ADHD and “Weak Muscle Disorder”

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Attention Deficit Hyperactivity Disorder is a construct codified by the American Psychiatric Association. It conceptualizes a set of behavioral tendencies as a distinct condition marked by inattentiveness and impulsivity.

The construct originally appeared as ADD in the 1980 edition of psychiatry’s diagnostic manual, and it was modified in the 1994 and 2013 editions. The symptom criteria changed across these editions of the DSM, but the two main features of ADHD have been consistent—inattentiveness and impulsivity.

Given that mental disorders are conceived of and diagnosed subjectively, the questions naturally arise: Is this a real condition? Does this construct have validity?

Cartoon illustration of a yellow brain lifting weights on a purple background

Well, if by these questions we mean do people really experience inattentiveness and impulsivity, then yes of course this is a real condition. And it’s a condition that can seriously interfere with a person’s functioning. But are we defining this condition clearly enough and are we thinking about the nature of it in the right way? My answer is no.

We’ll save the analysis of the construct validity of ADHD for another blog post, but let’s just take one jab at it for now by pointing out a criterion that allegedly describes the hyperactive, impulse feature of ADHD. Criterion 2e says: “Is often ‘on the go,’ acting as if ‘driven by a motor.’”

This really highlights what an outcast psychiatry is in the field of medicine. This criterion is very open to interpretation. The criterion also includes in parentheses: “is unable to be or uncomfortable being still for extended time, as in restaurants, meetings; may be experienced by others as being restless or difficult to keep up with.”

How long is an extended time? How soon into waiting for my food does restlessness at a restaurant reflect ADHD? Does my discomfort in sitting still in a meeting factor in how boring this meeting is, and, above all, who has the say for whether I am difficult to keep up with?

This criterion of “on the go, as if driven by a motor” is in the DSM III, IV, and 5. It’s mind boggling that three different DSM committees all agreed that this is a clear, genuinely assessable criterion. But anyway, let’s focus on how we think about the condition known as ADHD.

I think most people are thinking of ADHD in a problematic way, one result of which is the way people are led to internalize a fixed mindset about their inattentiveness and impulsivity.

To explain what I mean by this, let’s consider the question, is ADHD, or any other mental disorder in the DSM, continuous or discontinuous with normality?

To say that a condition, or, tendency is continuous with normality is to say that there is a wide continuum representing the degree to which a certain behavior is expressed, and somewhere along that continuum we draw a line to say that anything beyond this line is clinical and warrants professional attention. These lines are arbitrary, but useful and necessary for figuring out where and to whom resources should be allocated. The key point is that if a behavior is continuous with normality, then there is no organic, uncrossable gap between normal and abnormal levels of it. And if a problematic behavioral tendency on a continuum can be improved upon, as most of our behaviors can, that means that it can potentially be improved upon to a degree that would put it into a normal range.

Down syndrome—Trisomy 21—is discontinuous with normality. There is no one who has subclinical down syndrome. You either have it or you don’t. That’s what it means for a condition to be discontinuous with normality. There is an organic, uncrossable gap between the condition and normality.

Obviously, within the population of people with down syndrome, there is a broad spectrum of functioning. Shout out to people like my dad who specialize in working with this population and bring the best out of them. But down syndrome is a condition that is fundamentally distinct from a typical person, and there would be no way that a person with down syndrome could grow out of it. ADHD is not like that, but people tend to think it is.

ADHD is continuous with normality, and the symptoms of inattentiveness and impulsivity that define this construct can absolutely be improved upon because they are influenced by malleable psychosocial factors. Cognitive faculties such as these are not rigidly fixed at their current level of functioning. Studies abound that demonstrate the capacity for people to improve upon their attention and impulse control (for example, see 1, 2, 3, 4, 5, 6). An ADHD diagnosis is not evidence that a person’s brain functions in a fundamentally unique way, so it is reasonable to suggest that any study demonstrating people’s capacity to improve upon attentiveness and impulse control is applicable to people who have been diagnosed with ADHD. And there’s also direct evidence showing that various activities, including meditation, walking in nature, reducing screentime, or changing environments can improve ADHD symptoms.

Some people are barely beyond the clinical line—a “mild” specification—so any level of improvement would liberate them from an ADHD diagnosis. Even for people who have been diagnosed with severe ADHD, it is reasonable to suggest that they can develop their attention and impulse control to a degree that would call for an adjustment of their diagnostic specification to moderate, and that they could continue to improve until they merit a mild specification. And again, being continuous with normality, there is no organic gap between having mild ADHD and not having ADHD. Therefore, there is no reason to believe that a person cannot continue the trajectory of improvement well into the normal range of inattentiveness and impulsivity.

Saying that a person has ADHD is like saying a person who can’t lift much weight has Weak Muscle Disorder. If you assess a person who has never really exercised their muscles, you will find that their muscles are weak. It would be absurd to explain to that person that the reason your muscles are weak is because you have this condition called Weak Muscle Disorder—oh, and, here’s a prescription for an amphetamine that will help you lift heavier things! It’s plain to see that the reason this person’s muscles are weak is because they haven’t been exercising.

Herein lies the misconception about most mental disorders as conceptualized by the American Psychiatric Association: these diagnoses are descriptive, not explanatory. The misconception is that they are explanatory. It’s not because you have ADHD that you are easily distracted. An ADHD diagnosis merely confirms that you are easily distracted.

These diagnoses do not provide a reason for the symptoms; they just describe the symptoms. It’s understandable that people confuse these diagnoses as explanatory because that’s how most medical diagnoses work. But remember psychiatry is a very different branch of medicine, one that has suffered from crises of legitimacy throughout its entire history.

So, there is no natural line on the continuum of muscle strength between the strong and the weak. Anyone can make their muscles strong. It may not be equally easy to get stronger for all different body types, but it’s not easy for anyone. Similarly, anyone whose attention is easily distracted and who struggles to manage their impulses can improve.

Granted, a person may not be able to change their basic psychological temperament, which may be energetic, in the same way that a person can’t exactly change their basic body type, which may be ectomorphic. However, in the same way that slender people become strong, energetic people learn to harness their energy and/or find better-suited environments that result in them no longer experiencing any interference to their functioning, thus no longer qualifying for the ADHD diagnosis.

I don’t want this to come across in the wrong way. I’m not calling anyone who has been diagnosed with ADHD weak, and I recognize that many people who struggle with inattentiveness and impulsivity feel misunderstood, and have been told too many times in too harsh a tone that they need to just focus! Too many people have been telling them what to do but not how to do it. I also know that it’s helpful to feel that it’s not your fault that you struggle with this, and a diagnosis helps absolve the sense of fault but be careful, lest it absolve your sense of personal agency.

I wouldn’t say it’s your fault that your mind works like this in the same way I wouldn’t say it’s your fault that your muscles are weak. But moving forward from now, you can do something about it. I know it’s not that simple. It’s also not that simple to become physically strong. It takes dedication to change your mental tendencies and harness your impulses, just like it takes dedication to get stronger physically.

ADHD is not in your nature. You are not in a separate category, apart from a normal range of inattentiveness. Having been diagnosed with it does not mean that you’ll always meet the criteria for it. Had the DSM 5 committee voted differently, you may not have met the criteria in the first place.

ADHD doesn’t explain inattentiveness just like WMD doesn’t explain muscle weakness. You have the power to make your muscles stronger, but it takes work and it may take guidance. And you have the power to improve the stability of your attention and your impulse control.

I recommend adopting practices that hone your power of concentration, limiting activities that weaken your ability to sustain concentration (e.g. excessive stimulating ‘short’ online content), regularly exhaust your energy stores through movement and mental stimulation, and remember that often, the environment is the problem, and your response is actually totally understandable given the environmental conditions, so seek out environments that support your way of being.

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Mad in America hosts blogs by a diverse group of writers. These posts are designed to serve as a public forum for a discussion—broadly speaking—of psychiatry and its treatments. The opinions expressed are the writers’ own.

10 COMMENTS

  1. Superb and accurate analogies without obfuscating jargon! The author succinctly exposes the logical fallacies underlying the core premise of the mental health industry, i.e. that people with certain problems in living suffer from a clinical disorder requiring the assistance of an “expert” to regain the proper functioning of their faulty brain circuits.
    The continuum extending from “normal” to “maladaptive” behavior is a factitious construct, which differs from society to society and evolves over time in accordance with changing mores and cultural trends; it’s not something that can be precisely defined in scientific terms.
    See the excellent description of the category of “moral insanity” in Chapter 1 of Dr. Jeffrey Masson’s book “Against Therapy: Emotional Tyranny and the Myth of Psychological Healing” for a perfect illustration of this elementary truth.

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  2. I think it is downright stupid, and evil, to force amphetamines on children. I pray for the day our society ends its forced drugging of children, with any of the psych drugs.

    I know its profitable, but I think it is morally repugnant for grown adults to neurotoxic poison children.

    Thanks for helping to point out the absurdity and insanity of today’s iatrogenic illness creating, DSM “BS” based, psychiatric system, Nick.

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  3. Well put! Is it discontinuous with normality? While mental suffering is worthy of care in ways similar to medical suffering, a mental affliction is categorically different from a medical one, and we will all be better off when medical authorities recover from their decades-long slide into moral damage for profit and wake back up to this very basic fact. Huzzah!

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  4. I need a doctor, because I’ve just discovered that sperm are arrows shooting into eternity. The arrow is the symbol of the male, and unity is the symbol of the female. This too characterizes their psychological tendencies (and we all have the masculine and feminine centers in us, which we call the mental and heart-based consciousness respectively) because the masculine, aggressive ego is purposive and goal orientated, just like an arrow, proceeding along lines of logical instrumentalist tautology, which indeed characterises the actual arrow that comes with a bow – instrumentalist tautology to gain a power or a reality beyond what is. While the characteristic of the heart-based consciousness that we associate with the feminine and the maternal is unitive, the love extending across genders and uniting children and community etc. It is the aspect that never lets go of the whole and embraces what is as it is, rather then trying to act on it and change it purposively. It’s quality is therefore clarity and understanding as opposed to the potential clarity and rationality of the mind. This kind of consciousness nurtures the whole of life that is, whereas the masculine consciousness seeks to produce the life that is not, and can do so through domination of other life, until it has learned to go beyond this which is now becoming a primitive tendency of mind. But we all have the masculine and feminine centres in us – they are mind and heart. Obviously one tends to predominate within a human being more then the other, and the heart consciousness has always had a greater foothold in women then men, even today, although the mind has spread it’s domination to ever increasing degrees over women, which is not a good thing because it smothers their superior heart-based understanding, which is beyond words – that silent understanding through seeing that can’t be measured by words. The truly intelligent mind is observant of this understanding which it recognizes and reads like the eye reads the sky, exactly like that – without commentary, just following it’s movement. Unity of heart and mind implies the overcoming of the duality of heart-mind and the reaching of a higher unity of the two. This is so obvious if you look at it all. I think you’re all objectively mad for thinking you are a ‘me’ which is just a thought. Obviously you are the consciousness. Everything else is a happening in your consciousness including this thought which calls itself ‘me’ which obviously is still mere thinking. It produces emotional and physical reactions simply because the brain has not manifested the understanding that there is no real ‘me’ besides thought. We are consciousness, and consciousness is rooted in the infinite: it is everywhere and everything. What you call the sensuous, and conceptualize as material reality, is a mere layer of this conscious reality which goes on forever, and contains all realities.

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  5. I’ve enjoyed catching a few of Nick’s podcast, he has great guest’s and does and excellent job of coaxing great interviews from them. I really appreciate this blog because Nick cut right through to the heart of the ADHD BS. I’d bet the farm that if (this) exercise approach was taken with ADHD-as a ‘critically informed discipline’, that it would blow away the (alleged) affects of the singular drug approach!

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  6. How many children with Developmental Language Delay are being medicated for ADHD? It’s hard to be attentive when one can’t understand what is being said.

    Many other problems can make a child restless in school. Pain, difficulties at home, hunger….

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