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 ADHD sufferers," he said. "We called them boys."
What this analyst was implying wasn't merely that terminology often substitutes for the humanity of a patient, as if it sums up and replaces 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 male teenagers 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."
But since ADHD was officially defined as a mental disorder in 1980, the number of diagnoses each year has skyrocketed—there's simply no other word for it. When a mental disorder mushrooms by hundreds of percent each year, as in this case, it's in everyone's interests to pay attention—even to ask what's going on, and why. Is there a major uptick due to recognition, finally, of a once-hidden, underrecognized phenomenon? Or does the issue also involve a bandwagon effect, where aggressive direct-to-consumer marketing, patent cycles, media interest, "diagnostic bracket creep" (Peter Kramer's term in Listening to Prozac), and even in this case education policies and practices seem to prioritize certain disorders and treatments over others.
So let me ask, quite seriously: Why are so many boys and young men being diagnosed with this disorder? What is it about them that has led to such results? Has there been a corresponding off-the-charts increase in pathological behavior among them? Or is there a sharp rise in concern about such behavior, including the way we now characterize it?
To help answer these questions, I've also solicited input from a number of experts with different perspectives. In the coming days and weeks I will bring you their insights, to raise questions that clearly are far from settled but that strike me and many other people as urgently in need of being debated.