Have We Been Thinking About A.D.H.D. All Wrong?
nytimes.com
nytimes.com
The article itself says a catch-all solution for ADHD will never happen. At that point I think the term "ADHD" is misleading. It should be split up into multiple different categories, each of which either specifies the underlying cause (trauma, biology, idiopathic, others) and the "attention deficit" symptom renamed such that it is not mistaken for a disorder to be medicated itself. These are multiple distinct causes all rolled up under a single label causing doctors, psychologists and patients to argue past each other about what this singular term is supposed to mean. This is a futile situation, because they're really talking about more than one disorder. "ADHD" has become too loaded a term culturally and diagnostically to be specific enough and helpful. It has to go away entirely.
The "H" for hyperactivity in my diagnosis didn't even apply to me beyond elementary school, the "ADD" stemmed from me being metaphorically smacked down for the perceived "H" at too early an age for me to fully recover. Hence the truly negative issues in my case were environmental and not biological - even though biology may have played a part at inciting those around me into action. The whole deal was iatrogenic, put into motion by people close to me I had no choice but to trust, and stimulants were a dead-end.
The fact is, parents don't want to be blamed for traumatic upbringings, so they can pin it on the child's brain and almost always succeed - creating more trauma, symptoms and learned helplessness in the process. And nobody ever realizes the truth. Literally everyone you're supposed to trust buys into the same narrative of medicalization - guardians, teachers, counselors, doctors, the media - which means what what you think of yourself is set in stone from an early age, and the worst part is that it's totally false. You have to spend years trying to undo the damage stemming from this by yourself - and that only gets you so far. Some of it never goes away.
If I had been interviewed for this article decades ago, I probably would have said something like "I'm taking these stimulants. They seem to work for school, but I'm not sure yet. I'll keep seeing what's out there." Opening up about an issue as personal as childhood trauma - the real cause - wouldn't have happened since I had yet to do enough soul searching. This hesitance is from personal experience - youth and depression. So my fate was basically sealed for all those years.
All this is to say that leaving the conversation at "ADHD" would be a grave disservice to people in my situation. This is decades of one's life on the line, spent chasing solutions to symptoms instead of causes, proclaimed by people that don't understand me at my core being. And I still have yet to find something that works well enough for me.
God yup, I know exactly how this one feels. I may have given myself too much credit in my original comment; I got incredibly lucky. I happened to have two very wise people in my life who were smart enough to see through that lifelong medicalization. Talking to them was how we slowly came to understand how the meds worked and the perverse nature of the whole thing. I would have been completely screwed without them. Everyone else around me, without exception, framed it as though I was simply treating the symptoms of a bodily disease, when the primary purpose for me was the psychoactive effect itself. The euphoric, motivational feeling helped me temporarily suppress a heavy burden of negative emotion that hung over me for unaddressed reasons. The problem is, this gave stimulants addictive qualities for me. I'd abuse them to an excessive degree. I sometimes went on multi-day binges, during which I never slept, and almost certainly did myself permanent damage.
It's the inevitable result of treating ADHD as a simple symptomology and lumping everyone with those symptoms into a single group. You'll get lots of people like me for whom a good relationship with stimulant medication is a struggle. The worst part is that the medicalization itself makes a good relationship impossible. Understanding them as drugs, thinking of them like any other psychoactive substance, is the framing that makes it possible to use them in a way that's actually helpful--small, targeted doses that change how you feel to make it easier to operate in the world when you have no alternative. It would be odd to recommend that someone put themselves in a perpetual caffeine high, yet for amphetamines this suddenly seems reasonable? It's the medicalized framing that makes this logic make sense to people, and, as you said, the lumping together of many disparate conditions under one banner.