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 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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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.

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