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Comment by Nikolas0 | Hacker News Reader

My $0.02 as a response to several comments I read in this thread: I was diagnosed with ADHD in my 40s and got Concerta. My belief is that ADHD is not a disease, nor a disability (even though it acts like one very frequently) and in fact there is evidence that ADHD is an important part of our evolution as a species.

The problem(s) mostly relies with the modern way of life and what is expected from the society at large. In that context I try to feel ok when I daydream while I have countless of boring things to take care of as I totally feel ok when I hyperfocus in a creative endeavor.

The meds are just a tool that I use no more than two times per week in order to take better care of myself and others. It is not a therapy and it's not me. I believe that Sensitive Rejection Dysphoria is very real for people like us, but the worst version of it is when you reject yourself because you are different and you try hard to be someone else.

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This is a common belief people have, especially those with mild ADHD or those who wish to be dismissive of the disorder.

Unfortunately, in reality while there are some very limited advantages, as a whole ADHD is a whole-brain dysfunction where your neurons are literally incapable of maintaining their level of operation as long as in a healthy person, with ALL of your executive functions - all self-regulation, planning, delaying gratification, emotion management, etc - being impaired across the board, not just tuned differently.

Hyperfocus is commonly brought up, but neurotypical people experience it as well. Less often, but also without the compulsive loss of control, while being able to maintain a higher level of effort and work without it at all times.

People also like to claim we'd be better as lookouts or sentries but this isn't true. People with ADHD don't pay more attention to a broader range of things, they're just incapable of focusing it when necessary, not to mention they drift off and get distracted instead of staying watchful far, far more.

That's before getting into the fact that ADHD correlates negatively with pretty much every single life outcome, not just those depending on society - things like neurodegenerative disease, cardiovascular and metabolic problems, sleep disturbance, etc.

I understand the desire to frame things you're experiencing in a positive manner, but... in this case, it doesn't really work, and I somewhat resent it personally, as it makes people less likely to take ADHD as seriously as it needs to be.

> People also like to claim we'd be better as lookouts or sentries but this isn't true. People with ADHD don't pay more attention to a broader range of things

Have to disagree. Noticing every small noise a neurotypical Brain filters out makes you a good canary.

...assuming the person is able to focus on the 30 minutes of nothing that comes before the noise.

The person in my life with ADHD would start scribbling equations in the dirt or braid the loose threads on their clothing after five minutes, and easily fail to notice the noise twenty-ive minutes after that.

That's not how ADHD works though.

I've done a huge number of hours on sentry duty (unmedicated) and the the hour would either pass by in an instant and I wouldn't even realise it, or it would seem to drag on for hours.

One thing I certainly couldn't do was pay attention to nothing happening for an hour just incase something happened.

I sympathize with this point of view but I disagree. I’m not sure if I’m ADHD, but I’m autistic. I’ve been diagnosed as ADHD in the past, I’m just not sure how useful it is as a diagnosis for me. I have enormous problems with focus and executive functioning. For large portions of my life I’ve been seriously disabled, unable to work or support myself. There are times where I’m unable to talk. And I still don’t see autism as inherently dysfunctional.

If you put me in a village in Europe 5000 years ago, I’d be fine. I’d be better than fine. I’d be the guy in the hunting part who could smell the fresh scat from 50 yards away. I’d be the guy who could remember all the fucking barks and plants and mushrooms that are good for what ails ya. I’d be the guy who knew the story of every god and goddess and why they’re important. Most social situations would involve people I knew very well or people in the same culture, where I could depend on knowing the rules of the culture.

The modern world is full of random noise and stifling bureaucracy. I love being autistic. But it’s awful, truly awful to have this nervous system in this society. The endless stress breaks you down day after day, year after year, and system teaches you to see yourself as inherently broken, when it’s the system that has broken you.

Maybe you’re disabled, but maybe it’s the system that did it to you.

I'm diagnosed autistic and ADHD.

A lot of my autistic issues are caused by society because they are mostly sensory - bright lights, random noise, synthetic smells.

The social model of disability doesn't cover all my symptoms and issues though, I am very much disabled. Pre diagnosis and medication my rejection sensitive dysphoria would cause me to perceive sleights and fly off the handle very easily.

5000 years ago I would have had a rock to the head.

Framing it as a handicapping disease is not particularly helpful either. ADHD cannot be cured, we have to live with it and cope however we can. Treatment is absolutely an option but we can also change our environment.

People act like ADHD patients are feeble minded and that just isn't the truth. In the right contexts we can also focus quite intensely. Especially with treatment.

It's true that neurotypical people also experience hyperfocus, that's not in dispute. I don't really like these comparisons to be honest. I just think the fact ADHD patients also experience hyperfocus really should make people rethink the pejorative "attention deficit" label.

For vast majority of human history most people spent their days doing fairly simple physical work, which didn't require that much sustained focus compared to what an average knowledge worker needs today. Obviously they didn't have smartphones, computers and other forms of distraction either. So really it's quite obvious that most people with ADHD would have done much better in such environment, compared to the unnatural mess we live in today.

So, people with ADHD have always existed, but it's our modern world full of distractions and unnatural work which makes it a much bigger deal than it would otherwise be.

It's copium.

People don't want to think of themselves as of "diseased" or "disabled". So you get this strange phenomenon: people who are completely deaf, or lost an entire limb, and argue quite passionately that they're "not really disabled". Coping.

ADHD screws with executive function, attention and impulse control. All three are incredibly important for a person to function in a modern society. A person with severe untreated ADHD would be unable to hold almost any job. It's a disability.

But admitting that requires the kind of mental fortitude a lot of people simply don't have.

"The problem(s) mostly relies with the modern way of life and what is expected from the society at large."

I assumed not just ADHD but a number of other psychological conditions are more about reconciling some individuals to this particular society. It seems baked into a lot of their diagnostic criteria, like how well one "functions" at school or work. Surely ADHD would not be cognizable where people don't have to spend 8hrs/day through their youth sitting in one place.

> Surely ADHD would not be cognizable where people don't have to spend 8hrs/day through their youth sitting in one place.

Or, for that matter, in a society where people regulated their days by cues like the sky and the body, rather than the carefully organized "rain or shine" clocked time needed by the Industrial Revolution.

(This thesis isn't mine: the historian EP Thompson wrote a classic article on how the transition from a rural to an industrial working class in Britain was accompanied with timetabling and "clock discipline".)

https://academic.oup.com/past/article-abstract/38/1/56/14546...

https://academic.oup.com/past/pages/special_issue_3

The line is indeed, fuzzy. The basic definition of a disorder is very much dependent on context, because in general it requires that the behavior or thought pattern is causing distress or danger to the patient or those around them. There are many facets of the human mind which have a substantial variation among the population, where some range is adaptive to certain situations and some part becomes a problem, and where exactly that flips will depend on the individual and the context they are in. But I think it's unhelpful to claim that because this line is contextual, it means there isn't really a problem. It's a problem because that individual is in that context (and often it's preferable to address the behaviour or thought patterns than the context), and there are individuals where it would be a problem in basically any context.

ADHD is obviously a spectrum, (possibly on top of a binary), and more and more cases on the light end are getting diagnosed, which is, I have no reason to doubt, very helpful. I don’t know if the light end is a disability or a disease.

The heavy end of the spectrum, the lying on the floor suffering crippling bladder pain but unable to muster the willpower to walk to the bathroom and piss even though that would immediately fix the problem end of the spectrum, is a disease and a disability. I cannot picture an ancestral environment where this is adaptive.

Completely agree. People with ADHD are simply incompatible with many facets of mormal life.

Take school for example. If someone doesn't fit into the mass education model, they say they have attention deficit. That same person might then go home and hyperfocus on computer programming for 12 hours straight like a machine. It makes no sense.

The mass education model where hundreds of people sit on a chair listening to lectures for hours on end just isn't right for people with ADHD. Medications are just there to help cope with an imperfect reality which refuses to change for our sake.

ADHD isn't a personality quirk and also, it is fundamentally a disorder of regulation not attention. The education system (for all its drawbacks and inflexibility) works for most because they're able to regulate the urge to get up and climb random shit when they can't figure out how to start writing the answer to Q1 on the worksheet..

I also think its cope to take a disorder where a specific part of the brain tasked with very specific functions is physically less dense and performs than other people and go "ADHD isnt real he's just quirky!1"

I guess its tempting to take like MRI/ECG style studies and draw fundamental conclusions from them about the distinction between "personality" and "disorder" but I think its good to bear in mind at least three things:

1. a lot of these studies suck. Brain imaging is very hard, the interpretation and analysis of the results involves lots of degrees of freedom, the study sizes are typically not as big as you'd like, and most of the results are only really visible in aggregate. I do not give much credence to them, as a scientist. One way to think of this is that if someone separates two groups of people into "ADHD" and "NOT ADHD" and you average their MRIs you might detect a difference in the two groups. But one person's MRI would be almost useless to assign them to one of the two groups. You could certainly try it, but it would not be very effective.

2. Literally every difference in behavior between two people or between a person and themselves at a different time is necessarily reflected in a difference in brain behavior, at least if you buy the materialist paradigm that brain -> mind or at least brain == mind. Thus, you would expect differences in personality to show up in MRI scans as well as differences which rise to the level of "disorder."

3. The brain isn't made up of "specific parts with specific functions." While its certainly true that we can roughly map different areas to different functions, its really not separable in any way that (for example) a human designed machine might be. We cannot remove and replace your "attention center" and it doesn't really mean anything to talk about it without all the rest of your brain. The part/whole relation is bullshit in all contexts (in my opinion as a mereological nihilist) but especially in neuroscience.

I guess its sort of a useful rhetorical frame to point to physical differences between brains as some kind of determination of the distinction between "mere" personality differences and "disorders" but I just don't think it makes sense in a fundamental way.

I'm a person with ADHD and Autism diagnoses and I think they are handy things to use from time to time, I think of them as entirely relational descriptions pertaining to my position with respect to the world, not fundamental ontological categories. On the other hand, I think of essentially everything as relational and I don't really believe in fundamental ontological categories so maybe I'm the fucked up one.

Nowhere did I claim ADHD was a personality quirk. Nowhere did I claim ADHD wasn't real. I'm not disputing the neurodevelopmental pathophysiology of ADHD. I'm questioning the labels society applies to people with such a disorder.

I claimed it's not the "attention deficit" people think it is. People with ADHD are clearly able focus when the subject is interesting enough to them. That's a huge contradiction. The truth is probably that school is way too boring for them.

I think signal to noise ratio is a good analogy. People with ADHD are easily distracted by noisy stimuli and need disproportionally high signal to focus. Society consistently fails to provide high enough SNR then labels neurodivergent people as problematic.

ADHD discussions always remind me of this article:

https://www.marktarver.com/bipolar.html

I think the bipolar diagnosis is off the mark. Substitute bipolar with ADHD though and the profile fits quite well.

it's just poorly named; it's an executive function disorder. The hyper focus you described is just as uncontrolled and pathological as lack of attention. I used to hyper focus on StumbleUpon. You think that's evidence I _don't_ have an attention disorder?

Stop spreading medical misinformation. You're extremely uninformed.

Here are some lectures, go educate yourself: https://m.youtube.com/playlist?list=PLKF2Eq0eYbbrNLoJjFpWG_U...

> it's just poorly named; it's an executive function disorder.

That's my point. Labeling people as having "attention deficit" leads to unnecessary stigma and marginalization.

> The hyper focus you described is just as uncontrolled and pathological as lack of attention.

I didn't say it was controlled or healthy. I said it was evidence that people with so called attention deficit were, in fact, capable of paying attention. And it is.

> You think that's evidence I _don't_ have an attention disorder?

Nobody claimed that.

> Stop spreading medical misinformation. You're extremely uninformed.

> Here are some lectures

Refer to lecture "Why is ADHD considered a disorder?".

When does it become a disorder? When it starts causing harm, adverse consequences, for the individual. When the environment starts kicking back.

In other words, if you can adapt the environment so that it doesn't kick back at the patient, harm is mitigated.

In other words, ADHD patients might adapt reasonably well to certain environments and not others, and we can reduce impairment by putting patients in an environment that is stimulating for them.

This logic is not even unique to ADHD. Numerous diseases have adaptation of the environmental as a vital part of the non-pharmacological treatment. For example, adapting the environment is vital for preventing falls in elderly patients.

So I don't see where the lectures disagree with me. I shadowed a neurologist who specialized in ADHD patients, he combined pharmacological treatment with this environmental approach and it was very successful. Schools labeling kids as problematic was a huge problem for us.

> People with ADHD are clearly able focus when the subject is interesting enough to them

"interesting enough" is not a sufficient condition. You may be super interested, very motivated, and yet completely unable to start. That is one of the most frustrating parts of ADHD to me. When and how hyperfocus kicks in seems to be mostly outside of your control.

If it's not a disability, then why can't I work on projects that I am excited to work on?

Sure, my ADHD experience is probably the impetus for most of those projects in the first place, but that doesn't help me get anything done, whether I want to or not.

It sounds like what really happened is that you found an appropriate amount/cadence of medication for your body. That's much more difficult than many realize, which is why each stimulant is sold with 5 different delivery methods: immediate release, capsule with drug dust coated in timed digestion substance, capsule with hole to pump via capillary action, skin patch, and the bonus prodrug lisdexamphetamine that metabolizes into amphetamine at the rate of digestion.

Too often the conversation swings between "meds are bad" and "meds fix everything," when the truth is way more nuanced

Isn't one of the criteria for something to be a disability that it makes it harder to function in the world you are in?

So it has to do with the mismatch between yourself (including the accommodations in place for you), the world and whatever is considered a reasonable life for a person in that world.

I think can be a disability but not a disease, I think is the idea.

You might enjoy reading “The ADHD advantage” by Anders Hansen. He describes the evolutionary explanation as well.

I enjoyed reading Jurassic Park, for all it had to do with science.

Respectfully, my experience is very different than yours -- and I'm somewhere in between you and people who have it really bad.

ADHD can absolutely be a handicap. It might be that it's exacerbated by modern life's demands, but I frankly can't be bothered to care -- I live with these symptoms that I wish would go away, and I can't switch to some world that would work well with them.

And it's not rejecting myself or trying to be someone I'm not. I spent quite a while before diagnosis doing that. Getting treatment for and acknowledging the issues of ADHD is being more aware of who I am and what I need than pretending that things will work out. They don't, and they didn't.

And I know my experience isn't unique.

I think this is a nice attitude. I would say I do think it's possible to hyperfocus too much, I feel like I might have done that.

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