The Problem with the ADHD Diagnosis

Based on my experience, the vast majority of people who claim to have ADHD do not really have it. As a diagnosis, it relies so heavily on subjectivity and conjecture as to be simultaneously unfalsifiable and unprovable. Let’s begin with the basics. First, I want to introduce two important terms: medicalization and the symptom pool.

Medicalization is the process of monetizing a completely typical experience of the human condition by labeling it a problem and then providing a medical solution for it. This is now so obvious a fact of American life as to be self-evident. You see this in medicine all the time. It used to be that a person either had a condition or did not, and now there are all these ways a person can be labeled pre-that-condition. This is quite convenient because it allows the pharmo-medical industrial complex to expand the usage of countless prescriptions before they are actually necessary and to ignore the less profitable, but significantly more sustainable, behavioral-change treatments.

This happens not only in medicine, though. Medicalization also occurs in mental health. The Diagnostic and Statistical Manual of Mental Disorders (DSM), used for rendering mental-health diagnoses, gets larger with each new edition. The first one that came out in the 1950s was about 130 pages long and contained about 100 diagnoses. The current version has about 1000 pages and something like 300 diagnoses, depending on how you break them down. It is important to keep in mind that diagnoses are not only added to the DSM but also removed. The DSM is, after all, a fallible and even culturally sensitive document, prone to sociopolitical tides. Homosexuality, for example, was once a diagnosis in the DSM but is no longer. There can be no question that the DSM is deeply rooted in the culture from which it hails. That brings me to the second term, the symptom pool.

Medicalization

When regular experiences are turned into medical problems

1 Normal experience Tap to turn› Normal experience A common human struggle Stress, sadness, distraction, and aging can be ordinary parts of life. Their presence alone does not necessarily indicate a disorder. Tap to return↺

2 It gets labeled Tap to turn› It gets labeled The framing changes The experience is interpreted through diagnostic language and framed as evidence of a disorder, shifting attention from context toward pathology. Tap to return↺

3 Medical solution Tap to turn› Medical solution The answer becomes medical Once the experience is defined medically, treatment, medication, or formal intervention can become the expected response. Tap to return↺

Swipe or drag horizontally to follow the full process

The symptom pool is comprised of all the ways a person’s culture permits her to recognize, describe, understand, or express distress and dis-ease. For example, some cultures might prioritize physical pain over mental. Others might have certain concepts that make it easier to discuss a given set of symptoms. In other words, the culture provides much of the context, awareness, and vocabulary for a set of afflicting conditions, real or not. This is why diagnoses like anorexia are common in one country and basically unheard of in another. When medicalization tendencies join forces with a specific symptom pool, some diagnoses can rapidly gain undue prominence in the respective society.

ADHD, or Attention-Deficit Hyperactivity Disorder, made its official debut in 1987. However, initially it was described in the DSM under the label Hyperkinetic Reaction of Childhood in 1968. Up until then, there wasn’t any clear consensus on what we now call ADHD other than a general awareness that some people struggled with impulsivity and focus.

Amphetamines, the group of drugs that would later become the main treatment for ADHD alongside methylphenidates, were first recognized as having treatment potential for children in the late 1930s, when a doctor named Charles Bradley tested them on kids with behavioral issues. One of the unintended outcomes was that amphetamines improved focus and academic performance. Thus, long before ADHD became a defined medical problem, the solution to it was discovered.

As stimulant use in children became more widespread, researchers increasingly studied and applied these drugs to behavioral problems like distractibility and troubled school performance—issues that would eventually come to define the modern ADHD diagnosis. By 1996, the cycle was complete and ADHD met its partner for life, Adderall—the FDA-approved drug for inattention and hyperactivity.

How symptom pools work

The same human experience can receive different labels

1 Culture shapes the symptom pool Tap to explore› Culture Culture teaches us what to notice People learn which behaviors count as unusual, concerning, or in need of help. A behavior noticed as a symptom in one culture may be understood differently in another. Tap to return↺

2 The same behaviors can fit different labels Distractible↔Creative High energy↔Restless Impulsive↔Emotional Tap to explore› Interpretation The label depends on the lens A behavior may be understood as a strength, a difficulty, or a symptom. The label it receives depends on context and cultural expectations. Tap to return↺

3 This can lead to different diagnoses Tap to explore› Diagnosis The same person may receive different conclusions A clinician may connect the same behavior to ADHD, anxiety, depression, another diagnosis—or decide that it does not indicate a mental health disorder. Tap to return↺

Swipe or drag horizontally to follow the full process

Key takeaway

A symptom pool is a culturally shaped way of making sense of human experience.

This, however, is only one part of the ADHD story. The question remains: What explains the eagerness with which so many people these days seek out such a diagnosis? For that, we’ll have to look at the changes happening in our culture.

For several generations now, people have been exposed to a daily media bombardment of geniuses, beautiful people, and wildly successful young folk who have it all by the age of twenty-five. So much so that one might begin to suspect that such lives are easily attainable and, in fact, the norm. And if that is the case, what is wrong with those who have not achieved greatness before grad school?

Diagnoses like ADHD have become the perfect psychological salve for the last three generations of Americans who cannot accept the natural limitations of the human condition or grapple with the consequences of their decision-making. Instead, they have opted for the easiest solution for when things go wrong—taking a pill to feel better.

Just like autism, ADHD is meant to be objectively impairing. Failing to achieve a personal goal like reading more or studying enough for a test does not qualify. The reality is that most people struggle to focus on boring things for which they have no clear incentive, or for which gratification is greatly delayed. This is an entirely ordinary part of the human condition, not a mental health diagnosis. But of course, by making it one, many people get something they want. Big pharma gets forever patients and big profits. And the patients get a diagnosis that excuses them from being accountable. A win-win it may seem, but one of a questionable kind at best.