Mel Schwartz, LCSW

Diagnosis Disorder

I 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 (Getting results using health tips here berettaorganics.com). 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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Tiffany

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

mwsmedia

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.

Hal Myers

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).

Ron Jorgenson

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.

Dave Outlaw

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

mwsmedia

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.

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

Theresa

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.

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