The sentence that proved most controversial in my book Shyness: How Normal Behavior Became a Sickness was a line I quoted from a psychoanalyst. When he mentioned it at a meeting we were both attending, it struck me as painfully accurate: "We used to have a word for sufferers of ADHD," he lamented. "We called them boys."
What this man was getting at, it seems to me, wasn't merely that lingo often substitutes for a patient, as if it sums up their identity. Nor was he disputing that there is suffering involved, or even a problem. What he wanted to signal was a troubling, quite noticeable, gap in prevalence rates between young men and women—a gap that caused him serious concern.
His statement made me wonder: Why are so many boys and young men being diagnosed with ADHD in particular? No one would expect simple parity between men and women in psychiatric diagnosis, but that doesn't mean the matter of gender is settled or off the table.
To my mind, the statement, "We called them boys" wasn't a nostalgic throwback to an earlier age, long before ADHD was even a blink in the eye of American psychiatry. Such throwbacks are easy to idealize and oversimplify. "The past is a foreign country," we can imagine, where mental illness did not exist, "hysteria" was just another name for defiance, and melancholia was the sign of a tortured artist. In fact, earlier forms of ADHD were recognized as early as 1902, but they were viewed as a problem of impulsiveness and given the thoroughly un-Romantic title, "Defect of Moral Control."