While there has been a level of diagnostic expansion that I don’t think is helpful, it’s also important to consider:
What’s the psychiatric equivalent of a sprained ankle?
Does something have to be catastrophic to warrant a diagnosis?
Our physiological system does have that uniformity across the population but our psychological system does not seem to. Isn't it then misguided to try characterizing small deviations when we don't even have a uniform "background" to subtract?
Some people can’t get stranded ankles because they don’t have legs, so you don’t necessarily need a universal baseline across all of humanity when diagnosing conditions. Someone who is still within normal ranges but significantly doing worse than they where can quite reasonably seek treatment.
One of the biggest problems with psychiatry is that every diagnosis is a spectrum, and over time it's become more and more obvious that the boundaries for what is considered "neurotypical" are way too narrow.
Depression being a chemical imbalance was a complete lie to sell more medication, and how prolific this type of occurrence is within the industry is not hard to see.
At the very least, a plurality of phycological diagnoses are manifestations of physical behavior: diet, exercise, exposure to sunlight, etc
We're so overprescribed on medications to try to feel a certain way within far too narrow of a spectrum.
Why do you presume that there has to be an equivalent to a sprained ankle? Maybe the answer to your question is yes, only the catastrophic is worth addressing.
https://journals.plos.org/plosmedicine/article?id=10.1371/jo...
This is a very privileged view of the mind. I have ADHD (and autism). But I also have a quite high IQ, if one cares about such things. I'm pretty successful, professionally.
But it took until around 40yo to get the ADHD diagnosis and get a prescription for medication that has been life-altering. Was I suffering from catastrophic failures? Absolutely not: married, have kids, in the 1%, etc.
But have the meds had an incredibly positive influence on my life? Hell yes. I can do things that everyone else acted like was normal, but I straight up couldn't do it before. Housework is a prime example. It was like torture. Sitting around waiting for people to finish their sentences because they're "talking as slow as molasses" made for often unenjoyable social experiences.
But with the meds, this stuff is either tolerable or fun. My life is significantly better thanks to medical interventions. Instead of my wife blowing up because I didn't do something like mop the kitchen floor, I actually get it done (without meds I straight up cannot hold that kind of task in my mind if I'm not in the room looking at the mess; I will flit between ten other things in a different part of the house, then walk through the kitchen to get into my car to pick up the kids, see the kitchen, and think "ah, fuck me")
I'm happy that you're neurotypical and have a great life, but that's not true for a lot of us, and the idea that "only catastrophic mental issues should be dealt with by professionals" is you just telling on yourself and your ignorances.
I bet if you knew your house would burn down if you didn't do "normal" things you would have done them no problem.
Stimulants make otherwise unenjoyable things enjoyable? Who would have thought? Do you think people that do "normal" things enjoy them? Is it necessary to enjoy everything all the time?
Edit: by chaos I mean things breaking down, going wrong, catching fire, etc. I accomplish things easily once I've taken so long to get to them, that they're seriously urgent.
Getting yourself to do things in a boring situation that you might only do in an exciting situation is a big challenge in ADHD management
If everything was a "house on fire" level emergency, many ADHDers would get more done but would eventually collapse from running around on adrenaline for days
These problems are not easily solved
To pretend that humans are hedonic beasts incapable of cognitive adaption is ridiculous. We do not operate purely on impulse save for pharmaceutical intervention. We can force ourselves to give things more or less importance regardless of the actual stakes.
People were constantly bombarded with death, disease, things like starvation were near term risks, violence was everywhere, etc.
You're also overestimating the prevalence of alcoholism. Alcohol consumption was largely driven by safety and necessity, not abuse. Alcoholism was arguably more of a social stigma historically than it was today, certainly with harsher criminal penalties in many societies.
People with ADHD cannot all just "force themselves" to function. Novelty, excitement and interest can help, some of the time, but the rest of the time it's disaster. Depending on severity, the result of not getting the treatment they need can often include things like an inability to keep a job, homelessness, prison sentences, and accidents/injury. Those kinds of outcomes are pretty damn important to avoid, extremely stressful (exciting) to experience or be in imminent danger of, and certainly more than enough to motivate people to do the best that they can, but some percentage of people will never be able to avoid those outcomes by trying to will themselves into "cognitive adaption".
Others may be able to stave off the absolute worst outcomes without medication, but only through exhaustive efforts that prevent them from accomplishing the things they want in life. Why should someone constantly and needlessly push themselves to their absolute limit just to accomplish what comes easily for most people? For what? Bragging rights about how they reshaped their brains by sheer force of will? If medication for a mental condition can make people's lives better they should be free to take it.
To whatever extent you've been able to function without medication, that's great. Don't assume that what worked for you is applicable to everyone else, or even to most other people.
Why do you think that is?
Asian Americans are so successful that they certainly must not have disproportionately higher rates of suicide right? That might be a sign of some "impairment" going unaddressed! Or maybe you see the rate at which they're killing themselves as yet another metric of success? Those scrappy East Asians are just so good at doing stuff!
They outperform by the metrics that matter for a clinical diagnosis and the West is so quick to jump to the conclusion that they're "under diagnosed", it's a uniquely Western and especially American conclusion.
Because you talk like one, with no apparent empathy for the neurodiverse, except perhaps people with profound issues. "We shouldn't treat any problems except the catastrophically bad." Gross.
> I bet if you knew your house would burn down if you didn't do "normal" things you would have done them no problem.
This is not arguing in favor of your stance, but rather in favor of mine. You're essentially saying "ADHDers can't get shit done without being in dangerous situations, and THAT IS ACCEPTABLE." And yet you think this supports your idea that non-catastrophic disorders shouldn't be treated.
Like many other biological systems, neurological wiring is multidimensional and not a natural fit into our arbitrary culturally defined abstractions, or even language. And the dimensions themselves are multifaceted expressions of multiple genes and environmental factors. I am happy to hear stories like yours, of people who can ultimately achieve "normal" functional parity without medication.
Have you considered if that would have been possible without the journey? Had you, on day 1, cancelled that first therapist appointment and decided to grit your teeth and "try" instead, could you have "accepted discomfort" on your own? Or is it possible that the methylphenidate created supportive conditions that improved your chances?
I ask because there is a body of well reproduced research demonstrating not only that ADHD patients have specific genetic and neurobiological differences from neurotypicals in areas associated with executive function, but that long term ADHD medication use can permanently bring the neurological differences into line with neurotypical controls. Something like 20% of medicated childhood ADHD patients can ultimately stop medication without losing points in functional testing or the associated brain structures. It's a lower percentage in adults and less well studied, but still exists. It's a big difference from the results of every non-chemical intervention we've studied, which have single digit efficacy percentages if they beat P at all.
I'm interested in your feelings about this because ADHD is by far the most-studied psychological disorder in the world, and ADHD medications as a group are not only equally well studied, but also the most successful and least harmful of any psychiatric drug. There are more safety and efficacy studies for ADHD medication than for ibuprofen.
So... if you feel your recovery was not helped by the neurogenetic compensations provided by methylphenidate, you should know that you are flying so far in the face of some of the best-validated medical science, that you imply invalidity of pharmaceutical or medical science as a whole.
... which is fine of course - it's your body and brain! But I bet it would help readers to know how you think this aligns with the science, or maybe what you think of medical science altogether. Questions like "Do you take ibuprofen?" And "Do you vaccinate?" Become relevant.
You're leaving out the part about being "well studied" paired with your conclusions is almost exclusively in American and Western European populations, things are significantly less clear in other populations and cultures.
Edit: ok, that was vallium. ;)
For those with ADHD they turn on the prefrontal cortex which reduces or removes the feeling of utter torture and pain from doing chores.
It's sort of like taking a drug that takes away the fear and almost physical inability to to touch a hot stove most people have. Normally that'd be bad. Except here the hot stove is actually harmless and useful to touch.
Benzodiazepines, opioids, stimulants, opioid-like substances like carisoprodol (there is a reason why people call it Soma). these are the first that come to my mind. contrary to popular belief, downers often give you euphoria.
There also is a good chance I don't have children because just being alive and by myself was super exhausting before I got diagnosed in my late 30. Having children was unthinkable until then.
But was it catastrophic? I don't know. I finished college except it took two times as long and got a job where I of course suffered pretty much the whole time.
But that was all very normal for me, just the way I was, at least that's what I used to believe.
You have inadvertently outed yourself as not having a clue by your reply. It’s nothing personal but you just clearly don’t have a clue and/or don’t have skin in the game.
It’s fine. I don’t know anything about professional juggling because I have zero skin in that game.
Paging Dr. Brochacho: fMRI and brain networks have been around for a while!
Your articles also say that:
- depression medication does appear to be effective in some cases regardless, indicating some other neurochemical mechanism at work.
- the existence of a "neurochemical imbalance myth" underpinning psychology as a whole is, itself, a myth.
- the idea that this mythical myth about neurochemical imbalance has been debunked, is also a myth.
- that the psychological scientific consensus has, since the first peer-reviewed mention of the word "neurochemical" in the 60s, quite consistently been aligned with the 1978 synthesis statement by the then president of the APA:
> "Psychiatric disorders result from the complex interaction of physical, psycho-logical, and social factors and treatment may be directed toward any or all three of these areas."
Your second article is particularly clear in explaining all this.
Exact quote from second article
"Furthermore, the SSRIs were accorded a rock-star status as effective antidepressants that they did not deserve. Most troubling from the standpoint of misleading the general public, pharmaceutical companies heavily promoted the “chemical imbalance” trope in their direct-to-consumer advertising."
There second article admits the overuse of the term while trying to defend psychiatry for never officially adopting it, but everyone who's been on them knows that's exactly what they were told about their effectiveness, so whether the trope originated with the pharmaceutical companies (my assertion) or not, they were still way over prescribed and there's no statistically significant evidence they actually work when controlling for confounders, as the first meta analysis clearly demonstrates.
Most people recognise a sprained ankle, at least mild ones, as a self limiting illness. An issue with psychiatric diagnoses is that they are often not taken to be self limiting and often become a large part of a patients self image. While sometimes this can be helpful and help inform treatment it can also be harmful and I have seen this harm first hand in patients I see.
If someone smokes a lot of cigarettes and gets lung cancer, we don’t blame the doctor for the lung cancer. This shit is the patient’s responsibility.
And doctors only react when you can no longer use your legs for a year, otherwise they must be amputated.
Or would you rather have an earlier disgnostic with instructions to reduce extreme loads and try to take it easy. Let's check again in a week.
Not sleeping a night.
A concussion? Obviously it’s not considered a psychiatric condition but concussions check a lot of the right boxes abstractly.
Instead, I would point to the physical trauma of a concussion as the differentiating factor.