Disclaimer: I’m not a licensed medical practitioner, and I can’t give medical advice. None of the below should be considered anything more than the opinions of a highly opinionated dilettante suffering from at least one mental disorder.
If you make choices regarding your health based on something you read on the internet written by someone who thinks the end is nigh, ADHD is the least of your problems.
Boring Dullness Hypertolerance Disorder (BDHD)
Someone on LinkedIn was describing how reassuring it was to learn that they had ADHD. I’ve heard similar from others discovering that there is a name for their torment and I’m sympathetic: a diagnosis is a gnosis after all, a “knowing”, and there is solace in knowing that you are something that can be categorised. As the post put it, “it’s better to be a zebra than a weird horse”. But a zebra is a lovely thing, so much so that its collective noun is “dazzle”. I’d like to be in a dazzle of zebras. Being called “deficient”, “hyperactive” and “disorderly” is less flattering, and I don’t think there is a collective noun for people with ADHD.
Oppressed groups have successfully reclaimed offensive labels such as “queer”, but calling ourselves ADHD feels like something different. Adopting this language feels like allowing psychiatrists to pathologize us, and even those who are sympathetic to our plight fall into the trap. For example, while I appreciate Gabor Mate’s kindness, his idea that ADHD is just a trauma response only tells half the story. There is a highly heritable (80%) cognitive style that, when subjected to the stresses of the 21st century, often leads to a set of symptoms, but that isn’t a simple causal relationship. By comparison, I get sunburned easily in Brazil and so does my father, but my half-black kids don’t; the “disorder” of sunburn is a combination of our genetics and an environmental condition. If we were measuring Vitamin D deficiency in Northern Europe rather, their disorder would be graver than mine.
The diagnostic category of ADHD is good for the pharmaceuticals industry, certainly, with the global market for ADHD medication projected to reach nearly $25 billion by 2025, but is it good for us to adopt a label which is not only insulting but inaccurate? My attention is in abundance, not deficit, if the material I’m attending to is interesting. If I find you boring, that might say more about your deficiencies than mine. Perhaps you have BDHD?
Along with measured benefits including higher energy, an appetite for adventure, more courage, integrity and resilience and better self-awareness, those of us with (the cognitive style AKA) ADHD don’t create or apply categories as readily as the people categorised as neurotypicals (NTs – which I pronounce “nautists”). “Autistic spectrum disorder” (ASD), “attention deficit hyperactive disorder”, “dyslexia”, “obsessive-compulsive disorder (OCD)” and so on can be helpful markers, but the labels are unhelpful if we confuse them with reality. So, rather than trying to parse this pudding, I’m going to consider the wider topic of neurodiversity. 50-70% of individuals classified as having ASD also present with ADHD anyway, and these conditions share not only traits but also structural markers in the brain. We also share jail cells. An estimated 3-4% of the UK population is thought to have ADHD, whereas in prison it is 25%, and while 1 in 10 people in the UK are dyslexic, in prison it is 50%.
Many scientists seek to explain the causes of ADHD, but the question I want to address here is different. I’m interested in how we survive under conditions of psychological apartheid.
For one thing, it seems that we club together and even form new clubs – so some people have begun to self-identify as AuDHD (Autistic and ADHD). This is not surprising, as neologism (coining new terms) is one of the ways that the neurodivergent are more creative than nautists. But maybe we can think of better words for ourselves than “deficient”. How about Asper(ger)ational? Or awetistic.
People have been asking me about ADHD recently – perhaps because I’m vocal and positive about my own neurodivergence. I’m also sceptical about how our culture denigrates non-normative experiences (from voice-hearing to psychedelic-induced) and I’m interested in how traditional medicines perform compared to neat white pills. I’ll be surveying research into both modalities below, as well as looking at how society defines norms and pathologizes the abnormal, and asking questions about how we make decisions on matters as important to us as what is happening inside our heads.
But let’s not sugarcoat this pill. While the diagnostic category is disempowering, (the cognitive style AKA) ADHD can be exasperating. Forgetting why you have gone upstairs three times in a row is boring, and it can be uncomfortable for everyone concerned when you won’t join in with small talk about the Royal Family or Arsenal, or can’t turn off your empathy or passion, or sit quietly when someone does something that makes your brain itch, or just sit quietly. I manage well enough when I’m managing but at the moment I’m not. I’m rewriting this article because I erased weeks of work by hitting save on a previous version that was hiding amongst a… frazzle (?) of unnoticed tabs. I also have a rat infestation, despite the fact that I seem to be clearing up after myself constantly, and one of them chewed through the washing machine pipe, so I’m also rewriting in a flooded room. I can hear them squeaking at me mockingly and I’m terrified I’m about to be ejected from my home for the third time in as many years.1
As a former schoolteacher, I can also confirm that while I don’t agree with how hyperactive kids are conventionally managed, they can ruin a classroom when their disruptive traits aren’t managed. But creativity and disruption are two sides of the same coin, and keeping the coin spinning is a lifelong struggle for people like me. The history of technology, art and science shows, however, that this struggle drives a great deal of innovation and also generates rewards for nautists. Neuro Tribes is a good history of this.
Personally, I’ve learned to enjoy how my brain works, and that necessitates accepting the tails side of the coin. I know (because I keep getting told) that I am a challenging person to be with – but that is everyone else’s problem as much as it is mine. Sometimes I challenge people into thinking differently.
That includes clients who come to me for hypnotherapy (pattern-interrupt.co.uk) asking if I can treat ADHD. I can no more treat ADHD than I can treat tallness. I can help tall people remember to duck when they go through doorways, and I can help people manage the downsides of (the cognitive style AKA) ADHD, because I’m a very good hypnotherapist. But I can’t fix something that isn’t broken.
A friend who felt he had benefited from methylphenidate (Ritalin) recommended it to me the last time I was struggling with my own cognition, around the same time that a teenager I’m rather fond of was medicated by parents who are well-meaning but ill-informed, so I did some research. We’ll start by exploring psychiatric treatment and then come back to other ways of thinking about the condition. I hope you’ll forgive the massive info dump – I found the whole area fascinating. You can blame it on my ADHD, and if you skip some of it I’ll blame it on yours.
The Diagnostic and Statistical Manual of Mental Disorders (DSM) is the text psychiatrists use to categorise humans in a way that satisfies American healthcare insurance providers that their feelings or behaviour constitute a disease covered by their insurance plan. The first edition was published by the US Army in 1952, the year that the American Federal Security Agency proposed expanding health insurance as a step towards compulsory universal coverage. 1952 was also two years into the Korean War, and the foreword of DSM-1 notes how war leads to “an increasing psychiatric case load” of soldiers without obvious physical injuries who require treatment (and therefore insurance payouts, and therefore defined mental disorders). It is currently in its fifth edition (DSM-5). To a hammer, everything looks like a nail; to DSM-5, my cognitive style is a disorder.
Homosexuality was classed as a disorder in DSM-1, along with “pedophilia, fetishism and sexual sadism (including rape, sexual assault, mutilation)”; the recommended treatment was electric shocks. Psychiatry has a long history of using Greek and Latin to classify deviance. Slaves with poor motivation were said to be afflicted with “dysaesthesia aethiopica” (literally bad black/Ethiopian feeling) and those so disorderly as to keep slipping their chains and running away were suffering from “drapetomania”. Once the category is applied, remedial measures become justified. The former was cured with the whip, the latter by amputating the big toes.
DYSAETHESIA AETHIOPICA… CALLED BY OVERSEERS, “RASCALITY.”
“There is a partial insensibility of the skin, and so great a hebetude of the intellectual faculties, as to be like a person half asleep, that is with difficulty aroused and kept awake… it is accompanied with physical signs or lesions of the body discoverable to the medical observer… It is much more prevalent among free negroes living in clusters by themselves, than among slaves on our plantations, and attacks only such slaves as live like free negroes in regard to diet, drinks, exercise, etc.”
DRAPETOMANIA, OR THE DISEASE CAUSING NEGROES TO RUN AWAY
“The cause in the most of cases, that induces the negro to run away from service, is as much a disease of the mind as any other species of mental alienation, and much more curable, as a general rule. With the advantages of proper medical advice, strictly followed, this troublesome practice that many negroes have of running away, can be almost entirely prevented, although the slaves be located on the borders of a free state, within a stone’s throw of the abolitionists.”
$200 Reward! for runaway slaves, June 7, 1860 (PD0)
It is easy to demonise those who administered the treatments, but perhaps more charitable to consider how slave owners (along with parents of queers, physicians of fetishists and husbands of nymphomaniacs) were trying to keep their charges safe from harmful influences according to the mores of their time. Reserving judgment also frees us up to think about how those mores came to be, and about our current societal norms.
It would also be easy to think we are more enlightened these days. The third edition of Stedman’s Practical Medical Dictionary, published in 1914, was the last to list drapetomania, and homosexuality was dropped from the revised edition of DSM-3 in 1987. This was around the time that a well-meaning and ill-informed teacher called Mrs. B suggested that Ritalin might be beneficial for 11-year-old me. I have no intention of demonising Mrs. B, nor any teacher or parent trying to negotiate the gears of a machine without letting a child be mangled by the cogs. My intention here is to understand the workings of the machine.
Having given some context to the nature of the psychiatric gaze, let’s consult DSM-5 on the typical ADHDer:
Displays poor listening skills
Loses and/or misplaces items needed to complete activities or tasks
Sidetracked by external or unimportant stimuli
Forgets daily activities
Diminished attention span
Lacks ability to complete schoolwork and other assignments or to follow instructions
Avoids or is disinclined to begin homework or activities requiring concentration
Fails to focus on details and/or makes thoughtless mistakes in schoolwork or assignments
I’m not denying that this is a painfully accurate description of some aspects of my mind in some circumstances. I’m just saying what I said to Mrs. B: no thanks.
In part 2, we dive into the scientific literature on Ritalin and explore how it gives you brain damage and fails to help in any way except promoting obedience.
Then part 3 is about traditional ways of alleviating the difficulties of this kind of neurowonk, and traditional perspectives on what it means.
Bringing in the nuance, I love it. The awareness of the DSM as a military technology is indispensible. Also the "psychiatric gaze" is going in the lexicon. Thank you.
Marvelous! I look forward to reading parts 2 & 3. Also, it reminds me to trawl back through billions of tabs to continue reading about the Rabbi.
Must've got myself distracted somehow...
Meanwhile, send help.
Bringing in the nuance, I love it. The awareness of the DSM as a military technology is indispensible. Also the "psychiatric gaze" is going in the lexicon. Thank you.