History of ADHD Research Reveals Our Flawed Thinking About Mental Disorders

Stephan Schleim examines the history of ADHD to demonstrate the limits of our biological understanding of mental disorders.

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In a new article in Frontiers in Psychiatry, the theoretical psychologist Stephan Schleim shares his perspective on the ongoing search for the biological bases of mental health disorders. Using ADHD as an example, he suggests that one-to-one biological causes for psychopathological symptoms are unlikely ever to be found due to the variety in how symptoms manifest and the inherent complexity of their causes.

This viewpoint, part of an ongoing academic debate, has implications for the accuracy and usefulness of diagnostic taxonomy systems like the Diagnostic Statistical Manual (DSM) and Research Domain Criteria (RDoC).

Schleim writes that “mental disorder categories are such complex and heterogeneous entities that the discovery of reliable diagnostic biomarkers is unlikely, which is also supported by some 180 years of psychiatric history.” He adds that “diseases like epilepsy or Parkinson’s, which were originally understood as psychiatric disorders moved to neurology after the discovery of strong neural markers.”

Diverse happy kids stacking empty square boardsSchleim describes the history and progression of research seeking to find biomarkers that would allow consistent identification and treatment of mental disorders. He argues:

1) specific mental disorders have too vast, varied, and individually manifesting symptoms to make it possible to find a singular biological mechanism per disorder, and

2) research has failed to find biological markers of common cognitive or emotional processes.

The desire to show strong biological explanations for mental health difficulties goes back at least as far as 1845. Scholars suggested that the first step in the knowledge of mental health-related symptoms is understanding “to which organ do the indications of the disease belong.” While the search for disordered organs is somewhat reminiscent of phrenology (a now rejected practice of assigning psychological characteristics to the shape and size of the head), the scientific quest for biomarkers has shifted mainly to genes and neurological activation.

Schleim explains that the development of fMRI gave researchers hope that tying cognitive and emotional phenomena to specific brain structures or processes would be possible. However, this has presented, if anything, an even more complicated picture of how emotions and cognition relate to the brain. Secondly, correlations between genes and mental disorders have frequently been found but are too weak to serve as the primary explanation for mental disorders.

Providing Attention Deficit/Hyperactivity Disorder (ADHD) as an example, Schleim explains the history of the disorder’s classification and the unlikelihood for mental health disorders to demonstrate “strong biologism.”

“Examples for strong biologism would be a certain genotype, a certain brain function or structure strongly correlated with a particular psychological process or behavior.”

Disorders with strong biologism may involve a one-to-one biological explanation for their development and treatment mechanisms (e.g., a specific injured or underdeveloped brain structure, a consistently explanatory gene, etc.). Conversely, Schleim argues that psychological disorders have “weak biologism” or multiple biomarkers that are loosely associated with or not fully explaining occurrences of the disorder.

ADHD was previously considered moral misbehavior by children, followed by a combination of categories like Hyperkinetic Disorder, Minimal Brain Dysfunction, and Minimal Brain Damage. This categorization was replaced by Attention Deficit/Hyperactivity Disorder in the DSM-III, to be succeeded by consideration as a neurodevelopmental disorder in the DSM-5-TR. Currently, there is some debate about the validity of biomarkers for ADHD, including dubious claims that people with ADHD have smaller brains.

The three types of ADHD identified in the DSM-5 are 1) inattentive, 2) hyperactive/impulsive, and 3) and combined. As an example of the variety of presentations of single disorders, Schleim writes:

“Similar to Major Depressive Disorder, of which there are 227 variants, we can distinguish 130 pure forms of ADHD for each major type. Combining each pure type of 1) with each pure type of 2) already adds 16,900 additional mixed types; including the remaining symptom combinations yields a total of 116,2202… they make it unlikely to reduce the heterogeneity of a category like ADHD to one or a few reliable biomarkers.”

Schleim puts forward three categories of approaches by which therapists and researchers engage in the classification of mental disorders as follows:

  • Essentialism: the idea that there are reliable biomarkers for mental disorders that facilitate equally reliable classification and treatment of disorders
  • Social constructionism: that definitions and societal understandings of mental disorders are constructed by institutions (e.g., when homosexuality was considered pathological by psychological organizations)
  • Pragmatism: a focus on what is most useful for clinicians and clients

However, these categories are far from exhaustive and are presented as unnecessarily exclusive of each other. Schleim suggests that it is difficult to find clear links between biology and psychological phenomena partially due to challenges in operationalizing phenomena like “attention” that are not physical.

Further, he says that biologically-based taxonomy mistakenly treats psychological disorders as “things” when they are primarily pragmatic constructs to assist the task of treating clients. However, the fact that they do not have one-to-one biological markers does not make them less real nor solely pragmatic. This supposed conundrum relies on the idea that if psychological phenomena are not physical, they are vague, diffuse, or unprovable, an issue that has been well-addressed by several decades of psychological research method development.

Although Schleim acknowledges that mental disorders are not “only constructs,” he critiques over-attachment to that which is concrete and tangible while also committing the same logical fallacy himself.

This may reflect a deeper issue within the field of psychotherapy research – we disbelieve the very real existence of psychological phenomena if we cannot pin them to something physical, biological, or visible. But, on the other hand, if open to the possibility that psychological phenomena have psychological or social causes that present consistent etiologies and mechanisms for treatment, we may be able to give up the so far fruitless fight to reduce their causes to biology.

Schleim critiques the biological approaches to the classification used in both the DSM and RDoC, concluding:

“A continuation of the quest for biomarkers or “broken brain circuits” carries the risk of neglecting the patients’ perspective and delaying clinical translation into an uncertain and far future. The biologization/medicalization of mental disorders has furthermore not solved the problem of stigmatization and can instead increase the social distance between patients and non-patients.”

This work is a valuable continuation of debates about the utility and relevance of biological categorization for psychological phenomena. It highlights that iterations of the DSM and RDoC differ very little from each other in their tendency to hyper-medicalize and over-concretize psychological and abstract (though conceptually discrete) phenomena. The conversation would be deepened by an acknowledgment that things do not need to be biological to matter.

 

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Schleim, S. (2022). Why mental disorders are brain disorders. And why they are not: ADHD and the challenges of heterogeneity and reification. Frontiers in Psychiatry, 13. https://doi.org/10.3389/fpsyt.2022.943049 (Link)

53 COMMENTS

  1. There is no doubt that adverse psychological and social factors are major causes of mental disorders. But I believe some people are more susceptible to having bad reactions to negative life events. So there must be some genetic component. In addition, there may be other factors that impact development of mental disorders, such as disease, anxiety provoking events and drugs.

    The interrelationship among all these things must be extremely complex meaning the DSM is worthless and putting people into mental disorder categories is inadequate for research and discussion.

    We might be able to move forward a little if researchers admitted the limitations of our state of knowledge.

    • That there are differences in how people react to trauma does not necessarily mean that they are based on genetic differences.

      We embody histories of our experiences, relationships, including our biology. So I’m not against biological research at all. But as a matter of fact, after decades of genetic research with now data from more than 100,000 people for some mental disorders, the genetic differences between people only explains very little of their psychological problems.

      A recent scientific review, summarizing the genetic data:

      What Do We Know About the Genetic Architecture of Psychopathology?
      https://www.annualreviews.org/doi/abs/10.1146/annurev-clinpsy-081219-091234

        • Certainly.

          The study I referred to above summarizes a vast amount of genetic data – and taken altogether, quantitatively, they explain very little of mental disorders (strictly speaking: a very small correlation between the variance of the genotype and the variance of the phenotype).

          • “…a whole-genome approach that jointly considers all available SNPs has been introduced2, allowing estimation of the proportion of phenotypic variance explained by genome-wide SNPs, i.e., SNP-based heritability. Central to this approach is the use of linear mixed models3 (LMMs)—extensions of random-effects models or variance-component models4—which treat SNP effects as random.”

            I think we are just beginning to scratch the surface in our understanding of how to analyze genetic information. The research into these incredibly complex, microscopic, bio/chem/elect mechanisms reminds me of the quest to find the theory of everything. To me, there is no question (I could be wrong) that “real” ADHD is the result of some type of disruption biologically-chemically-electrically or a combination thereof. No doubt whatsoever. It could be that a critical mass of certain neurons must be reached for “attending to” or to work properly. “Slow drift” seems very promising, too. We are getting closer, inch by inch. I am excited. In the meantime I hate to think of any child stuck sitting in a classroom wasting away and in terrible pain unable to function as the result of dismissing ADHD as a treatable issue. I would to God someone had recognized what was happening to me. I don’t want sympathy or pity. Nothing like that, at all. I don’t want anyone to go through that. And some kids and older folks are suffering needlessly this very moment.

          • So what’s your take on putting kids with these personality characteristics into classrooms where they naturally do better and have a lot less stress, since we know that open classrooms can provide this kind of experience?

    • … Aerobic exercise might be effective in improving executive function in ADHD. Studies in healthy participants as well as patients with several pathological conditions including ADHD have shown that both chronic and acute exercise can improve executive functioning, attention, as well as symptoms of hyperactivity and impulsivity (15)(16)(17)(18)(19). The majority of studies concentrating on children with ADHD have found positive effects of acute exercise on different aspects of executive function [e.g., (20)(21)(22)(23); see (24) for review], whereas there are only two studies on adult patients revealing mixed results. …
      … Proposed neurophysiological mechanisms underlying the cognitive benefits of acute exercise include increases in arousal and catecholamine levels (27)(28)(29). These mechanisms are mainly associated with prefrontal cortex functioning which might explain why executive functions seem to benefit more from exercise than other cognitive functions (16,(30)(31)(32)(33). Furthermore, increases in cerebral blood flow (CBF) due to exercise have been observed (34,35), while it is not clear yet if these changes are specific to prefrontal brain regions or rather global. …
      … Previous studies showed that exercise influences different areas of cognitive processing in a differential manner, with several moderating factors playing a significant role. Examples for such factors are the timing of cognitive task administration, which might interfere with the duration of exercise effects, and the fitness level of the participants, which might interact with neurophysiological responses and contribute to behavioral effects (15,16,36,43). Higher levels of fitness have been associated with enhancements in brain structure, function, and cognitive performance [for reviews, see (44)(45)(46)(47)]. …
      Acute Effects of Aerobic Exercise on Executive Function and Attention in Adult Patients With ADHD

      … Dysregulation of dopamine and norepinephrine in the PFC has been suggested to underlie the EF deficits observed in ADHD (Pliszka, 2005). The dopaminergic system, which is associated with motor control, motivation, re-ward, and affect, is believed to interact with the PFC as a regulation network that is associated with cognitive and behavioral control (Wigal, Emmerson, Gehricke, & Galassetti, 2012).

      Experimental studies have shown that working memory tasks increase dopamine levels in the PFC, and obstructing dopamine receptors in the PFC creates working memory impairments (Durstewitz, Kelc, & Güntürkün, 1999) Given that individuals with ADHD often display impairments in working memory, these studies suggest that dysregulation of dopamine may correspond to the cognitive deficits observed in ADHD (Wigal et al., 2012). Specifically, it is hypothesized that attentional deficit may be caused by a hypodopaminergic state in the PFC (Solanto, 2002). …
      … Human and non-human animal studies have shown that PE results in short and long-term neurobiological effects and can improve several aspects of cognitive functioning (for reviews, see Hillman et al., 2008;Loprinzi, Herod, Cardinal, & Noakes, 2013). PE has been hypothesized to be an effective therapeutic tool to target the neurobiological mechanisms associated with ADHD (Berwid & Halperin, 2012;Gapin et al., 2011;Wigal et al., 2012). The following section provides an overview of the cognitive and neurobiological effects of PE with a focus on components that underlie ADHD to identify theoretical mechanisms of change for PE interventions for emerging adults with ADHD. ..

      I didn’t get a job in the summer breaks. I worked out with weights and ran for miles wearing a weight vest and ankle weights, up hills backwards, wind sprints, bear rolls, carrying piggyback teammates and more, spending at least 8 hours every day to prepare for the upcoming football season, college football and hopefully the pros one day. Most major collegiate football powers recruited me due in part to all that physical exertion, but it did nothing to help me to direct my attention where I tried to use it. I wish it had. I might have been able to hear our beloved football coach as he taught us how to play.

      • Examples for such factors are the timing of cognitive task administration, which might interfere with the duration of exercise effects, and the fitness level of the participants, which might interact with neurophysiological responses and contribute to behavioral effects (15,16,36,43). Higher levels of fitness have been associated with enhancements in brain structure, function, and cognitive performance [for reviews, see (44)(45)(46)(47)]. …

        That is too cool. The human brain is so fantastic. That it functions at all is practically miraculous. What does it consist of? Flesh, blood, electricity, water, fat, proteins, capillaries. Incredible. With it, mankind figured out how to hang out on the moon and return safely. If no one had a human brain, we would not have built a Saturn 5 engine which generated more electrical power than every dam in the U.S. combined

  2. Very well written. I disagree with the rounded off conclusions in some ways. We have invested far more money, time and the expertise of researchers/scientists into understanding and successfully treating cancer, and while we have made a lot of progress, we have a long way to go. Yet, we have no thought of giving up the quest to eradicate it and the damage it causes. The biomarkers may be weak or minor contributors that cause ADHD, but right now we now use the most sophisticated medical equipment ever developed and we are teasing out the microscopic weaknesses, defects, and the dysfunctions within and among neurons. It is a fascinating time to be hangin out. Remember, too, we can’t cure the common cold and we know colds are real.
    Stimulants help the majority of those with this disorder. I assure you from my experience as one who has used them for decaders, they work. I could never write what I just have, without the focusing benefit they yield. Years ago I was given an Rx for a new pair of glasses. Tragically, for most of my life, I only caught glimpses of life as it is. Thankfully, due to my new pair of glasses, vistas I never dreamed of have opened up before me. I participate in all of life.
    Reminds me of an ancient biblical story in which a man born blind bumps into this carpenter who gives him sight. Some accuse him of being healed by some crackpot. I don’t know about that, he says. All I can tell you is, I was blind but no longer.
    This QB for New England, Josh Allen, is the real deal and he is exceptional. I hope he can stay healthy.

    • My argument is that the psychological phenomena (including states we now call ADHD) are way too heterogeneous and complex to understand them on a biological level (I did cognitive neuroscience research myself for my PhD).

      Importantly, that doesn’t make psychological phenomena any less real.

      Many people would feel better taking stimulant drugs, focus better and feeling more motivated to get things done. I believe that much of the “illicit drug use”, as the authorities call it, could be seen as some kind of self-medication.

      I want to look beyond moral categories and think that people should have all means available that help them live their lives. I have a book forthcoming on mental health and substance use in which I try to explain that point in more detail.

      • I want to avoid discussions about whether “ADHD is real”, as people identifying with this label then often get the impression that their problems are not taken seriously.

        My position is that “ADHD” describes certain kinds of problems, in a certain historical period and a certain cultural context. This is complicated by the fact that, particularly in the case of ADHD, we are talking about a mismatch between the society’s moral expectations (e.g. not to disturb class, to sit still, to pay attention) and a person’s (often a child’s) behavior.

        I especially don’t want to “convert” people identifying with that label and benefiting from the therapy to my theoretical view.

        P.S. I’ve summarized research on how stimulant drugs, including amphetamine, work (or rather don’t) in healthy people in my new “brain doping report” which can be accessed for free here:

        Pharmacological Enhancement: The Facts and Myths About Brain Doping
        https://research.rug.nl/files/228970238/Schleim_2022_EN_Pharmacological_Enhancement.pdf

        • I appreciate your respectful approach. I wouldn’t make it as a hunter, either. I like the consideration given to us, a way of defining our differences that isn’t insulting and instead relies on evolutionary forces to explain our brief attention spans. Back in the day we made a positive impact on society because of our ADHD-like abilities to pay attention to the slightest movement or sound, too restless not to be hunters, thriving on the rush of hunting wild animals.
          And, indeed, stimulants help almost everyone to pay attention better. We are merely a cross section of society who function at a level so far below our potential, that we are unable to master life in a meaningful way.
          I can’t follow along during a lecture, no matter what I do, including consuming dozens of cups of coffee or smoking nicotine or chewing it, or working out aerobically. Novelty helps and being fascinated by a topic can help briefly. However, if I take my rx as prescribed, I experience a miracle (with tears in my eyes I tell you this.) I had no idea I couldn’t or wasn’t paying attention. I couldn’t figure out how others knew what to do, what was spoken or read. I was a lazy G D. S.O.B. is all. I was told that so often I believed it and the only way to prove I wasn’t “no good” was to improve at my schoolwork. Since I couldn’t do that, I hated myself as much as I could, hoping that if I detested myself sufficiently (by believing what I was told) I would find the motivation to improve. But, I couldn’t even hate myself as much as I should have, or I would have changed. So, I just kept trying to hate myself as much as I deserved. Then, one day, I was given “a new pair of glasses.” I could see and hear and follow along, do Algebra II, write, follow instructions. I was in heaven. I was alive. My past was not the result of defiance, being a spoiled punk, a jerk, a useless bum. That wasn’t me. I wanted to learn my entire life. I was fascinated by this incredible world (still am) and it broke me not to be able to demonstrate that to my parents. I longed, I ached for my dad to know that I wasn’t “no good.” No one knew my heart.
          A “new pair of glasses” has completely revolutionized my life.

          • I have to disagree with you that “we” (meaning all ADHD-type personalities) “function at a level so far below our potential.” This is only true to the extent that you accept the normal capitalistic go-to-work-and-do-what-your-boss-says-for-a-paycheck kind of standards as one’s “potential.”

            A fascinating study was done not too long ago where they took kids and put them into groups of three. The study groups had two “normal” kids and one diagnosed with “ADHD.” The control groups had three “normal” (non-ADHD) kids in each group. They gave them a set of three problems to figure out the solution to. I can’t remember the age level, but I think they were elementary, something like 8-10 years old.

            They measured “on-task” behavior, and the non-ADHD groups did far better. The groups with the “ADHD” kid in them screwed around more, focused less on the problems and more on just hanging out together. But when it came to solving the problems, NONE of the so-called “normal” groups solved ANY of the problems, while each of the ADHD-inclusive groups solved at least one, and if I am recalling correctly, a couple solved all three.

            Now if you’d run groups where ALL THREE kids had an “ADHD” diagnosis, it’s quite possible nothing would have been accomplished at all in terms of the problems at hand. But it’s clear from the results that the off-task, goofy, creative, “what about this” kind of behavior from the supposedly “mentally ill” child played a very important role in getting the task at hand done, even if less time was spent at the task itself.

            I think the implications of this study are quite huge. Perhaps instead of trying to FORCE the “ADHD” kids into becoming more willing to do as they are told and focus rotely on the “task at hand,” we ought to be looking at figuring out how to make the most of this skill set that clearly our society needs to survive! I think that’s why the “ADHD” kids in the open classroom settings were almost impossible to detect – they weren’t being expected to be rigidly “on task” doing something they found dull or pointless, so they had far fewer problems than their counterparts in “regular” classrooms.

            Another interesting study looked at employer satisfaction with their “ADHD” – diagnosed employees. One might expect they’d be less satisfied because these employees would come late, be disorganized, say offensive things to other workers, etc. But as it turned out, their satisfaction levels were quite similar to “normal” employees. The experimenter observed that the “ADHD” employees tended to CHOOSE jobs where promptness and adherence to assigned tasks were not as important. They became ski instructors, computer programmers, entrepreneurs, salespeople, whatever suited their personality best.

            Which goes back to my original thesis: “ADHD” is a real phenomenon, but it is mostly a problem only because we expect these kids to do things that they are not ready or able to do, and then punish them for failing to do so. When they have more control of their environment, deciding what to do and when to do it and when to shift to the next task, as in an open classroom, on the whole, they do MUCH better than if they are being constantly directed by authority figures on what to do next and when to start and stop their activities. So much better that they look “normal” to professional observers who are looking to pick them out.

            This does not even take into account the HUGE percentage of kids “diagnosed with ADHD” when something else is really the problem. 20 years working in the foster care system showed me how frequently kids with horrible home lives and super high anxiety levels or even frank PTSD symptoms are labeled “ADHD” because they “have trouble concentrating on their work!” Well, if YOU were removed from everyone you ever knew after years of being abused and neglected and were forced to live with a family who had to be PAID to take care of you and could dump you at a moment’s notice, you might find concentrating on schoolwork a bit difficult, too!

          • Thank you for sharing your personal experience. I find the “hunter example” also very interesting.

            I wonder how soldiers experience that (i.e. ADHD-like symptoms) during their service. But actually the armies around the world started using stimulant drugs long before the diagnosis ADHD even existed.

            Some even argue that, for example, the Nazi’s Blitzkrieg in WW2 wouldn’t have been possible without methamphetamine, see:

            https://www.history.com/news/inside-the-drug-use-that-fueled-nazi-germany

            (In the end, the side effects were severe.)

          • Thomas I really feel for you. No one should have to do said task in order to get approval from anyone. People are born themselves, not an entity that needs to find approval. As if God doesn’t exist, or Nature. Or that the Universe isn’t diverse enough that you would find yourself what interests you, what makes you tick, what motivates you, all without having to find approval from others. A tree isn’t looking for approval, it grows towards the sun without fear. It’s human that have these fears that get in the way of their growth.

            “I couldn’t figure out how others knew what to do, what was spoken or read. I was a lazy G D. S.O.B. is all. I was told that so often I believed it and the only way to prove I wasn’t “no good” was to improve at my schoolwork. Since I couldn’t do that, I hated myself as much as I could, hoping that if I detested myself sufficiently (by believing what I was told) I would find the motivation to improve. But, I couldn’t even hate myself as much as I should have, or I would have changed. So, I just kept trying to hate myself as much as I deserved.”
            Sorry but what kind of dehumanizing logic tells you that you couldn’t hate yourself enough to improve? I’m really glad that you can talk here about how you felt, because you shouldn’t at all have this idea that YOU need to hate said part of yourself enough, because why? You just didn’t see how wrong it was, and hating would fix that? Hating doesn’t fix it, and those other people or that part of yourself that would be appeased if you hated yourself enough, that’s simply wrong…..

            You also say: “Novelty helps and being fascinated by a topic can help briefly.” Why briefly? I hope you find people, or the space where a topic you find fascinating, just for yourself, that you can indulge in that more.

            I mean there’s nothing going on when you don’t know why you can’t concentrate. I know in this society, when one can’t concentrate on said things there’s something wrong with you, but that’s a comment on the society, not the person. If you can’t concentrate, then you can’t concentrate. Like the food you eat isn’t going to grow otherwise, from the mother earth. You might actually find that things also work in a way that you at first don’t know why, because you don’t need a reason for it to work, it just was something else you could concentrate on, or a way you could concentrate on it, and that’s OK that it does…..

            If everyone is deciding whether you’re a LAZY S. O. A. B. when you don’t do what they decide is your task, how are you ever going to find out what would just sink in by itself, by yourself, that ISN’T something someone else has decided you NEED TO be able to understand, or understand their way? And when you don’t, when you don’t understand it their way, or you simply can’t make sense out of it, or it doesn’t register, then you don’t hate yourself enough!? That’s just wrong!

            The ADHD medications probably facilitate you being able to do this stuff that isn’t really so much from your own nature, but stuff that hurts you too much when you can’t. I would encourage you to find other ways that your mind works.

            Looking for rewards isn’t really how harmony works. John Nash actually exposed that with game theory, and then a psychiatrist found that when his patients did better, and went home to relapse, when he tested what “home life” was like, that everyone was playing game theory with each other. They weren’t honest, they were all wagering loss the way they communicated even to the people they live with. Their spouses even. It wasn’t what they really thought or felt, it was what they thought they needed to say or do to get what they wanted from the other person. You just, in your post, were extremely honest beyond such boundaries with what you said. You’re not supposed to say how they made you feel worthless, you’re supposed to get their approval….. And I’m getting tired, it’s like I have to have ADHD medications myself, because I can’t remember so and so’s name, and next are all of the weird terms they give stuff that have to sound scientific. I’m also A Lazy Son of a Bitch that doesn’t hate myself enough…… What is his name!? What do you call that!!?

            WELL! The book of that man used to be piled next to my bed, which is mattresses on the floor without anything underneath, so I had made a bookshelf out of it. Then I got some bookshelves from my parents, my mother passed away beautifully blossoming into spirit 2021, 94 years old, and my father moved to be with my sister, selling their condominium. I remembered I had put those books from beside the bed down in the basement on the shelves. And there it was. I first looked up “The Anatomy of Experience” because I thought that was the name of the book, but it’s the (no still can’t remember): it’s the “Politics of Experience:” although I just saw it downstairs I had to look it up online. Because I remembered the author’s name R. D. Laing. That’s just one of his books, but he is the one who when his patients would do better, after he helped them, and after they got out of the asylum and returned home, found they relapsed. Consequently wanting to see what was going on he handed out questionnaires (that’s another thing, this SOAB doesn’t know there’s two n’s in questionnaires and the spell check had to tell him). Laing handed out questio[n!n!]aires to people in normal home settings (in contrast to asylums, where people might actually be a little more honest, because they don’t have to be sane, for all I know) and he found out how much they were playing game theory…..

            I don’t think people are lacking in the ability to concentrate when they are prey to such games…..

          • Thanks Stephan. I have read a great deal on this topic and the “experts” all seem to agree that, “if taken as prescribed” they are safe.
            You mention Germans who took amphetamines during WW2 and became more effective. It seems to me that the idea that stimulants improve our ability to focus is generally accepted. Why doesn’t anyone demand proof? Why don’t we insist on determining how they work, and if they work at all, through the same rigors demanded of those diagnosing ADHD? The real question is, why do we accept their efficacy in general, but not for ADHD?

          • Nijinsky, I absolutely agree with you: I am not a tree! It’s taken me quite a while to arrive at that conclusion, but I believe it.
            Grandfather was a surgeon. I thought the human body and medicine were incredibly interesting. As a young boy, I wanted to learn more about them. I couldn’t. I didn’t know why. It broke my heart.
            I am not a tree sums it up pretty well.

          • If I am not permitted to know why my comments stay stuck in the review for moderation limbo, I won’t ask about them. I am confused by this procedure. I don’t want to take the time to make a comment only to have it blocked. I’d like to know what I’ve done that disqualifies particular statements so I don’t keep making those mistakes.

          • COMMENTING AS MODERATOR:

            This kind of claim is completely disingenuous. You know very well that I’ve contacted you a number of times to discuss why your comments are being moderated, and you have chosen not to respond. If you don’t check the email you have included with your registration, please send me an email you DO read and I’ll be happy to keep you informed. It is extremely inappropriate to engage in this kind of backhanded attack in the comments section, and I normally would not have posted it or any reply, except for the fact that so far, your comment is completely contrary to reality and I want to know if there’s a legitimate reason you have not been reading the emails I have sent or if you’re pretending I have not tried to reach you in order to try and create dissention.

            Do not respond to this comment, as it will not be published. If you care to have a genuine discussion of the problems created by some of your posts, please direct it to [email protected].

        • Who here has said that chemicals can’t change one’s cognition? Nobody here would believe such a silly, obviously incorrect thing. It’s just that altering cognition does not constitute medical treatment per se. People have taken drugs to alter consciousness since the beginning of time. Tons of people drink coffee to increase alertness, a lot of anxious folks (like me) have used alcohol to moderate social anxiety, people use hallucinogens to have altered perceptions of reality. Sure, people can take stimulants to help them concentrate, or antidepressants to help them focus less on what is worrying them and more on what is happening now. Why the hell not? But it’s not like it’s some great technological discovery that drugs alter consciousness. The concept has been around for millennia, undoubtedly from before recorded history. They’ve invented some newer drugs recently, and MAYBE they are better in some ways for some things. But they have no idea what they are “treating” with these drugs, and they can’t predict ahead of time whether or not the drugs will “work,” they don’t really understand WHY they have the effects they do, nor is there any kind of broad agreement on what “works” even means (Is it better NOT to be anxious about the fact that your husband might come home drunk and possibly kill you and the children? Is it a positive to take a drug to be OK with your dead-end job and your crappy boss? Is it an improvement to be able to “stay on task” in school when the long-term studies show that those kids who “pay attention” don’t learn any more than the ones who are goofing off?)

          And there are ALWAYS costs for taking any mind-altering substance, and almost every one of them leads to tolerance over time. One of the very worst failings of psychiatry is their unwillingness to be honest about the real costs vs. long-term benefits so clients can make an honest cost/benefit analysis.

          You may not be a scientist, but I am by training (a chemist). And I’m telling you, the fact that a drug temporarily ameliorates a particular condition or state of mind is no big discovery in medicine. If someone could actually discover WHY a certain 20-30% of people responded to Drug X, that might be the BEGINNING of something of significance. But a pretty decent percentage of people respond to mega-vitamin therapy or changes in diet or improved exercise plans or meditation, too. So which is the real “treatment?” Or is the “disorder” not really a medical condition at all, but simply an inconvenient mismatch between one’s personality and the expectations of the society one lives in? And as such, would there not be multiple possible “solutions” to the problems so created, including the solution of simply not playing by the rules one is expected to comply with?

          “It works for me” is not a scientific argument. It’s a personal testimonial, which is great, but there are a lot of varying testimonials out there that have to be taken into consideration, and some of them are VERY different than yours.

          • “But they have no idea what they are “treating” with these drugs, and they can’t predict ahead of time whether or not the drugs will “work,” they don’t really understand WHY they have the effects they do, nor is there any kind of broad agreement on what “works” even means”

            “They” sure do have an idea how stimulants work and what they act upon.

            They know they work in most people.

            Adults being prescribed the drugs can decide if they work or not. That individual’s opinion counts for a great deal. Kids should be observed by competent adults including an M.D., who, after evaluating all the feedback, ultimately makes the decision.

  3. Thank you, Tsotso, for this informative and refreshingly hard-hitting post.

    You wrote: “Scholars suggested that the first step in the knowledge of mental health-related symptoms is understanding “to which organ do the indications of the disease belong.”

    That quote nicely encapsulates the absurdity of the biomedical paradigm. A Nobel prize awaits the person who can locate a hypothetical concept in a bodily organ.

    • The original quote is Wilhelm Griesinger’s (1817-1868), a pioneer in not only scientific psychiatry, but also clinical reform. Unfortunately, he died early and thus could not develop his ideas further.

      Later, Emil Kraepelin (1856-1926) continued the biological approach and has become an inspiration for the DSM since the DSM-III of 1980.

      Localizationism and the biological model make sense for many health-related problems; but it’s an exaggeration and fallacy to believe that ALL of medicine (and particularly all of psychiatry/clinical psychology) could be understood that way.

      Griesinger’s ideas are still interesting today. You can find a selection of them in my article.

      • The brain is so complex it is bound to fail. It should have many “pieces” that are in low supply or do not function as designed. A brain is a part of human anatomy and we are prone to breaks and sprains and wearing out. It is the seat of thinking and feeling and it can become diseased. With hundreds of billions of connections through synapses our neurons can’t possibly function perfectly all of the time. If I cut off my foot, I can still think and feel and function. If I cut off my brain, that’s it.

        • That brain damage can lead to neurological, psychiatric, or psychological disorders/problems merely proofs this: that the brain (or, more largely, the nervous system) is causally necessary for psychological processes.

          That doesn’t mean that the psychological process IS nothing but a brain process, or that the psychological process (or mental disorder) can be grasped, described, treated beset on the neural level.

          P.S. Already in ancient Rome, the physician Galen described all kinds of functional deficits in gladiators with all kinds of wounds, including head wounds.

          • There is certainly no denying that physiological damage CAN cause psychological phenomena. The problem, as you intimate, is the assumption that physiological damage is the ONLY thing that can cause psychological phenomena, or worse, that physiological DAMAGE (and let’s be honest, that’s what every drug intervention AND so-called ECT does to the brain, and usually to other parts of the body as well: physiological damage) is the only way to address psychological phenomena. It’s like saying insufficient memory can cause a computer to slow down, so the answer to any computer slowing down is adding more memory chips. Illogical. Except adding memory chips at least enhances the machine’s capacity, while psychiatric drugs without exception decrease the body’s capacity to do something, whether the reuptake of serotonin (SSRIs), the reuptake of dopamine (stimulants), or whatever process these drugs disrupt.

            So if some observable physical defect can be detected, it should be addressed as best we can. But ASSUMING that we’re addressing a physiological deficit that no one can actually identify is a very dangerous pathway.

  4. It it staggering, and arguably grossly unethical, that there isn’t a basic level of scientific and philosophical consensus on some of the underlying fundamentals touched on in this debate. And so telling that the academic fields don’t seem to consider it a priority to resolve these questions, especially given their monumental ethical consequences.

    • According to the new study, that gene may just be CDH2, should that gene mutate.

      CDH2 is a gene that encodes N-cadherin, which is responsible for helping in brain synapse activity and formation. A mutation in CDH2, however, alters this activity. This, in turn, impacts molecular pathways and dopamine levels in two specific brain structures: the ventral midbrain and the prefrontal cortex, both of which are involved in ADHD.

      Further studies have been initiated by the Birk team at BGU’s National Institute for Biotechnology in the Negev (NIBN).

      ADHD is complex and researchers are beginning to zero in on the areas of the brain most responsible for the condition. There is a consensus that the symptoms are real and they can and do cause great injury.

      • Consensus is not science. Scientists have had “consensus” on all sorts of things that were stupid or dangerous in the very recent past. Thalidomide was safe, bottle feeding was as good as or better than nursing, Benzedrine was not addictive, Valium was not addictive, Prozac had a only few mild side effects, Viiox was safe and effective, schizophrenia was caused by overproduction of dopamine, depression was caused by low serotonin, Tardive Dyskinesia was a consequence of being schizophrenic and was NOT caused by antipsychotic drugs… all of these things were agreed upon by “consensus” and turned out to be totally wrong. So scientific consensus is not worth wasting our time on. People agree to false ideas all the time and swear by them, even in the world of science.

        You seem to have spent a great deal of time reading research on these genetic factors, which is great! I’m interested to know what PERCENTAGE of those “diagnosed” with ADHD have the specific CDH2 mutation you mention, and how many have that mutation who do not have an “ADHD” diagnosis? This information is essential if one is going to assume causality of a particular gene. Most of the genetic studies I have seen have found only probability correlations, and I seem to remember someone talking about this one and it was also a correlation – more people diagnosed with “ADHD” had this variation, but most did not, and a lot of folks having the variation did NOT get diagnosed with “ADHD.” Which suggests it could be A causal factor in SOME subset of those diagnosed with “ADHD”, but does not explain the phenomenon overall. Which might be good if that subset is in some way able to be identified and “treated” in some specific way. But it would not be proof that “ADHD is genetic.”

        But I could be wrong. Please share.

      • “ADHD is complex and researchers are beginning to zero in on the areas of the brain most responsible for the condition.”

        Or one could say that there are a number of complex interactions between various factors and adversities in a child’s life that can impact on the brain’s ability to stay focused, pay attention, etc. and understanding it such can help these children who are already struggling not to feel there is something wrong with them or be exposed to the toxic effects of drugs.

        • Or one could say that there are a number of complex interactions between various factors and adversities in a child’s life that can impact on the brain’s ability to stay focused, pay attention, etc. and understanding it such can help these children who are already struggling not to feel there is something wrong with them or be exposed to the toxic effects of drugs.

          It doesn’t make any difference to me at all how they help someone who cannot pay attention sufficiently to reach her potential. That is not what I care about. If swimming in cold water and eating lobster improved my ability to concentrate as a drug does, I’m all for it. If putting a powerful magnet in my pillow at night worked for me, glory! I want to pay attention as best as I can whenever I need or want to. The mechanism whereby that is accomplished isn’t the issue. That it can be achieved at all by anything has given me a new life. That’s what is important to me, personally, minus any damage.

          • So why not simply have kids who struggle with Kindergarten wait another year to enroll, and have kids who don’t do well in standard classrooms assigned to open classroom environments where “ADHD” kids do so very much better? These are two things that we KNOW help and do absolutely ZERO damage.

            Perhaps the need to “pay attention” to what other people think is important is very much overrated in our society. Maybe we need to help these kids build on their strengths rather than making them feel ashamed of not being able to or interested in doing what the adults have decided is “essential” for kids to do.

      • I have taken what Thomas has shared, and tried to fill in explanations would anyone want to gain perspective that might be missing is one so inclined to continue reading. It may help them. I want to thank Thomas for sharing, and must also point out that any sarcasm used in these attempts at possible explanation are there to possibly allow for perspective that might occur, and are not a personal attack on anyone, nor are they to ridicule, they are an attempt at promoting perspective on issues and ideology that might otherwise be missing.

        The result of taking different statements and trying to explain the underlying generators of thought from here:

        “According to the new study, that gene may just be CDH2, should that gene mutate.

        CDH2 is a gene that encodes N-cadherin, which is responsible for helping in brain synapse activity and formation. A mutation in CDH2, however, alters this activity. This, in turn, impacts molecular pathways and dopamine levels in two specific brain structures: the ventral midbrain and the prefrontal cortex, both of which are involved in ADHD.

        Further studies have been initiated by the Birk team at BGU’s National Institute for Biotechnology in the Negev (NIBN).

        ADHD is complex and researchers are beginning to zero in on the areas of the brain most responsible for the condition. There is a consensus that the symptoms are real and they can and do cause great injury.”

        I will now proceed to take separate statements and proceed with possible modes of perspective.

        “According to the new study, that gene may just be CDH2, should that gene mutate.”

        This is:

        “According to the new study” How many prior studies failed need not be mentioned because we continue with the expression: “that gene may just be” the word “may” denoting potential, no matter how much we have failed in this genre of pursuit (it denotes how we have opened up our potential of insistent pursuit quite a bit, although we stick to what’s considered during these times scientific, for example one should not suggest that it might be whether one says a number of Saint Mary’s, does the rosary, recites incantations, repeats mantras or such even if such non-mainstream approaches could illicit more recovery; sacrificing goats or virgins remains completely not condoned when out of mainstream doctrines) but we adhere to mainstream biological ideology so we mention: “CDH2, should that gene mutate” and when that gene research doesn’t pan out, since up to this time we have tried numerous connections which sadly only remain connections we find compelling in our pursuit, it is likely and to be heralded that we will list that we have discovered our first possible link once more regarding another connection, should this well meant endeavor fail, because fortunately there is quite a prolific array of dna connections….

        “CDH2 is a gene that encodes N-cadherin, which is responsible for helping in brain synapse activity and formation. A mutation in CDH2, however, alters this activity. This, in turn, impacts molecular pathways and dopamine levels in two specific brain structures: the ventral midbrain and the prefrontal cortex, both of which are involved in ADHD.”

        That is:

        “CDH2 is a gene that encodes N-cadherin, which is responsible for helping in brain synapse activity and formation. A mutation in CDH2, however, alters this activity.” Although any mutation in any gene can effect the expression of said gene, and mutations can occur anywhere within the strands of DNA, one must list this when one in endeavoring to make headway is suspecting an activity that hasn’t been proven, this again denotes and illicits the necessary belief and comfort that science is involved, one must again not mention above listed non-mainstream beliefs, as we continue with “This, in turn, impacts molecular pathways and dopamine levels in two specific brain structures: the ventral midbrain and the prefrontal cortex, both of which are involved in ADHD.” This hasn’t been proven, how could it be when it is only suspected, but it promotes necessary belief in science and that we endeavor to follow it in making headway.

        “ADHD is complex and researchers are beginning to zero in on the areas of the brain most responsible for the condition. There is a consensus that the symptoms are real and they can and do cause great injury.”

        That is:

        “ADHD is complex and researchers are beginning to zero in on the areas of the brain most responsible for the condition.” Note the use of the expression “beginning to zero in,” and then how we make references to the brain in order to maintain scientific iedology, this in contrast to years past when the sanctity of reformed thinking thus deemed as sanity was determined regarding whether someone repeated said doctrines of the church (whether this made any sense to them or not, certainly would they question it rather than repeat it was questionable), we are talking about sanity not the outdated doctrine of whether one is demon possessed or not, this is the age of science and objective materialism, one must use appropriate terminology when making such statements as: “There is a consensus that the symptoms are real and they can and do cause great injury.” which is stated to emphasize that there is a problem, which we have detailed in that it “may be” because of something that goes along with a scientific approach.

        This all in order, we should get funding: governmental and good will where it is considered a tax write-off. So we have already stated:

        “Further studies have been initiated by the Birk team at BGU’s National Institute for Biotechnology in the Negev (NIBN).” This in contrast to the whole school of disturbed ones who can’t take the trouble to filter their expression into appropriate scientific modelling (this may take some education), and sadly complain when our so conscientious methods are not to their liking, as they disregard are certainty that although things may seem to fall apart and seem difficult, although we have been accused of causing an epidemic ( was the great depression an epidemic, or did people not know how to handle their money and blame it on the banks? ); and although they have given up on us, we deserve this funding to continue, for we herald science.

    • Scientists must “publish or perish”, a fact known since the 1930s/1940s already. (Nowadays they must publish, communicate, get funds etc. or perish.) To publish, they must succeed in a hypercompetitive system (and increasingly competitive society) shaped by vested interests and subject to financial incentives.

      Whether such a system facilitates the pursuit of truth more than the pursuit of career aims and profits is questionable. If people want another science, they should contribute to changing the scientific system. The continuous attention generated by Mad in America is a contributing factor to such a change, in my view.

      • And yet, while there is truth in what you say, I am not convinced that all scientists will only research and present their findings to support those who subsidize or otherwise have a vested interest in their work.
        Some, maybe most, I don’t know, but personally I don’t believe every scientist/researcher yields to such pressure. Published experiments are subject to peer review and if not duplicated, present serious problems for the originators.

  5. Thank you for this apt summary of my research. I would have preferred to exemplify these points for depression, but the research topic (special issue) was on ADHD. I’ve highlighted more interesting aspects of the history of ADHD in a German essay, but have an English book on mental health forthcoming where I have more space to elaborate on the philosophical points.

    I was wondering what this remark refers to:

    “Although Schleim acknowledges that mental disorders are not ‘only constructs,’ he critiques over-attachment to that which is concrete and tangible while also committing the same logical fallacy himself.”

    It may be that in this very short article – with a 3,000 words maximum (which I already exceeded) – not every expression is sufficiently clear. But I’d still be interested in what my “logical fallacy” supposedly consists in.

    “The conversation would be deepened by an acknowledgment that things do not need to be biological to matter.”

    That’s an interesting last sentence. My view is that we are embodied beings, where biology and physiology are an essential basis of perception, emotion, and cognition. But that doesn’t mean that biology itself could provide a sufficient basis for grasping what it means to be human (including our psychological problems). The distinction between strong and weak biologism is meant to emphasize this.

  6. First I want to thank Stephan and Tsotso for this article and information sharing.

    Secondly, I want to insert that regardless of ADHD diagnosis, many people lead wonderful lives and still manage their condition to their best ability with or without medications. It is important to state this so it is not all doomed all the time.

    Thirdly, and I have said this before many times, has any of these researchers find those who have recognized or recovered from ADHD or many other conditions that affect one’s behaviour, thoughts, emotions and attention. I think without having anyone who ever recovered from these conditions defeats the point of looking for solution or understanding the other side of the coin. Any biological condition is verified by its existence and by its absence. We know something exist but how do we know when it is absent or removed?

    I will leave you few things:

    Our educational system seems to be set up in a such that the end game is to get a “job” not to live one’s life. It is to get work (not necessarily capitalisms since all cultures do this) regardless of if this work fits one’s attention or not. This seems one reason ADHD shows up in children. You put a child who can be a great creator with their hands in a reading class. It is obvious to me. Multiply that experience by 1000 layers of socializing that child. The child is broken down to work for the expense of society than to understand self. As an adult, the child/adult feel life has been lost because one was put into a system of socialization without their consent or permission and now has to pay the price. Who would not lose interest, attention and be depressed? Why some people but not others? Precisely some people are not supposed to be in this old dated educational system – we are evolving subtly. Evolution of human race has not stopped.

    The second issue is we all sort of realize intuitively there are some mental health conditions that seem to lessen when we talk about them with others whom we pay (not necessarily a family member). This also seems to me to point a direction that perhaps there is a kernel of truth and talking (use of language) with another person works. It works to a point of realization and what to do after can be devastating to realize the loss of human potential. It may make the issues from the social construction obvious but it does not solve the hard problem of being middle age and struggling to control “attention” that was destroyed since grade school.

    The third is combining these two areas into one: socialization and language development.
    Both of these things are not tangible. One is layers and layers of interactions among humans that we call it construction or what, but it does impact on the embodiment of the person. The second is quite elusive. I called it the human condition since we are the only animal that has language as complex as ours. The road from amygdala to the prefrontal cortex is extremely impacted by the socialization and language development. Ask any immigrant of their experience of learning the new social and language (this is like a great learning for what a child may feel like becoming conscious of their socialization and language). The social attention is much faster than the language attention – this may be needs a research to sort it through.

    I will give you an example: to say the fword in English when English is not your first language does not feel as deep (in the body) as those whose English is their first language? Why is that? Language is not mentioned often in mental health unless a person cannot talk but IMHO, language seems to me the human condition that underpins all. How it is related to attention is an interest of mine.

    We do not know much about how language really develops and how it impacts on the body that supposed to hear itself. How does the body speak to the brain is different how the brain speaks to another brain and we often confuse these two parallel processes.

    I do not have the answers that is why I am giving free associations to allow others to expand on their experiences.

    Thank you,

    • I think it’s accurate to say that the description of ADHD in particular is about a mismatch between individual and the social environment: such as not paying enough attention (to someone or something), interrupting others, not following rules (e.g. to stay seated at one’s place).

      Some people say that they benefit from drugs (with interesting class and race differences, by the way), some from psychotherapy or other kinds of behavioral training, some from changing the social environment (to a place where their behavior is perceived as less disturbing). Until a while ago, 20 years or so?, it was widely believed that ADHD is exclusively a childhood/adolescent condition and disappears as people grow up. This has now changed and clinicians’ consensus is that adult ADHD can exist independently.

      Thus “recovery” seems to be possible in many ways such that the mismatch between individual and social environment disappears or is at least reduced. As far as I know, many children also stop taking the drugs during the holidays (i.e. out of school with its behavioral demands).

      To me, that’s an odd “disease”, that seems to only exist in particular environments (particularly schools), not others.

      • A few good studies back in the 1970s showed that “ADHD” diagnosed kids placed in open classroom environments were indistinguishable from “normal” children. Additionally, a bunch of studies in very different places ALL showed that if you wait a year to enroll kids in Kindergarten, the rate of “ADHD” diagnosis goes down by 30%! A very odd “disease” indeed that is reduced by 1/3 if you just let kids develop for another year before enforcing your expectations on them, and pretty much disappears completely when you stop enforcing those expectations entirely!

        • I understand that ADHD medications are quite a black market commodity for stock brokers or people that have to keep the account for hospitals or decide who gets billed. Either extremely predatory mean spirited stuff, or stuff they hate and just want to get through for the money, and is that devoid of meaning. What does that say about what the “medications” really do? And what kind of ability to “concentrate” is forced on children in school that they would need such drugs to help? I don’t know since when attaching the ability to brainwash people onto deciding whether they have the ability to concentrate or not articulates learning abilities, or whether when someone can play pin the tail on whoever is supposed to pay what also keeps them an underling also means productivity… I read somewhere that someone (was it a mailman?) was able to determine how many of the psychiatrists in a very up to do neighborhood were taking ADHD meds, could be because they delivered their prescriptions, I don’t remember exactly, but….. it was a majority.

        • Thanks a lot for that remark. But AD(H)D was not added to the DSM before 1980 (DSM-III). Probably those kids were labeled as having MBD (Minimal Brain Dysfunction) – or possibly “Hyperkinetic Disorder”.

          Now in the year of 2022, the most predictive factor of an ADHD diagnosis is, to my knowledge, indeed the age at entering school: You see that the youngest in each class have the highest likelihood of getting the diagnosis. That sounds to me as if those kids are labeled (and then treated) for behaving childish. Well, they are children.

          And this has been shown for many countries and is evidence based:

          Whitely M, Raven M, Timimi S, Jureidini J, Phillimore J, Leo J, et al. Attention deficit hyperactivity disorder late birthdate effect common in both high and low prescribing international jurisdictions: a systematic review. J Child Psychol Psychiatry. (2019) 60:380–91. doi: 10.1111/jcpp.12991

          (And, again, this is not to say that “ADHD doesn’t exist” or that there aren’t some individuals severely suffering from insufficient attention spans or impulsive behavior.)

          • “The results of this study show that better outcomes are possible for those suffering from chronic pain,” said Biswal. “This clinical molecular imaging approach is addressing a tremendous unmet clinical need, and I am hopeful that this work will lay the groundwork for the birth of a new subspecialty in nuclear medicine and radiology. Using this approach will require knowledge and expertise not only in nuclear medicine but also in musculoskeletal imaging, neuroradiology and potentially other fields, such as body imaging and pediatric radiology, where pain syndromes are important clinical problems.” Provided by Society of Nuclear Medicine and Molecular Imaging

            In search of pain

            “In the past few decades, we have confirmed that anatomic-based imaging approaches, such as conventional MRI, are unhelpful in identifying chronic pain generators,” said Sandip Biswal, MD, musculoskeletal radiologist and associate professor of radiology at Stanford University School of Medicine in Stanford, California.

            For Pain.

            Does pain exist? We are on the threshold of breakthroughs in an exceptionally fascinating field

          • And, again, this is not to say that “ADHD doesn’t exist” or that there aren’t some individuals severely suffering from insufficient attention spans or impulsive behavior.

            You got it. That’s my point. I have tried to emphasize what you just added to the discussion. My concern is not for those who do not suffer. My concern is for those, however many there are, regardless of race, age, sex, education, hobbies, physical appearance, whether rich or poor, hip or nerdy, smart or slow, if ADHD is holding you back, preventing you from reaching your potential, I say there is hope in drug therapy for many of us. The externals make no difference to me regarding treating ADHD. If someone is movin along, singin a song, jaunty jolly, dig it. I am focused on those in agony over his/her multitude of failures, or her inability to keep up with classwork and his inability to follow instructions on the playground.
            ADHD is not a disease, just like nearsightedness is not a disease. Do what works for you. I will do what works for me. Hold whatever position on the nature of and treatment for ADHD you choose as I am doing the same.
            If I take off my glasses, I’m lost. Yes, a seeing eye dog would be helpful. Yes, learning to use a special cane for the blind would be useful. Listening more carefully to the sounds of cars and other obstacles makes sense. But, for me and those deeply impacted by ADHD, I am convinced glasses make all the difference.

          • Well, good! We agree on that point. I’ve never, ever criticized someone for making an informed decision to use stimulants. I am only objecting to representations by doctors that that things are true which really are not.

    • I am given a reprieve. As long as I take my meds as prescribed, have regular consultations with my doctors and other professionals who monitor my situation, and make adjustments as needed, I will continue to be able to function in ways I couldn’t have imagined for decades.
      It is a phenomenon indeed that no one celebrates this miraculous-like break through with me here. I mean no condemnation. No criticism. It just is, and to me it is amazing. Absolutely amazing. Who doesn’t rejoice when someone is rescued from drowning? How is that possible? Do you see what I’m saying or getting at?