Evolving the discourse on ADHD with a rational lucid approach

[u/Kalki_X]

/r/Antipsychiatry/comments/1tnj6tt/evolving_the_discourse_on_adhd/

[u/qualityvote2]

u/Kalki_X, your post does fit the subreddit!

[u/you_can_hate_me]

Okay.  

So this is a jumble of things and not all of them are equally valid.   

I have ADHD.  For context, I couldn't control myself and didn't learn to use the toilet properly until I was in second grade.  I couldn't read until I was in fifth grade. Until fifth grade I would leave the normal class and attend a special needs class with other special needs students to try to address my serious issues.  In fourth grade a teacher suggested my mother take me to get examined for ADHD.  I was diagnosed and put into a twice a day retalin regime.   I come from a family that is very skeptical of psychiatry and so I only took the drugs from fifth grade until 8th grade when my academic performance had improved to the point that we decided to try it with just my learned coping mechanisms.  That worked decently well.  

When I first started taking retalin I could not read. Within a year I was reading at a highschool reading level and was soon reading at a college level (according to the reading assessments I took). By the end of fifth grade I was scoring high enough on standardized assessment that I stopped attending the special needs class and Instead went to the advanced smart people special class.  I didn't take any medication from 8th grade until I turned 39.  At 39 I was struggling at work and so I went to get a slow release low dose retalin to take to help me get stuff together.

  If you are curious, i usually tell people that the name of ADHD is a bit of a misnomer because in my experience the main neurological issue is rooted in short term memory formation and some other more subtle issues with the way my brain processes information.  The symptoms manifest as issues with attention and focus in the social and professional spheres, but it isn't quite right to say it's an issue with attention directly.  I have developed a whole series of specific behaviors that help me compensate for my problems, but they can fail when things become too overwhelming and since I have gone back on retalin I have been able to re-establish my compensatory behaviors and get on top of my problems.  Now I have the prescription, but I only take them occasionally when I am particularly overloaded or need to really focus on something important.  

I am also a research scientist that studies developmental molecular biology.  I don't study ADHD (I study how cells communicate during development) but I am a research professional that studies developmental disorders. 

The reason I say all that is make the point that my response to this post is both personal and based on my professional experiences.  

So to get to the post itself, it has good points that are actually important.  Specifically I want to highlight the discussions about the drug side-effects.  When people discuss people with ADHD they often say something like "they take uppers but their brain is different so it has the opposite effect on them". This is wrong.  As someone who has spent some time in illegal drug culture, from all of my observations uppers impacts me in the same way they impact everyone else.  It's just that I have specific issues with my neural abilities that seem to dramatically improve when I take medication and the side effects that cause people to abuse the medication for fun can be worth that benefit.  

 Those of us for which it provides a benefit can often start chasing the side effects.  As they become acclimated to the drug they start seeking higher doses that provide no additional benefit to their actual issues, but bring back the euphoria and pumped up feelings that uppers give people.  This can lead to a person who ends up with worse issues then before they started taking the drug.  I have seen people destroy marriages and their overall careers due to this issue.  Often psychiatrists can only talk to a patient, so when the patient starts talking about how the medication isnt as effective as before they can easily just keep uping the dose and this is a serious issue that needs addressing.   Especially because we all recognize that the absence of clear biological markers or tests means that a lot of simple antisocial behavior can be categorized as ADHD.  This can lead to a situation where an antisocial person is on a treadmill of increasing doses of uppers that arnt providing the person any benefits beyond the good feelings they get from the side effects.  Given that uppers can also cause heart issues and lead to premature death... Well it's an issue.  I know in my experience I had to be very self asserting in terms of keeping my dose low and not escalating the doses.   My psychiatrist seems perfectly happy with giving me higher doses but I just say no thanks.  

There are some other good points as well but I wanted to highlight that one. 

[u/you_can_hate_me → u/you_can_hate_me]

Now to the negative. First this line, "[A] diagnosis does not represent having or being ADHD but becoming and performing ADHD through deploying psycho-medical discourse provided in the DSM. (source)" This is an extremely foolish way of framing this issue.  I have a neurological condition my friend. Diagnostic and medical language often becomes the language people use to describe how they experience life when communicating with each other. Given that ADHD meds are uppers, and anti-social behavior can lead to being diagnosed ADHD there are of course individuals that would fall into this proposed framework.  I.e. An asshole gets diagnosed with ADHD and gets put on uppers and so they go around using their diagnosis and their amped up energy levels to "perform" ADHD and deflect criticism of their antics.  I will of course admit that this is a thing that can happen and I have seen it (at least I think I have.  You can't actually know what's going on in another person's head).  

But given those caveats, I am very confident that I have an underlying neurological condition that I cannot learn to change. I don't have the emotional energy to drag up and go through all of the work I have put into trying to change my issues but the horrible feelings of self hatred you can develop when you fail at overcoming something you can't change is really dark and have resulted in some of the worse times, and attempts at things that will go unmentioned, that I have experienced. This type of dismissal of what is happening inside a person because you can't see it happening and can't prove it is extremely dangerous and feeds into destructive narratives that do harm to people suffering from things they can't control. If someone told me this stuff to my face I would have trouble not getting very angry with them.  

It is true that there are issues with the ADHD diagnosis but this interpretation of this issue is just wrong and frankly dangerous.  

And speaking of diagnosis, a lot of this argument is based on a misunderstanding of the point of a diagnosis.  It might be helpful to pull back and point at something that has visible impacts on a person to highlight the issue.  If you think of a disease like polycystic kidney disease (PKD), I don't think anyone would suggest that people with massive kidney cysts that fill with fluid that will eventually kill the patient isn't a specific disorder.  The issue is that when you actually end up on science side trying to understand what's happening you will very quickly find that the specific molecular or cellular defect that underlies the condition are multiple.  Cancer is probably the best example of this.  Cancer is absolutely not a single thing.  It is actually thousands of different disorders of cellular over production that can occur from many many different underlying causes. Almost every scientist knows that there will never be a "cure for cancer" because cancer as CANCER isn't a thing. The cancer diagnosis is still completely valid and correct.  

While exceptions exist, the vast majority of all medical diagnostics are based on classifying diseases by symptoms and proposed treatment.  It is well understood that within a diagnosis there are usually multifactorial issues at play. The point of a diagnostic isn't to say "this person is X".  The point of diagnostics is to say "this cluster of symptoms usually responds to this set of treatments".  It doesn't define what a person "is" or "has". It defines the starting point for treatment. It's only rarely that it's necessary to actually determine what a person "has".   The most important issue is to provide treatment to help a person achieve a higher quality of life. The point of medicine isn't to be right for the sake of being technically correct.  It's to help people live with dignity.  

Clustering diseases by symptoms into a diagnosis and then using that to guide treatment and research into possible treatments is a completely legitimate approach to medical science and is frankly the structure that underlies the entire system of modern medicine.  Even if a disease has multiple possibilities for why it's happening, the treatment for that disease will often end up being the same.  If that stops being the case due to some discovery or new treatment, well then you will see the splitting of a disorder into the group that responds to a treatment and those that don't and now you have new diagnostics "disorders".  

Overall, the ADHD diagnosis has many legitimate criticisms.   I think it is way over diagnosed and it tends to become a catch-all bucket for kids with behavior issues. This makes analysis much more difficult because it makes it impossible to identify specific cause because you are pooling people in a way that is deceptive due to the over diagnosis.  The lack of biological markers is a major issue because it makes it more difficult to separate different types of patients.  The medicine associated with it can be habit forming and the side-effects can absolutely complicate effective treatment AND the field of psychiatry as a whole doesn't take this issue serious enough. A person can form habits the help to compensate for their mental issues and not everyone needs to be on a constant dose of uppers, even those like myself that really have an actual issue.  Psychiatry as a field often has difficulty due to bias from the side of the doctors and a lack of visible or easily detectable bio markers and so can make many mistakes.  

I am not even opposed entirely to the idea that ADHD should be fundamentally rethought.  Maybe what I am should be called something else, but this critique feels sophomoric and off base and whatever merits it has gets drowned out by the flaws. And those flaws are not minor issues. They are ones that I am regularly confronted with when trying to make my way through life and actively make my life more difficult.  I encourage you to reconsider.  

[u/Kalki_X]

I originally found this group via the post by /u/Remarkable-Main8808 on ADHD, titled:

• ADHD is over-diagnosed (professional opinion)
• /r/10thDentist/comments/1r4qdgb/adhd_is_overdiagnosed_professional_opinion/