Rebecca Blood links to a number of pieces about adult ADHD, IMHO mixing the wheat with the chaff with regard to an issue about which there is as much chaff as wheat. As an adult psychopharmacologist, I tracked from early on the emergence of the idea that ADHD, previously thought of as a condition of childhood, persists into adulthood, and was referred numerous people interested in being evaluated for ADHD. As Thomas Spencer MD notes in one of the quotes Rebecca reprints, ADHD is one of the most dramatic examples of a condition defined so vaguely, broadly and imprudently that not only do millions of people believe they have it but millions qualify for the diagnosis. I groaned when a freelance journalist described his idiosyncratic and unscientific take on ADHD in a 1987 New York Times Magazine piece which basically used the diagnosis to explain away his lifelong underachievement. I have spluttered ever since, as certain unscrupulous psychiatrists, including John Ratey and Ned Hallowell here in Cambridge (shamelessly marketing their ‘Harvard Medical School’ affiliations), have made a lucrative cottage industry in mass market fiction books, workshops, consulting work and media appearances from fueling the idea that this diffusely defined ADHD (“driven to distraction”, the title of the US News series to which Rebecca links, is the title of the first of their enormously successful books) applies to nearly everyone, and have gone on to describe other ‘shadow syndromes’ that are, similarly, versions of established psychiatric diagnoses so watered down as to similarly apply to virtually everybody.
This is such a travesty of my sense of what psychiatry is supposed to be, in which a diagnosis is a distinction that makes a difference. However, it is consistent with the medicalization of daily life and the era of cosmetic psychopharmacology, which has completely buried the distinctions between normal variants and pathology in the notion that personality can (and should) be hacked and tweaked… regardless of the consequences to the human soul. Many of my assessments consisted in trying to persuade people who thought they had they syndrome that they really did not, by stringent criteria and my attempt to ferret out what might be going on in their brain physiology and chemistry. Many were disappointed, some more legitimately than others. (Of course, the issue is complicated by the fact that the treatment of choice has been any of a variety of stimulant drugs. Needless to say, stimulants make most people feel better and more productive, so stimulant response does not confirm the diagnosis.)
Strattera, by the way, the new medication mentioned in Rebecca’s excerpts (a non-stimulant; actually a sort of antidepressant) sales of which reportedly topped $370 million last year, is largely useless in clinical practice, regardless of what the pharmaceutical-industry-funded research protocols show. (They demonstrate distinctions which do not make a difference.) And the Dore program, which claims to “rewire the distracted mind”, is pure hokum utterly inconsistent with any neuropsychological understanding of attention and its neural control. “Exercises to stimulate the cerebellum???!!” If it works, it is because of the powerful influence of wishful thinking and the charisma of its sales staff, IMHO.
