Comment by derefr | Hacker News Reader

Comment by derefr | Hacker News Reader

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> per the DSM two individuals can be diagnosed whilst sharing only 3 of the 9 symptoms, whichs admits that each of the symptoms can have a cause that is not from ADHD.

To be clear, ADHD, despite having "disorder" in the name, is actually a syndrome: a complex of symptoms that, when recognized together, indicate that a certain set of interventional treatments will likely be applicable.

Diagnosing someone with a syndrome does not indicate any knowledge is available on the cause (etiology) of the symptoms. Many different things can cause the same set of symptoms. But if a certain treatment ameliorates anything qualifying as that syndrome, regardless of the upstream cause, then the diagnosis of the syndrome (and so the existence of the syndrome as a concept) is useful, even if it's not informative.

The DSM actually covers two very different categories of what we might call "mental" illnesses: neurocognitive illnesses, and neuroendocrine (or neurohormonal) illnesses.

Neurocognitive illnesses — structural problems with the brain or its cells (think Parkinson's Disease, or ALS, or Lewy Body dementia) — are usually traceable to specific etiologies, as each one usually has either a very unique presentation of signs and symptoms, or has unique markers that can be assayed/biopsied for.

Neuroendocrine illnesses, on the other hand, are almost always syndromes. Many different upstream problems (genetic, toxic, nutritive, auto-immune, etc) can potentially cause the same small menagerie of messenger-chemicals to get out of whack, and due to this, many different upstream problems end up looking like the same few "templates" of symptoms. If you can put the particular out-of-whack messenger-chemicals back into whack with drugs that do that, then you've fixed the symptoms — which doesn't fix the upstream problem (if it even can be fixed), but does fully compensate downstream for the upstream problem.

If we fully admit that the DSM is merely a tool for treatment, a stastical tool to say "this drug might help the issues youre feeling" fine, however this is not the view Ive commonly seen in phycitatric literature, which points at ADHD being a "real disorder", as something definite one "has". Patients also commonly believe they have a definite disorder, saying things like how they finally "discovered" they have ADHd or even that they might "have undiagnosed ADHD". If we agree that the diagnosis is not informative, thst it is merely putting a name to something one already knows about themselves, do we then agree that this kind of talk is invalid?

If so, and if this view is really prevalent in psychiatry, somehow it's completely lost on the general public and media.

> saying things like how they finally "discovered" they have ADHd or even that they might "have undiagnosed ADHD"

This is not in contradiction to something being syndrome. Plus patients usually do not understand and do not have to understand technical nuts and bolts of whatever issues they have.

You cant require people to talk in clunky language qualifying every single nuance each time they speak about issues or diagnoses they have. You would just render them unable to express what they need to express.

> If so, and if this view is really prevalent in psychiatry, somehow it's completely lost on the general public and media.

General public and media are completely lost on eating disorders, OCD, psychosis and pretty much any other psychiatric/psychological problem. They are equally lost on AI, HIV and economic policy.

I don't think I am being pedantic. There is a monumental difference in how you perceive your condition between "I have some troublesome behaviors which these drugs can sometimes alleviate" and "I have an inherently disordered brain that cannot function properly". Perhaps the HN crowd is different, but the latter fits most people's understanding of what Ive seen

What is the qualitative difference between "having some troublesome behaviors" and "having an inherently disordered brain" in your opinion?

Behaviours are what you do - how you interact with the world. Having disordered brain is about how your brain functions. If I yell at you, it is behavior not am "inherently disordered brain".

If I feel sad all the time, it is not a behavior. It is a feeling. If I am forgetting a lot, it is a brain function too, not a behavior. Behavior can be used to mitigate the disordered brain, it can be result of it, it can be completely intendent of it.

Behavior can be something positive or neutral. Eating is behavior, giving a gift is a behavior.

I understand what behaviours are, but "having troublesome behaviours" implies something kinda systemic right? Something that someone does habitually (otherwise you probably wouldn't seek out medication for it). What is it that causes that habit, and if it is a mental cause, how does that differ from having a "disordered brain"?

Having troubles in your life does not imply something systemic no. The qualitive difference is one a name for a group of symptoms, the other claims to be a cause of those symptoms.

You may be losing things often because your place is a complete mess. You may not keep attention in conversations because you spend all your time playing video games and cant relate to anybody, or because regular people simply bore you and you need to find your own crowd.

These kind of explanations are far different than "My brain is inherently and permanently incapable of 'proper executive function'. and the REASON Im like xyz is because of ADHD". Take a look at /r/ADHD if you get a chance. I saw a top thread that read "Does anyone else have trouble keeping eye contact during sex?" with everyone going "wow me too! I didnt know this was an adhd thing!"

Right, but both ADHD and Autism don't have clear neuromarkers, we diagnose people largely based on their symptoms (or the results of their symptoms). The stuff you describe (being bored by regular people, your place being a complete mess) can have "ordinary" reasons, but can also themselves be symptoms of neural disorders. If you have a bunch of symptoms that you've dealt with for years and that you also (succesfully!) take the same medication for that people with the disorder take, I think it can actually be difficult to clearly delineate what is causing it.

Also your example is kinda dumb! You don't have to have Alzheimers to be forgetful, it's actually quite common. But if you post "anyone else here keep forgetting things?" on r/Alzheimers obviously people on there are going to be like "yeah me too".

I am not sure what your point is. Mine is precisely that there is no clear definition nor diagnostic criteria for ADHD, and that merely having more than an average collection of these otherwise ordinary behaviors, does not automatically constitute a new neurological disorder.

>Also your example is kinda dumb! You don't have to have Alzheimers to be forgetful, it's actually quite common. But if you post "anyone else here keep forgetting things?" on r/Alzheimers obviously people on there are going to be like "yeah me too".

What I was trying to demonstrate is that people DO have the belief that ADHD is a causative thing in itself, and not merely a name for a collection of symptoms used to make treatment easier, as was suggested is the case.

Yes, and it's likely due to low-intensity disorder showing up as something one can control, manage, compensate for, and find a place for oneself in society, but if somehow the dial gets fiddled with, things start to fall apart as we move up the sigmoid curve, positive feedback loops turn negative, and a state sponsored suite soon seems sensible.

In other words people with mental illnesses/conditions/disorders/syndromes doubt their own diagnosis, because sometimes it "just feels like an adorably tiresome behavioral `oh you` that everyone laughs at", and other times the wolves are howling inside and suddenly you understand every and all kinds of disability, escapism, compulsion, and serial killers, as you are trying to cancel plans, make up excuses, ask for help, while - by definition - fail to do any and all of those as a headwind of hurt hurls heavy and hopeless.

I think you should re-read the parent comment, and try to read what is written instead of what you are looking to read.

First and foremost, DSM is a classification tool. It is to set up the jargon and coding of the disorders

I wish this were more common knowlegdge. Every time I see someone whether ADHD "exists" I think to myself "Dude, we decided that certain traits falling in a certain range on a spectrum warrant their own category because it might facilitate research and treatment. Whether it's real or not isn't even a question."

I just want to know whether my issues are normal and I'm gaslighting myself into thinking I'm broken or a loser, or if my specific issues are actually falling outside the norm. This way I know what treatment modalities might help, and which literature I can peruse instead of wasting my time reading up productivity advice meant for neurotypical people that will try to solve the wrong issue for me and just make me feel worse.

There’s no such thing as advice for “neurotypical” people.

There’s advice for people.

Sometimes it will help you, and sometimes it won’t.

Regardless of the number of people it helped and didn’t help, and what labels apply to them.

As someone taking adhd meds, I think you’re missing this person’s bigger point.

You can be stuck for decades, as I was, taking advice that won’t work for you, until you figure out that you can get a medical solution that instantly enables all of those pieces of advice becoming usable.

It is not a coincidence that those pieces of advice weren’t working, they were never going to work unless preceded by medical help.

Many people pre diagnosis suffer the equivalent of taking years of running advice and wondering why the stay behind before noticing they’re missing a leg and it won’t work until they get prosthetics.

If it’s not optimal, it’s useless, isn’t it? You can’t run as fast as the others, so why bother running at all? You just can’t do it. None of the advice about running will ever apply to you unless you can afford a prosthetic that works with your ailment that you can wear all the time.

That’s not true, of course. You are not relegated to a category of defunct by simply existing without a leg. You can learn to get by without it — many do — and you can learn to excel without it.

When you exclude yourself based on blankets of labels, you miss good advice. Much advice about “running” has little to do with having 2 legs: Breathing, clothing, hydration, nutrition, time of day. Pacing advice can even apply when you run with an implement.

For some people this is their entire reality, having to fight against categorizations that split them into complete ability and disability.

For some others, they don’t even know there’s a fight to be had. They give up before knowing they had any chance at all.

It’s troubling for something like ADHD, where a constellation of symptoms are possible and some do not apply to you personally.

You can’t read because you have ADHD? It may be true. It may also be true that you have been forced to read things you’re not interested in, something rendered practically impossible by this disorder, and someone has labeled you as a non-reader due to your differences. It may also be true that you haven’t discovered Terry Pratchett, and you’re actually quite the reader with the right material.

For some even more others, they feel able with their medication and useless without. Luckily for them, their medication lasts all day, medication shortages do not exist, and their psychiatrist will always prescribe their medications forever.

>For some even more others, they feel able with their medication and useless without. Luckily for them, their medication lasts all day, medication shortages do not exist, and their psychiatrist will always prescribe their medications forever.

The sarcasm there is unwarranted. Need for a treatment, when it exists, is orthogonal to its convenience. If you need an organ transplant to live, you need it regardless of whether you have donors and hospitals available or whether the lifelong meds they require can run dry at some point.

As for your larger point, to be clear, I understand the idea you’re trying to convey. Diagnoses can be limiting for some people either internally (limiting self perception) or by external judgement.

I don’t deny that, what I’m saying is that I feel you’re (probably unintentionally) falling into a different extreme that is just as damaging to others, which is to deny the need or convenience of treatment for those for which _there is no successful alternative_.

Shutting down a person through a label is harmful, dismissing their limitations because that would be labelling is harmful as well.

For the point of advice, advice can and will be harmful when it assumes realities that don’t apply to you.

To leave the analogy aside and give actual examples, methods to keep organization and accountability like checkboxes or diaries will not only be failed tries to those who need meds, but also reinforce a feeling of inadequacy as the user now feels lacking in discipline to commit to the method. Lack of self steem and negative self perception (lazy, messy, uncaring, etc) is a way too common comorbility with ADHD for a reason.

Slate Star Codex' take on Adderall (and ADHD) is a good read: https://slatestarcodex.com/2017/12/28/adderall-risks-much-mo...

In short: no-one "has" ADHD. We just decided that people on the lower end of the spectrum in the "ability to concentrate" trait deserve a bit of a boost from otherwise illegal drugs to function in the society. Being in this lower end is called "having ADHD".

I'm a bit wary about arguing with a psychiatrist, especially if it is Scott Alexander, but ADHD is clearly not just "low ability to concentrate". It is hard to explain to normal people without phrases like "executive function paralysis" but it is a severe illness, and not some variation of a norm.

I would also challenge his premise about boring monotonous work is ill suited for humans, hence the ones with ADHD are people who can't do it (as good as others). ADHD people can do boring monotonous work for hours, month after month, and often not even struggle with that. On the other hand some banal easy (and short!) tasks, which won't even register as a task for normal human, will leave ADHD person in shambles, unable to even think about it.

There is lots of bad shit going in on the ADHD brain, it is certainly not just "20% worse concentration" debuff.

Also if its just meant to serve as a stastical tool, isnt manually making up these classifications complety outdated? Why not just feed people's data into a machine and find statsical corrolations for what helps?

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