A Shift of Mind

Rethinking the way we live.

Diagnosis Disorder

ADHD and why the DSM needs to be reexamined

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. 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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Mel Schwartz, L.C.S.W., is a psychotherapist and marriage counselor who works toward creating resilient relationships and fostering authentic communication. His website is Melschwartz.com.

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