that perspective helps me do that.

Well, nothing in that perspective prevents you from using the best tools available now, but it does suggest that the best tools are likely not the only tools, nor that they can't be better. I think that's Sroufe's point in the linked article, and having a conversation about the limitations in current understandings and treatments is not the same thing as blaming the sufferers.

But also, you have a lot more to say about hysteria than about, say, "refrigerator mothers" and other cruel examples of psychiatry falsely blaming bad mothers for their children's mental illness. You're truly not conscious of that risk here?

I'm not sure what you're asking here, can you expand it a little bit? You seem to be bringing up other explanatory failures, and ones about which mental health professionals should feel badly, but I'm not sure how that relates to my comment. There's a long history of mental health services being used for nefarious and horrible purposes, and causes being wrongly attributed. But I'm not sure what that has to do with this conversation, or most especially with the linked articles. Can you elaborate?
posted by OmieWise at 7:29 AM on February 1, 2012


I do think it's worth considering that our diagnostic nosology for mental disorders is mixed up enough that asking whether a particular disorder exists as a distinct condition is well within the bounds of acceptable discourse, and is not on par with calling the disorder "not real."

Such a question is well within the bounds of acceptable discourse, which is why I went through that comment point by point to argue against it. When did I ever say or imply that such a question was outside the bounds of acceptable discourse?

On the other hand, I'm at a loss as to how "this disorder does not exist as a disorder" could possibly translate into something other than "this does not exist as such." Yes, I know that that person wasn't saying that everyone was just making these symptoms up, but there was also the erection of strange, idiosyncratic standards for what constitutes an actual disorder, as opposed to merely a syndrome or something else.

Ian Hacking, who has written with balance and sympathy about these types of surges in particular diagnoses, suggests that real mental distress is expressed within an "environmental niche," predicated on some of those things I listed. This is not the same thing as saying that these mental illnesses are not real, that the sufferers are not suffering, or are somehow faking it, it's a recognition that we diagnose mental illness based on subjective symptoms whose expression appears to be influenced strongly by cultural and social factors (including how psychiatry is currently talking about the problems under consideration).

I've read Hacking, too. This is very old news. Of course mental illness is inextricable from its environment.

What's strange about much of this "questioning", such as the questioning I had actually been responding to, is that it actually reflects the "end of history" order, and not the more modern approach. Much of this line of questioning assumes that something can't be a distinct disorder unless it is somehow independent of an "environmental niche." The fact that a mental disorder is necessarily enmeshed within a particular society does not in and of itself make it not a disorder. The opposing attitude strikes me as being every bit as sophomoric as the realization that fiat money isn't "real" money, which is of course true in a limited sense, but is of course also false in almost any useful sense, especially when it's time to pay rent.

Psychiatry has no blood tests, no brain scans, no assays to use in diagnosis; there are no identified physical markers for the mental disorders we're talking about here, even the "biggies" like schizophrenia.

No brain scans? Are you serious? You have never read one of the myriad articles about fMRI scans of schizophrenics, or bipolar disorder, or even ADHD? The science here is still rudimentary and evolving, but it is still quite false to say that there are no brain scans in psychiatry.

You are also mistaken to think that there are no blood tests in psychiatry. To take just one of many examples, there are blood tests to determine if thyroid glands are hypo- or hyperactive in disorders.

In other words, it's entirely plausible to suggest that ADHD as we currently understand it didn't exist when our world was substantially different, that the mental disorder we now know as ADHD was expressed differently when the concerns of our social world were different.

My very first comment in this thread was exactly this, but in different words. I feel like you're talking at me, without actually engaging with what I'm saying.
posted by Sticherbeast at 7:54 AM on February 1, 2012 [3 favorites]


If I'd been one of the unlucky ones who only hyperfocused or found it hard to pay attention all the time in class, my ADHD might have remained undiagnosed for years or even a decade, until I started out in the working world and wondered why I could never get anything done.

That's pretty much what happened with me. I have a few of the hyperactivity symptoms but I'm about 95% on the inattentive side. Despite the fact that I was constantly spacing off in class, could literally never hand in my homework without outside help (I'd forget to write the assignment down, forget to bring the right materials home, forget to do it or forget to bring it into school) and never had a clean room or desk, not one person ever thought I might have ADHD (this was the 80s). I imagine that the fact that I could lose myself in a book for hours made an ADHD diagnosis seem unlikely.

I actually wound up doing pretty well in school once I got into high school and college, where I could skate by on my writing and cramming skills (nothing like an exam or a due date tomorrow to kick hyperfocus into gear!). And my career started out well - I fell into a field with a lot of ADHDers (politics) and the entry level jobs are great for someone with my strain of ADHD - clear directives with tight timelines, but also a good amount of room for creative thinking, and the adrenaline!

But then, once I started to move up into jobs that required more independent, long-range projects, my career started to seriously stall, and I couldn't figure out why. It was only once I got diagnosed and started taking (the lowest dose of) Ritalin that things started turning around. Actually, it's kind of crazy how much they turned around: 18 months and two promotions later, I'm really happy with how my career is going for the first time in my life.

What I love about Ritalin, for me at least, is that there don't seem to be any negative side effects. I don't feel speedy, I don't have trouble sleeping, it hasn't changed my personality in any fundamental way (I still have that unique ADHD way of thinking where I make connections that no "normal" person would). I wouldn't know I was on the meds at all if it weren't for the fact that I can do things I couldn't do before, and my life generally runs more smoothly than it did.

Personally, I am interested in the nature vs. nurture debate - I think that's a completely valid question and I assume the answer is somewhere in the middle. For my part, I don't think it was purely caused by any of the common "nurture" villains, because I didn't watch a ton of TV as a kid, I wandered all over the damn place and I was heavily involved in theater and music, which are pretty active hobbies (of course, I never was able to stick with any one instrument for more than a year, because I never practiced).
posted by lunasol at 8:47 AM on February 1, 2012 [3 favorites]


My very first comment in this thread was exactly this, but in different words. I feel like you're talking at me, without actually engaging with what I'm saying.

Yes, I see your comment now, and I read it before, but it's a long thread. I apologize if you think I've been talking at you. That has not been my intention, and I have tried to respond to your statements, but also to others in this thread at the same time.

What's strange about much of this "questioning", such as the questioning I had actually been responding to, is that it actually reflects the "end of history" order, and not the more modern approach.

I think you're right that there can be that tendency to go to the other extreme. There is a middle road, which is what I've been arguing for, and you seem to support as well. I don't think, however, that questioning something as a distinct diagnosis is always a reflection of that tendency. I think one could dismiss a particular diagnosis as valid for all sorts of reasons that have to do with the mechanics of the disorder under discussion. Of course, as seems to have been the case here, one can also simply misunderstand how psychiatric and medical diagnosis works, and say uninformed things (which are also hurtful) as a result.

No brain scans? Are you serious? You have never read one of the myriad articles about fMRI scans of schizophrenics, or bipolar disorder, or even ADHD? The science here is still rudimentary and evolving, but it is still quite false to say that there are no brain scans in psychiatry.

You are also mistaken to think that there are no blood tests in psychiatry. To take just one of many examples, there are blood tests to determine if thyroid glands are hypo- or hyperactive in disorders.


You and I may have to agree to disagree about your examples. I've read plenty of the literature on brain scans and mental illness, and when you've read it for any length of time you see that new studies and theories often fail to support, or actively contradict, old studies. This is not surprising in science experiments, but when I say there are no brain scans, what I mean is that there is no scientific consensus on what brain abnormalities are descriptive of which diseases. People continue to do brain scans, the research goes on, but not only is it nowhere near diagnostic, it isn't even adequately descriptive. This does not imply that it won't someday be.

Similarly, thyroid function tests are used by psychiatrists to rule out medical causes of possible psychiatric illnesses. In other words they are medical tests applied to determine if something may or may not be a psychiatric disorder. Once it is a psychiatric disorder, there are no blood tests available to diagnose it as far as I know.
posted by OmieWise at 9:29 AM on February 1, 2012 [1 favorite]


there are no identified physical markers for the mental disorders we're talking about here, even the "biggies" like schizophrenia

There are actually some studies that have reported links between schizophrenia and exhaled volatile compounds (like ethane, pentane, and carbon disulfide), as measured by putting a breath sample through GC-MS, but reproducibility seems sort of equivocal. Definitely still a long way off from a diagnostic test, unfortunately.
posted by en forme de poire at 10:15 AM on February 1, 2012


This is not surprising in science experiments, but when I say there are no brain scans, what I mean is that there is no scientific consensus on what brain abnormalities are descriptive of which diseases. People continue to do brain scans, the research goes on, but not only is it nowhere near diagnostic, it isn't even adequately descriptive. This does not imply that it won't someday be.

This is quite a change from your initial "no brain scans" statement, and just as you and I may disagree over how consistent the results have been, there are quite a few people behind me who would disagree with you as well. But, we're not going to resolve this here.

Similarly, thyroid function tests are used by psychiatrists to rule out medical causes of possible psychiatric illnesses. In other words they are medical tests applied to determine if something may or may not be a psychiatric disorder. Once it is a psychiatric disorder, there are no blood tests available to diagnose it as far as I know.

Psychiatric disorders do not cease to be psychiatric disorders simply because there is a medical cause underlying it distinct from a "brain-only" cause. If my stomach is persistently bleeding, it does not cease to be a gastroenterological issue simply because the gastroenterologist suspects cancer and refers me to an oncologist. If anything, it's a sign that I have a good gastroenterologist.

This is basically a repeat of what I was describing earlier, where from one side of the mouth we talk about how aware we are that mental illnesses are integrated into our societies and our bodies and all the rest, but then from the other side of the mouth, we pretend as if a psychiatric illness can only be a psychiatric illness if it has some sort of strictly defined, culturally and corporeally independent existence. This is not consistent reasoning, and it distorts what could otherwise be a productive critique of psychiatric issues.
posted by Sticherbeast at 1:09 PM on February 1, 2012


I think calling it a disorder or an illness implies that the locus of the problem is the individual, though, no?
posted by empath at 1:16 PM on February 1, 2012


This is quite a change from your initial "no brain scans" statement

When I said there are no brain scans I thought it was clear that I meant no brain scans with consistent descriptive or diagnostic value. There are brain scans of dead frozen salmon, for god's sake, but no one argues that they have any medical value.

Psychiatric disorders do not cease to be psychiatric disorders simply because there is a medical cause underlying it distinct from a "brain-only" cause.

You're incorrect. If you have hypermania secondary to hyperthyroid disorder, your diagnosis is hyperthyroid disorder, not hypomania. It is a medical condition and not a psychiatric condition. You might receive a nonce psych diagnosis, but it would be corrected once the underlying medical cause was found. Your desire for integration is worthy, but it isn't how things operate.

There are no blood tests for psychiatric disorders.
posted by OmieWise at 1:50 PM on February 1, 2012


I should add: that I know of.
posted by OmieWise at 2:51 PM on February 1, 2012


This is quite a change from your initial "no brain scans" statement, and just as you and I may disagree over how consistent the results have been, there are quite a few people behind me who would disagree with you as well. But, we're not going to resolve this here.

You've taken this way out of context. Calm down.
posted by mek at 5:23 PM on February 1, 2012


If you have hypermania secondary to hyperthyroid disorder, your diagnosis is hyperthyroid disorder, not hypomania. It is a medical condition and not a psychiatric condition. You might receive a nonce psych diagnosis, but it would be corrected once the underlying medical cause was found. Your desire for integration is worthy, but it isn't how things operate.

Shows what I know. Sorry for the 'tude, I was in full Loud Guy On The Internet mode.
posted by Sticherbeast at 6:00 AM on February 2, 2012


OmieWise I'm under the impression that there are tests that use an EEG to diagnose ADHD. I'm also under the impression that there is an observable difference between control, unmedicated / diagnosed and diagnosed /medicated individuals. Is this incorrect?
posted by humanfont at 7:15 AM on February 2, 2012


I'm on a phone, so my resources are a bit limited.

I believe EEGs for diagnosis are still in the realm of something for which the research base is not robust. I'm sure folks use them for diagnosis, but as far as I know this is neither standard practice nor without controversy. Although its s bit old (1999), this technical review from ARQH lays out the lack of evidence. I'm sure there's more available at pubmed*.

Your question about scans raises an important issue. Everyone has differences in brain activity when on stimulants. However, scans may tell us that something is present, but they don't tell us anything about causes. The research is ongoing, though, and there are sure to be better results in the future.

*be aware when you read pubmed abstracts about brain scanning and mental illness that the trend of results over several papers by different authors is much more informative than individual findings. Brain scan findings can be all over the place across studies. I know many folks don't like metaanalyses, but they are often your best bet with imaging studies, since they roll up several sets of results.
posted by OmieWise at 9:16 AM on February 2, 2012 [1 favorite]


« Older In 1962, the New York Times called it a masterpiec...  |  Beautiful Day at the Dog Park... Newer »


This thread has been archived and is closed to new comments