As someone who would absolutely have been diagnosed with ADHD had it existed when I was a kid, and whose later-in-life diagnosis and medication has made me a FAR better employee (and a safer driver!), I’ve wondered about the idea of “spectrum disorders.” Not in the autism spectrum sense, exactly, but just where the edge of the natural bell curve is so maladaptive that it feels like a disorder. Vision happens along a bell curve, and when it’s bad enough it’s a problem and you need glasses. My experience of being really easily distracted to the point that I have low object permanence and get bored easily is that I get bored like anybody else, but more so, and more easily. Happiness is along a bell curve, with some people (me) being freakishly happy and others being unusually unhappy—depression.
In these cases, I wouldn’t go as far as saying that this is the social model of disability. (ADHD as culturally adaptive among hunter gatherers? BS. I would absolutely have been eaten by a lion while distracted by a pretty flower.) But I think it’s worth putting a category around when normal variation is a real problem, and if it can be addressed with medical interventions, be they eyeglasses or amphetamines, that’s not a bad thing.
Yeah, I will say speaking personally, I used to be very skeptical of the "learned helplessness" / "reverse CBT" idea and have now come around to the idea that I've succumbed to that at points in my life. But I'm still wary of the "overmedicalization" frame, because being prescribed ADHD medication was a key turning point in me getting past that. A lot of what I see people mention as the "real cure" for mental health problems (making plans with friends, eating fresh fruit, going outside and being more physically active) are things that I've been doing a lot more recently to very positive effect, but the underlying executive dysfunction is what made it hard for me to make habits of those things before. The medical / pharmaceutical approach was what most effectively addressed that core problem, and the non-medical day-to-day habits became achievable and effective in large part as a result of that.
"For many Americans, perhaps, what we used to call forgetfulness is now labeled ADHD. What we used to call a lack of motivation is now labeled depression. What we used to call nervousness is now clinical social anxiety. What we used to call awkwardness is now labeled autism. In this telling, it’s not our biology or our psychology that has changed. It’s our words."
Clinicians know very well how to differentiate these things.
No medical doctor is mistaking social awkwardness for autism.
Yes, that's a fair point! I was listing conditions that O'Sullivan addressed in an overview of her work, rather than conditions that she explicitly mentioned in the context of over-diagnosis. And since I've never deeply reported out any over-diagnosis or detection in this space, I'll remove the reference to avoid confusion.
Way back in the 90's, the syndicated radio host Doctor Dean Edell used to observe that ADHD was not a pathology but rather an evolutionary virtue for hunter-gatherers, who needed a percentage of the tribe to be able to acutely focus on hunting prey. Anyone aware of the rationalist community knows that almost all of them are on some variation of the autism spectrum, having been identified decades ago as NTs in the Myers-Briggs parlance of temperament theory, and which Carl Jung pointed out was one of the four temperaments found in many ancient cultures. Pathologizing what in a previous time might have been called "differing gifts" partly stems from an effort to bring "equity" to society. Well-meaning, but ultimately backfiring in many ways.
As an ADHD sufferer, I truly believe that I wouldn’t have made it to adulthood in a hunter-gatherer society without getting distracted at a key moment and getting eaten by a bear. :)
I have long pondered the very points made in this article. Sometimes putting a name to something helps a great deal but I feel medicalisation is making people collectors of unhelpful labels.
I subscribed to one of those services that run multiple tests because it was one way I could get the Galleria Grail multi-cancer early detection test. Thankfully the cancer test was negative but several of the other tests were slightly below range, so now it takes you down the rabbit hole of trying to review all the tests (i.e. vitamin b12, LDL Particle Number, Arachidonic Acid/EPA Ratio).
Interesting to think about this article alongside your reporting about inflammation / "inflammaging". There are many people suffering without an actionable diagnosis. Perhaps at some point these will become more actionable when we better understand how to address inflammation that underlies chronic conditions (including probably long covid).
I'm a psychiatrist who often writes about conceptual and philosophical issues around diagnosis. My discussion of the confusing ways in which we talk about "overdiagnosis," both professionally and publicly, may also be of interest to folks: https://www.psychiatrymargins.com/p/the-overdiagnosis-confusion
Highly recommend Julia Hotz’s amazing new book, the Connection Cure, about how healthcare should adopt the practice of prescribing social activities (not always replacing, but complementing medicine).
Derek, Here's my unsolicited advice from personal experience. Keep getting the MRIs unless you're someone who prefers not to know what might be growing uncontrolled someplace inside you. Get a colonoscopy every three years. The gastroenterologist removes pre-cancerous growths before the mutant cells become a serious risk. Get PSA exams every year. If your doc bitches about over testing, replace the doc. The doc is getting pressure from his employer and insurers to reduce costs. PSA is the sole biomarker detecting the presence of the protein in dead prostate cancer cells being shed into your blood stream. If the PSA increases, prostate cancer is growing in the gland. This test revealed aggressive PCa growing inside me six years ago.
Get a cardiac calcium blood test. The test detects vascular cardiac plaque accumulation the earliest with the least costly and non-invasive means. I learned that I was accumulating cholesterol plaque sooner than I would have otherwise, and I became aware of coronary artery disease (CAD) that eventually led to quintuple cardiac by-pass surgery.
I became a vegan ten years ago. I am still alive. I took control of my own too long ignored healthcare situation, and you should keep getting your MRI and diagnostic testing too. We are responsible for our own health care.
I had my routine colonoscopy at 68. My doctor found 1st stage colon cancer. Within two weeks I had surgery. No radiation, nor chemo was necessary. My oncologist told me I was one of the luckiest he’d ever seen. Seven years later I’m cancer free. The perks of early detection.
I read and read about how, past a certain age, screening for prostate cancer wasn't necessary. So, being someone who always tries to follow the science, I stopped getting PSAs.
Then we moved and I got a new family physician. She took no crap and ordered me a PSA.
I had prostate cancer. Not the kind you die with, but the kind you die from. My Gleason score was 9, which statistically predicts that only 30-50% of men are still alive five years later (and many of those will be alive with metastasis).
Basically, now, though, I'm cured. 5 1/2 years later NO evidence of metastasis. My Oncologist and Urologist are VERY pleased. I live with a lot of side effects of my treatments, but what kind of a person, who is alive, would complain about that?
So I'm not very objective on this issue of over detection. I'm perhaps an exception to the points made here, and I understand the issue of anecdotes versus data. (I'm an anecdote). There will be many men who will be overtreated if they find they have prostate cancer when they are elderly that basically won't spread or shorten their lives.
(p.s. I was a child psychologist......the over diagnosis of children these days frightens me. As I said at the start, this was another good article by Thompson)
For anyone interested, metabolic psychiatry provides a new, valuable, empowering approach to understanding and resolving symptoms. Books: 'Brain Energy' by Dr. Chris Palmer, 'Change Your Diet, Change Your Mind' by Dr. Georgia Ede. Specialists (just google them): Dr. Matt Bernstein, Dr. Lori Calabrese, Dr. Matthew Phillips (Neurology). Website with robust content including research, interviews with many additional experts, patient stories, and free user resources: MetabolicMind.org
For ADHD, I think part of the problem is that Adderall and other stimulants are very useful for lots of people. We used to achieve similar things with large amounts of cigarettes and coffee, but a turn toward health-consciousness has made that sort of behavior seem extreme rather than normal. But I think lots of modern jobs still call for powerful stimulants!
We created a weird situation though where in order to access the best and latest stimulants, you need to establish that you "have" something called ADHD.
As someone who would absolutely have been diagnosed with ADHD had it existed when I was a kid, and whose later-in-life diagnosis and medication has made me a FAR better employee (and a safer driver!), I’ve wondered about the idea of “spectrum disorders.” Not in the autism spectrum sense, exactly, but just where the edge of the natural bell curve is so maladaptive that it feels like a disorder. Vision happens along a bell curve, and when it’s bad enough it’s a problem and you need glasses. My experience of being really easily distracted to the point that I have low object permanence and get bored easily is that I get bored like anybody else, but more so, and more easily. Happiness is along a bell curve, with some people (me) being freakishly happy and others being unusually unhappy—depression.
In these cases, I wouldn’t go as far as saying that this is the social model of disability. (ADHD as culturally adaptive among hunter gatherers? BS. I would absolutely have been eaten by a lion while distracted by a pretty flower.) But I think it’s worth putting a category around when normal variation is a real problem, and if it can be addressed with medical interventions, be they eyeglasses or amphetamines, that’s not a bad thing.
Yeah, I will say speaking personally, I used to be very skeptical of the "learned helplessness" / "reverse CBT" idea and have now come around to the idea that I've succumbed to that at points in my life. But I'm still wary of the "overmedicalization" frame, because being prescribed ADHD medication was a key turning point in me getting past that. A lot of what I see people mention as the "real cure" for mental health problems (making plans with friends, eating fresh fruit, going outside and being more physically active) are things that I've been doing a lot more recently to very positive effect, but the underlying executive dysfunction is what made it hard for me to make habits of those things before. The medical / pharmaceutical approach was what most effectively addressed that core problem, and the non-medical day-to-day habits became achievable and effective in large part as a result of that.
"For many Americans, perhaps, what we used to call forgetfulness is now labeled ADHD. What we used to call a lack of motivation is now labeled depression. What we used to call nervousness is now clinical social anxiety. What we used to call awkwardness is now labeled autism. In this telling, it’s not our biology or our psychology that has changed. It’s our words."
Clinicians know very well how to differentiate these things.
No medical doctor is mistaking social awkwardness for autism.
Trust me, Derek, my migraines aren’t psychological. They are neurological. No psychological or psychiatric problems here.
Yes, that's a fair point! I was listing conditions that O'Sullivan addressed in an overview of her work, rather than conditions that she explicitly mentioned in the context of over-diagnosis. And since I've never deeply reported out any over-diagnosis or detection in this space, I'll remove the reference to avoid confusion.
Yeah, I was disappointed to see migraine mentioned here. Migraine is more akin to epilepsy than anxiety.
Way back in the 90's, the syndicated radio host Doctor Dean Edell used to observe that ADHD was not a pathology but rather an evolutionary virtue for hunter-gatherers, who needed a percentage of the tribe to be able to acutely focus on hunting prey. Anyone aware of the rationalist community knows that almost all of them are on some variation of the autism spectrum, having been identified decades ago as NTs in the Myers-Briggs parlance of temperament theory, and which Carl Jung pointed out was one of the four temperaments found in many ancient cultures. Pathologizing what in a previous time might have been called "differing gifts" partly stems from an effort to bring "equity" to society. Well-meaning, but ultimately backfiring in many ways.
As an ADHD sufferer, I truly believe that I wouldn’t have made it to adulthood in a hunter-gatherer society without getting distracted at a key moment and getting eaten by a bear. :)
Differing gifts, my foot.
I have long pondered the very points made in this article. Sometimes putting a name to something helps a great deal but I feel medicalisation is making people collectors of unhelpful labels.
I subscribed to one of those services that run multiple tests because it was one way I could get the Galleria Grail multi-cancer early detection test. Thankfully the cancer test was negative but several of the other tests were slightly below range, so now it takes you down the rabbit hole of trying to review all the tests (i.e. vitamin b12, LDL Particle Number, Arachidonic Acid/EPA Ratio).
Recommended reading: Crazy Like Us, about the globalization of Western concepts of psychopathology and psychopharmacology.
Interesting to think about this article alongside your reporting about inflammation / "inflammaging". There are many people suffering without an actionable diagnosis. Perhaps at some point these will become more actionable when we better understand how to address inflammation that underlies chronic conditions (including probably long covid).
I'm a psychiatrist who often writes about conceptual and philosophical issues around diagnosis. My discussion of the confusing ways in which we talk about "overdiagnosis," both professionally and publicly, may also be of interest to folks: https://www.psychiatrymargins.com/p/the-overdiagnosis-confusion
Highly recommend Julia Hotz’s amazing new book, the Connection Cure, about how healthcare should adopt the practice of prescribing social activities (not always replacing, but complementing medicine).
Derek, Here's my unsolicited advice from personal experience. Keep getting the MRIs unless you're someone who prefers not to know what might be growing uncontrolled someplace inside you. Get a colonoscopy every three years. The gastroenterologist removes pre-cancerous growths before the mutant cells become a serious risk. Get PSA exams every year. If your doc bitches about over testing, replace the doc. The doc is getting pressure from his employer and insurers to reduce costs. PSA is the sole biomarker detecting the presence of the protein in dead prostate cancer cells being shed into your blood stream. If the PSA increases, prostate cancer is growing in the gland. This test revealed aggressive PCa growing inside me six years ago.
Get a cardiac calcium blood test. The test detects vascular cardiac plaque accumulation the earliest with the least costly and non-invasive means. I learned that I was accumulating cholesterol plaque sooner than I would have otherwise, and I became aware of coronary artery disease (CAD) that eventually led to quintuple cardiac by-pass surgery.
I became a vegan ten years ago. I am still alive. I took control of my own too long ignored healthcare situation, and you should keep getting your MRI and diagnostic testing too. We are responsible for our own health care.
I had my routine colonoscopy at 68. My doctor found 1st stage colon cancer. Within two weeks I had surgery. No radiation, nor chemo was necessary. My oncologist told me I was one of the luckiest he’d ever seen. Seven years later I’m cancer free. The perks of early detection.
Good article.
I read and read about how, past a certain age, screening for prostate cancer wasn't necessary. So, being someone who always tries to follow the science, I stopped getting PSAs.
Then we moved and I got a new family physician. She took no crap and ordered me a PSA.
I had prostate cancer. Not the kind you die with, but the kind you die from. My Gleason score was 9, which statistically predicts that only 30-50% of men are still alive five years later (and many of those will be alive with metastasis).
Basically, now, though, I'm cured. 5 1/2 years later NO evidence of metastasis. My Oncologist and Urologist are VERY pleased. I live with a lot of side effects of my treatments, but what kind of a person, who is alive, would complain about that?
So I'm not very objective on this issue of over detection. I'm perhaps an exception to the points made here, and I understand the issue of anecdotes versus data. (I'm an anecdote). There will be many men who will be overtreated if they find they have prostate cancer when they are elderly that basically won't spread or shorten their lives.
(p.s. I was a child psychologist......the over diagnosis of children these days frightens me. As I said at the start, this was another good article by Thompson)
For anyone interested, metabolic psychiatry provides a new, valuable, empowering approach to understanding and resolving symptoms. Books: 'Brain Energy' by Dr. Chris Palmer, 'Change Your Diet, Change Your Mind' by Dr. Georgia Ede. Specialists (just google them): Dr. Matt Bernstein, Dr. Lori Calabrese, Dr. Matthew Phillips (Neurology). Website with robust content including research, interviews with many additional experts, patient stories, and free user resources: MetabolicMind.org
For ADHD, I think part of the problem is that Adderall and other stimulants are very useful for lots of people. We used to achieve similar things with large amounts of cigarettes and coffee, but a turn toward health-consciousness has made that sort of behavior seem extreme rather than normal. But I think lots of modern jobs still call for powerful stimulants!
We created a weird situation though where in order to access the best and latest stimulants, you need to establish that you "have" something called ADHD.
A cursory search of the internet seems to indicate that severe autism is also on the rise (as well as the social expansion of the term) https://rutgershealth.org/news/first-large-study-profound-autism-finds-rising-problem-disparate-impacts
A cursory search of the internet seems to indicate that severe autism is also on the rise (as well as the social expansion of the term) https://rutgershealth.org/news/first-large-study-profound-autism-finds-rising-problem-disparate-impacts