Diagnosis Disorder

ADHDdrugsideeffects2I would like to propose a new disorder for the American Psychiatric Association to consider in its Diagnostic and Statistical Manual of Mental Disorders: that of confusing a diagnosis with being a real thing unto itself. A recent New York Times article from April 1, 2013, reported that one in every five high school boys and 11% of all children are diagnosed as having attention deficit hyperactivity disorder.

My contention is that nobody has ADHD, because it doesn’t exist. The acronym ADHD simply describes behaviors and conditions that may correspond with a diagnosis, which we created. As with all diagnoses, when we confuse the description with being an actual entity, we trick ourselves and exacerbate the problem.

A psychiatric diagnosis should be descriptive rather than a statement of an objective reality. It should therefore delineate tendencies of behavior and personality as well as emotional and psychological patterns that a clinician observes, which should thereby facilitate our understanding and treatment. The concept of reification refers to taking an abstract idea and turning it into a real thing. This is precisely what occurs with diagnoses. They take on a life of their own. Referred to as the “fallacy of misplaced concreteness” by the philosopher Alfred North Whitehead, mind creates something – in this case, ADHD – and then denies its own participation in having done so.

If I hear a colleague say, “Jane has ADHD,” I may respond, “I have no idea what you’re saying. How can Jane have a disorder that didn’t exist until we in fact coined the term to describe it?” It would, however be accurate to say, “Jane exhibits behavior consistent with what we call ADHD.”

What’s the difference, you might wonder? In the former example Jane appears to have an affliction, yet it’s not objectively discernible as in the case of cancer, high blood pressure, or the West Nile virus. The diagnosis is a matter of subjective interpretation and needs to be acknowledged as such. If it’s not, we may fall prey to seeing this disorder wherever we look for it and, thus, may become influenced and further biased in our diagnosis.

What You Look for Is What You’ll See

I acknowledge that untold numbers of people suffer problematic or challenging obstacles that may align with the diagnosis of ADHD. We should first and foremost be asking why this is occurring. Are these diagnoses rising so precipitously because clinicians are being trained to look for these symptoms? What we look for is what we see, after all. In part, this growing incidence of confirmation bias may account for the rise in cases, but it is certainly furthered by the influence of the pharmaceutical industry and its profit motivation.

Moreover, if we examine our cultural condition, one could make a very convincing argument that our entire society exhibits and promotes behavior consistent with what we call ADHD. Certainly, the addictive relationship that we have with our electronic technology prompts such behaviors. Even executives sitting in boardrooms and members of Congress at the State of the Union address distract themselves by texting or browsing the web. These people are at the pinnacle of achievement in our country. Why aren’t we medicating them, which also begs the question why do we expect more obedient behavior from our children?

Many physicians and therapists act negligently, or worse, by casually prescribing amphetamines to children without an exhaustive and comprehensive evaluation. Do they take the time to inquire as to the family environment and interpersonal relationships, the child’s diet and exercise habits, or teacher’s demands for conformity? And how often are children medicated because of an overbearing pressure from parents who won’t tolerate anything less than complete focus and stellar academic performance?

Before we alter the brains of our children with amphetamines, we owe them some serious due diligence. Although there are many individuals that may have benefitted from such medication, a one-size-fits-all approach that blankets our children with serious psychotropic medication speaks mightily of where our society has come.

On another note, perhaps our runaway emphasis on performance, with its accompanying requirement for focus and attention, has taken us far from a balanced lifestyle and mindset. We have obscured and diminished our value for wonder and curiosity in our lives – and we undoubtedly suffer for that. It’s a good thing Albert Einstein isn’t a teenager in America today. Einstein was not known so much for his focus and diligence as he was for his sense of wonder. Just recall his assertion: “Imagination is more important than knowledge.”

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16 replies
  1. Tiffany
    Tiffany says:

    HALLELUJAH!! Thank you! ADHD does not exist….used to be known as “hyper” or “rascal” or “squirrely”….and now we medicate it! Good gracious!

    Reply
    • Mel Schwartz
      Mel Schwartz says:

      Tiffany, what I’m proposing is that there are many people afflicted with challenges around attention deficit and hyperactivity, but we shouldn’t confuse the diagnostic words with being an actual thing. We also need to add context and deeper evaluation into our consideration of such individuals prior to medicating them.

      Reply
  2. Hal Myers
    Hal Myers says:

    There are many studies showing the clinical efficacy of using Neurofeedback (Biofeedback of EEG) to treat children with ADHD and ADD, including pioneering work done by Dr. Joel Lubar as described below:

    A study was performed to assess the effectiveness of neurofeedback treatment for Attention Deficit/Hyperactivity Disorder (ADHD). The subject pool consisted of 23 children and adolescents ranging in age from 8 to 19 years who participated in a 2-to 3-month summer program of intensive neurofeedback training. Feedback was contingent on the production of 16–20 hertz (beta) activity in the absence of 4–8 hertz (theta) activity.
    Our findings corroborate and extend previous research, indicating that neurofeedback training can be an appropriate and efficacious treatment for children with ADHD.

    I would strongly suggest you look into this alternative and accepted treatment before putting your child on any of these stimulants. There are Neurofeedback specialist in every state. Do a Google search to find one nearby.

    You can find more information about this form of self-help therapy, which teaches physiological self control and self reliance at the American Association of Psychophysiology and Biofeedback Society (aapb.org), the International Society of Neuronal Regulation (ISNR.org) and the Biofeedback Federation of Europe (BFE.org).

    Reply
    • Ron Jorgenson
      Ron Jorgenson says:

      Working with Neurofeedback as a practitioner I totally condone your advocacy of this as a treatment option. What I feel both you and Mel have failed to acknowledge is that that a) some people like their ADHD like tendencies, of which there may be a variety of benefits and b) that ADHD, as diagnosed is more about a brain that is locked and unable to achieve a variety of responses to changing situations. There are times when it is beneficial to be able to focus and attend and times when “scanning” and integrating a host of data can be useful. However to have a brain that does not know that focus and attention is possible and to have limited choices to approach situations is the deficit that is most in need of being addressed. Neurofeedback does that for a host of things along with conditions identified in the DSM IV as Attention Deficit Hyperactivity Disorder. It is also worth noting that the roots of the behaviors that identify this condition may come from a variety of genetic, medical and environmental situations and should not be construed as being from the same cause or even the same neurologically derived condition. This is another valuable aspect of neurofeedback in its flexibility to treat conditions more appropriately at the level of the brain circuitry.

      I am sure there is nothing here that is new to you however it may not have been realized by many people reading your response, Also Biofeedback(neurofeedback) has been identified as an approved treatment protocol by the American Pediatric Society for the disorder identified as ADHD.

      Reply
  3. Dave Outlaw
    Dave Outlaw says:

    mel
    the one disorder that i beleive does exisr is the one created by low self esteem.. that has causef more harm to society than any other malady … the question we still fo not know the answer to is can it be cured and how do we prevent it
    Dave Outlaw

    Reply
    • Mel Schwartz
      Mel Schwartz says:

      Dave, I couldn’t agree with you more. Low self esteem has its roots in our culture and educational systems which have us focus on what I call other-esteem. Achievement, approval and avoidance of disapproval all lead to a betrayal of genuine self-esteem. Authenticity on the other hand enriches self-esteem.

      Reply
  4. Karen Roseneld, The Ottawa Valley Dog Whispereren
    Karen Roseneld, The Ottawa Valley Dog Whispereren says:

    Mel well said! You have made me smile and you have touched a subject that is very close to my heart, mind and spirit! This very same diagnosis – ADHD, has been transported from the human world and applied to the world of companion dogs. In the same vien, I see the true cause of the ‘condition’ and the true remedy 100% applicable to both beings – man and canine.

    This issue develops multiple tiers that trap the ‘diagnosed’ person into a situation in which both mental and physical health are increasingly and dangerously jeopardized. Conventional medical practice fails to recognize and resolve the real root cause – holistically address and thereby restore balance. Instead the focus of conventional practice is to medicate to ‘treat’ the ‘symptoms’ exhibited by the individual. Leaving those that created, enabled and maintained the behaviour (the individuals mentors – parents, guardians, etc.) to continue to exacerbate the situation, The chemical based pharmaceuticals prescribed by conventional practitioners (doctors and veterinarians) simply serve to increase the mental and health risks.

    It has been my observation over the years that, for the most part, the root cause of the condition does not reside in the human nor the dog that is exhibiting the over-stimulated behaviour. The root cause, the fundamental origin of the behaviour is the a) lack of self-awareness, lack of self-discipline, lack of communication skills of those who have the greatest influence on that individual…the mentors (i.e. parents, or in the case of a companion dog, the dog’s ‘people’). When we love selfishly, we lack the dedication to the collective good, we don’t challenge ourselves to face our own limitations of character and perspective. The result is that we limit our potential for intelligence by trapping ourselves in a world of limited perspective, which by default traps those who are dependent on us. In addition, diet, toxic loading, stress on the immune system, and the effects of poor diet on the brains ability to function at optimum potential simply exacerbate an already hypersensitive state.

    In order to mentor another being it is important to first be that thing that you want the other person to be. Achieving such a state requires self awareness, self discipline, a dedication to responsibility and patience. When we do not embrace this task ourselves we must then look to quick-fix solutions to repair the ripple effect of our own lack of control and its damaging effects on those who are dependent on us. This creates a demand on conventional practitioners of medicine to ‘solve the problem’. Which then provides a fantastic opportunity for pharmaceutical companies to meet the demand. With big money backing the large pharmaceuticals, intense marketing campaigns are developed to laud the ‘benefits’ of the drugs to conventional practitioners of medicine.

    In the end the individual that is labeled ADHD never has a chance to attain a naturally achieved balanced state of mind and physical health. They are trapped due to other people’s absence of understanding of themselves first and the effects of their lack on others, which is then is used by an industry to satisfy an unending greed to make money,

    Mel you might find these short articles interesting as they further example the link between the mistakes we make in the human world and how this is then transferred to our relationships with our canines (also applicable to human-human relationships and health)…
    First on Prozac
    http://ottawavalleydogwhisperer.blogspot.ca/2013/02/seperation-anxiety-doggie-prozac-does.html

    Second, the Effect of Diet on the Brain – in this case Omega 3 Fatty Acids and Anxiety
    http://ottawavalleydogwhisperer.blogspot.ca/2013/02/anxiety-and-stress-in-dogs-role-of.html

    And, perhaps most revealing of all – on Human Intelligence v.s. Canine Intelligence and the Limiters we place on ourselves, and then our dogs…also applicable to human-human relationships…
    http://ottawavalleydogwhisperer.blogspot.ca/2013/03/do-dogs-have-edge-over-humans-when-it.html

    Love your intelligence and work Mel! Cheers, Karen

    Reply
  5. Theresa
    Theresa says:

    It’s true that many human traits are are just a matter of degrees, ranging from mild to serious. ADD/ADHD is a complex issue and there is no one-size-fits-all solution. Medication has both pros and cons. One has to weigh the risk and benefits. Obviously, medication is not the whole answer but should not be ruled entirely. Broad “judging” people’s parenting skills is not particularly helpful to anyone. Dr. Edward M. Hallowell has several good books on the subjects, DRIVEN TO DISTRACTION and DELIVERED FROM DISTRACTION, among them. He has ADHD and actually considers it a gift in some ways (the creativity, etc.). He humorously claims that two of his children have ADD, the third wishes he had it, and his wife thinks it’s contagious.

    Reply
  6. Faith
    Faith says:

    I don’t quite agree with the “non-existence” part of ADHD, Mel, but – must admit – I did have to smile at the “Diagnosis Disorder” idea.

    On the other hand, I think it makes sense to explore approaches like neurofeedback more; particularly at early ages. We think nothing of taking strong medications [of which I am NOT against taking, but rather feel a lot more cautious, than flippant, like I used to feel].

    I thought I remember reading that there was finally to be a large-scale study conducted using neurofeedback [or was that just a nice dream?!].

    Reply
    • Hal Myers
      Hal Myers says:

      There is a good meta-analysis on the use of Neurofeedback for ADHD in the Journal ‘clinical EEG and neuroscience’ vol 40 no. 3 July 2009
      Efficacy of Neurofeedback treatment in ADHD: The
      effects on Inattention, Impulsivity and Hyperactivity:
      A meta-analysis.
      Martijn Arns Sabine de Ridder Ute Strehl Marinus Breteler Ton Coenen

      abstract:
      Since the first reports of Neurofeedback treatment in ADHD in 1976 many studies have been
      carried out investigating the effects of Neurofeedback on different symptoms of ADHD such
      as inattention, impulsivity and hyperactivity. This technique is also used by many
      practitioners, but the question as to the evidence-based level of this treatment is still unclear.
      In this study selected research on Neurofeedback treatment for ADHD was collected and a
      meta-analysis was performed.
      Both prospective controlled studies and studies employing a pre- and post-design found large
      effect sizes (ES) for Neurofeedback on impulsivity and inattention and a medium ES for
      hyperactivity. Randomized studies demonstrated a lower ES for hyperactivity suggesting that
      hyperactivity is probably most sensitive to non-specific treatment factors.
      Due to the inclusion of some very recent and sound methodological studies in this metaanalysis
      potential confounding factors such as small studies, lack of randomization in
      previous studies and a lack of adequate control groups have been addressed and the clinical
      effects of Neurofeedback in the treatment of ADHD can be regarded as clinically meaningful.
      Four randomized controlled trials have shown Neurofeedback to be superior to a (semiactive)
      control group, whereby the requirements for Level 4: Efficacious are fulfilled (Criteria
      for evaluating the level of evidence for efficacy established by the AAPB and ISNR). Three
      studies have employed a semi-active control group which can be regarded as a credible
      sham control providing an equal level of cognitive training and client-therapist interaction.
      Therefore, in line with the AAPB and ISNR guidelines for rating clinical efficacy, we conclude
      that Neurofeedback treatment for ADHD can be considered ‘Efficacious and Specific’ (Level
      5) with a large ES for inattention and impulsivity and a medium ES for hyperactivity.

      Reply
  7. Charlie Garland
    Charlie Garland says:

    Mel – this is an extremely well-written, and thought-through, piece. Thank you for bringing it to the fore. I fully agree with you, and support your position of such diagnoses as being truly made up, and dangerously so. If there’s any criticism I have for what you’ve written, it is that you did not go far enough in vilifying the pharmaceutical companies for their part in perpetuating ADD/ADHD as a “disease”…so to increase prescriptions/sales of their psychotropic drugs, as well as their obscene profits.

    I believe that the perpetuation of this “disease conceptualization” has yet another psychological impact — it erodes an individual’s internal locus-of-control orientation (i.e. sense of self-efficacy), but removing from his/her mindset the concept that we as individuals have the capacity to choose different thoughts, and thus, different behaviors. Yes, there is a challenge in terms of clearly understanding those choices, and the dynamics thereof, but that’s certainly where bio/neurofeedback can come into play.

    Those who are brainwashed into thinking that they (or their child) has a disease (i.e. “there’s this thing inside of me and there’s nothing I can do about it”) are naturally more inclined to accept the easy way out of the problem — pop a pill. This conveniently removes from them the obligation to extend any real effort toward addressing the “root cause” of the problem themselves. And such a cognitive response (or lack thereof) is an addiction in and of itself.

    Add to this the neuro-scientific tendency for the brain to prioritize routine activities (e.g. popping a pill each morning), rather than taxing the energy-hoarding brain’s executive functions, which would be called upon in the sort of strategic treatment responses that you are suggesting. Yes, our brains are “lazy,” perhaps out of necessity, but the dynamic you’re highlighting here exploits that…mercilessly.

    Reply
  8. Deborah TaylorFrench (@dtfpress)
    Deborah TaylorFrench (@dtfpress) says:

    Thanks for this. I liked the premise of Diagnosis Disorder. I know a young adult who has multiply challenges due to fetal alcohol and/other intrautero exposure. She had and still retains an exceptional ability to focus (since the age of 3) when she is engaged with the visual arts, drawing, painting, mastering Japanese pictograms, and has tested in the top 90% group for visual perception and visual memory.

    Academic work, English, math, history and science remain extremely difficult in terms of steady focus and memory. She has never been medicated for ADHD. College is a huge struggle to get assignments, complete and turn them in on time.

    What is your suggestion for her? How can she transfer or learn to use her natural visual memory for academic subjects?

    Reply
  9. Jessy
    Jessy says:

    I was diagnosed with “ADHD” and heavily meditated in the 3rd grade. I think that being on that medication eventually led to the substance abuse problems I faced in High School. I have since cleaned my act up, and am currently functioning as a responsible adult with no ADHD medication! Great post!

    Reply
  10. Brent
    Brent says:

    It is interesting that this has become a game of semantics. It is easy to toy with the human language and eventually arrive somewhere in the philosophical realm of “what is…” when language is, intrinsically, the means of communication by which we derive such things. Subscribing to a list of symptoms seems perfectly acceptable to the medical community, i.e., heart disease, etc., but when something is a little less objective such as ADHD, well, it becomes frayed with tendencies to abide by a softer science.
    The fact is, the measure by which is used to identify mental disorders are only as good as the clinician’s awareness. Neurofeedback is, of course, very beneficial and the advent of neurophysiological testing has made leaps and bounds in psychological sciences. Such tests can identify the differentiation of ADHD among normals, APD (Antisocial Personality Disorder), among normals, as well as other disorders and see the metabolic differences rather than it simply being a clinical “hunch”.
    Nonetheless, it is rather obtuse to make the assumption that everyone diagnosed with a disorder can have such expensive and time consuming measures taken. Therefore, the guidelines which the clinician abides is at least consistent among the spectrum of disorders, thus giving every clinician the same rules to follow given any set of behavioral, emotional, or psychiatric conditions. Of course, the subjectivity of the clinician may vary and such is the question; is ADHD symptoms the same as having ADHD? The point is understandable that any construct is simply that (love, hate, etc.), and yet we have no problem attaching a list of meanings, etc., to what those constructs actually mean. You know you’re “in love” based on “X” amount of feelings, behaviors, etc., and no argument could persuade otherwise. Yet, with a psychological diagnosis based on criteria the argument can be made? This is unfair to not only the clinical community, but also those seeking treatment. People want to know and deserve to know if “something” is off kilter. And the world we live in needs an answer; not a list of symptoms they already know about because of the things they face on a daily basis. They know the symptoms better than we, as clinicians, do.
    Thus, I think playing a linguistic game with symptomology vs subjective diagnostic criteria is frail and unfair. Attaining labels is really the only way to continue to be on the same page with other clinicians as well.
    Having said all this, I agree with the author’s statement in regarding the clinician’s automatic inclination to look for such symptoms. It is my firm understanding that ADHD is one of the most over-diagnosed disorders for children, mainly due to this very phenomenon in addition to the change of society’s norms–it’s a faster paced life these days for parents, discipline has changed, as well as what is deemed “hyper” has changed. If some kids are a little more hyper than their counterparts, it doesn’t necessarily mean that they are ADHD; it means that they are perhaps a little more hyper.
    And then there are the politics of it all. Pharmaceutical companies are making millions off medications…but I digress. The point has been made clear without writing a book.

    Reply

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