As someone with ADHD, I have to disagree with people in this thread who believe it’s easy to get medication.
It’s easy to get medication because you don’t have ADHD (or are high functioning). The rules that have formed around ADHD medication are designed to prevent abuse, but in reality are one huge ADHD obstacle course that is incredibly difficult to navigate for someone who actually has ADHD.
Many of the steps you take to get on medication when you don’t need it seem trivial. To someone with ADHD, each of those steps is a barrier that they have a high chance of failing to clear because they “just forget” or “don’t follow up.”
Needing to setup and coordinate appointments amplified by the regular required checkins, the monitoring of “steady use” in filling your prescriptions, on-again off-again potentially impacting your eligibility. Needing to coordinate migrating your entire diagnoses and treatment history over (including childhood) to get a new prescription from a new doctor. Etc.
I don’t like being on ADHD medication because of the side-effects and the impact on how I communicate. So I frequently fall off the wagon. As soon as I’m off my prescription, the obstacle course starts over and I have to navigate it to get back on my medication.
Yes! If you do have ADHD, getting meds is a bloody nightmare of the most ADHD incompatible procedures that could exist. You can only get three months of scrip ahead of time. You can only get meds once a month. You can only get meds one week prior to the prior month running out. You can't call a pharmacy to see if they have it in stock, you must stop by directly.
And that's when you're already medicated. If you've been getting sugar pills (yes, this has been happening to some folks), you'll be trying to do all of this with high emotional disregulation, high executive disfunction, and a severely impaired sense of time.
Taxes are bloody easier, since there's a strict date once a year with lots of surprisingly clear written instructions. Plus you can pay someone to do it for you.
> As someone with ADHD, I have to disagree with people in this thread who believe it’s easy to get medication.
I agree. In fact I have many friends who likely have it that haven't been able to get medication.
I was "lucky" because I had a childhood diagnosis which really sped things up for me.
> Many of the steps you take to get on medication when you don’t need it seem trivial. To someone with ADHD, each of those steps is a barrier that they have a high chance of failing to clear because they “just forget” or “don’t follow up.”
This is truly a profound thought I hadn't thought of.
I'm embarrassed at how long it took me to just answer the first question on my ADHD questionnaire.
The amount of friction I had at just searching for help was insane.
If I compare that to me on medication though, I know that the quasi-"normal" experience of this same thing is "this is easy - just... do it?". In fact it's sometimes quite hard to have compassion for non-medicated me struggling to do a few chores while me on medication does the whole week of chores in a day.
> Needing to setup and coordinate appointments amplified by the regular required checkins, the monitoring of “steady use” in filling your prescriptions, on-again off-again potentially impacting your eligibility.
Yes, in the periods of time I've forgotten to take my medication I've missed many of these checkin appointments and was warned missing them could affect my eligibility.
> I don’t like being on ADHD medication because of the side-effects and the impact on how I communicate. So I frequently fall off the wagon. As soon as I’m off my prescription, the obstacle course starts over and I have to navigate it to get back on my medication.
I agree with this. I would give the advice of giving a buffer day where you take your medication because the first day back on for me (and probably others) is things can be quite overwhelming.
So one thing I try to do is make sure if I skip meds for Fri/Sat I take it Sun or Mon productivity will be affected by the jarring difference between medicated/not medicated.
I really appreciate your comment and it brought up a bunch of emotions about my ADHD that I hadn’t thought of in a long time.
I don’t know if this impacted you in childhood the same way it impacted me, but to pretty much every one of my teachers I was the “smartest kid in the room” who “just didn’t try” and I would “do amazing things if I just applied myself” - and now as an adult I know that’s just my ADHD, it’s a super power and a curse all wrapped up into one. I wouldn’t be “the smartest kid in the room” without it, but I’d also be able to keep a calendar.
The buffer day is a fantastic idea. I’m considering getting back on the my medication again. If I do, I’ll give this a try.
> I really appreciate your comment and it brought up a bunch of emotions about my ADHD that I hadn’t thought of in a long time.
Yeah, it can be a journey that can seems to pull you back in randomly.
> I don’t know if this impacted you in childhood the same way it impacted me, but to pretty much every one of my teachers I was the “smartest kid in the room” who “just didn’t try” and I would “do amazing things if I just applied myself”
Yes, exactly the same. I think a result of it is self-esteem issues or identifying as lazy along with other types of self-shaming.
> and now as an adult I know that’s just my ADHD, it’s a super power and a curse all wrapped up into one. I wouldn’t be “the smartest kid in the room” without it, but I’d also be able to keep a calendar.
I can relate to this quite a lot.
> The buffer day is a fantastic idea. I’m considering getting back on the my medication again. If I do, I’ll give this a try.
To be honest, in true ADHD form, I haven't been able to consistently do it but I've found it has good results when I manage to do it. Kind of like meditation :)
This rings true because most forms of assistance seem to be hardest to get for people who actually need them. Disability supports, social assistance, lawsuits, great if you want to game them, less so if you actually need them.
It sounds like it should be designed in the opposite manner. Present those requesting meds a complicated process to obtain them, and grant the requests for those who demonstrate ADHD by failing to complete it by forgetting, not following up, etc. Those who complete the process quickly are denied.
eh. that wouldn't have helped me out. before I was put on ADHD medication, I couldn't hold down a job or a relationship for longer than 6 months; starting the process for an ADHD diagnosis was something I'd put off doing for years. when I finally made the decision to start the process, i would show up to appointments 2 or 3 hours early and sit in the waiting room on my phone, just to avoid forgetting/being late.
getting that diagnosis was life-changing. as a funny side-effect of getting medicated, I've been able to build up a life over the past 8 years. now I have a full time job where I've been for 3 years, a long-term relationship, family + friends, pets, a house to take care of, etc. etc.
Absolutely! For me, getting medication required multiple consultations with a doctor and a 3 hour IQ tests. Just scheduling all of those was difficult. And where I live you need a special registration card on top of your health insurance. On top of that, for other medication you can pay the full price and then reclaim the cost if you don't have your health insurance documentation with you but not ADHD meds. Multiple times I've been denied meds because my insurance card was being renewed. Not only that, but after missing meds for a month, getting them prescribed again the pharmacist nearly blocked me because they wanted to titrate up from a lower dose (this is a dose I'd been on for years).
People with ADHD being denied medication to help something like extremely bad executive dysfunciton that drastically lowers quality of life.
People being able to take advantage of the system to get medication that shouldn't get it.
Do we really believe the second group is larger than the first?
I'd also like to point out that if he talked to the NHS counselor about his project before-hand, that makes it a big confounding factor in the negative diagnosis.
On a more personal level if you're interested in knowing if you have ADHD or not, anectdotally it seems quite effective to see what your reaction to adderall is. I wonder if there is some way to judge your likelihood of ADHD by reaction to medication?
For me personally it's "Now I can 'just do the dishes'" or other obligations without 1000s of other thoughts raining down on me that make doing the dishes seem pointless before addressing the 1000s of other thoughts.
However there are other days where taking medication feels like literally nothing happened and I have what feels like the same amount of challenges.
"ADHD is not a disorder" in a nutshell. This is not backed up by science, not by experts in the field and neither by millions of people who suffer from it.
Well, it might be possible to reign in drug-seeking behaviour without denying medicine to people who need it. For example, with more rigorous oversight of healthcare providers, to make sure they're all providing an equally thorough diagnosis.
There are risks to turning a blind eye to drug use. We turn a blind eye to bodybuilders and hollywood actors using steroids because it's their choice, and it means the non-steroid-users either have to start using, or get left behind.
If we applied the same pressure to the nation's top scientists and mathematicians, or kids trying to get into the top colleges, and they all end up drugged to the gills like sam bankman-fried - we might not be doing the country a favour.
Also if someone wanted drugs, wouldn't it be cheaper/easier to get street drugs instead of this whole process which costs a ton of money? These treatments can cost thousands. Unreal, garbage piece. Leave people that need help alone. ADHD has been known to be underdiagnosed. There is a reason for a spike in dx and it's awareness and societal pressures. This article will hurt people.
this process does not carry the risk of getting caught buying street drugs or being caught in possession of those drugs which means you don't have to worry about court/jail or being ripped off via street crime
I don't understand what this twitter cliché is supposed to mean here. I personally know far fewer junkies than I knew when I was younger because they have died for the above reasons. Are you telling strangers that they don't know addicts?
They were implying that arguing that risk of breaking the law for someone addicted to drugs is a view divorced from the reality of how addicts typically behave.
Then where is the harm and why is it an issue? That's such a small minority comparing that to the actual people trying to seek answers and help. It is impossible to catch every single person acting in bad faith. You cannot make laws like that, it over litigates and prevents the people that need help from getting it. Those people are going to exist no matter what you do.
There's also various levels of addicts. Yes, your junkie level addict doesn't give a damn and will do whatever it takes. There's also the professional addict or the highly functioning addict that still has a modicum of respect and a image they are still trying to maintain that buying off of the street and getting arrested would destroy. Students trying to study "all the time", housewives with their "momma's little helpers", business people, etc.
I hope that they will respond with their own high quality sources and demonstrate how they reach their conclusion. Then maybe some commentary on why they believe their conclusion and sources contradict yours or how it changes their opinion.
I'll step in for rozal, because this is a big ask (and much more effort than picking out a few research papers, that no one here will surely read).
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The main issues with ADHD (and the current crop of mental health disorders) are postulates that researchers, practitioners, and regulatory bodies (RPR) all take for granted, without rigorous inquiry:
1. There is a "normal" state that some majority of people are in
2. There is an "abnormal" state that some minority of people are in -- with various subcategories/subsets of "abnormal"
3. That the "abnormal" set of people requires intervention to help move them into the "normal" set
4. That the set of people currently proposing and executing interventions (RPR) are the right people
5. That the current set of methods and tools used by (4/RPR) to move the "abnormal" to the "normal" is the right set
6. That (5) achieves the right goals
/*********/
For #1, this has never been formally agreed upon. There are various interpretations of what a "normal" life is, depending on one's own: value system, culture, upbringing, current environment, professional training, etc. Likewise, this "normal" may take on other labels, depending on who you ask: e.g. "fulfilled," "actualized," "happy," "content," "productive," "well-lived," "spiritually-rich," "good enough," "tolerable," "economically stable," etc. In lieu of any centralized and concrete definition, RPR has unconsciously gravitated to not defining what's "right," but what is "wrong."
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For #2, there is again no concrete and unifying criteria for what satisfies "abnormal," but a constantly changing set of qualifiers based on: statistical frequency (a), executive function (b), adherence to an ideal set of traits (c), adherence to social norms (d).
In (a), the basic idea is that statistically prevalent traits are the "norm" and those less prevalent are the "abnorm"; i.e. the mean set of traits is treated as an ideal. Generally, this method makes no subjective judgement on the nature or "rightness" of the traits, just that they are the most prevalent. Readers can generalize from their own lives, times when groups of people exhibiting similar traits were not what one would consider "normal," by personal definition.
In (b), executive function* concerns one's ability to self-regulate, deal with stress and adversity (i.e. adapt), and participate in one's society, i.e. sustain one's life as a human being involved within a group of other human beings. Once again, no subjective judgement is made on the nature or "rightness" of the environment or group one find's oneself in -- only that the individual is able to meet the demands of his or her environment. Readers can generalize from their own lives, times when environments are sufficiently harmful to themselves that adaptation to, rather than escape from, such environments would've been considered in their minds "abnormal."
* as reductively, but generously, rewritten by me, paraphrasing the gist of Rosenhan & Seligman, while ignoring the obvious subjectivity around "rationality," "moral/social standards," and "appearances/how one appears to others"
In (c), we start to get the first concrete, yet not-yet-popularly-accepted, definition of a "normal"; paraphrased from Jahoda (a la Wikipedia):
- Efficient self perception
- Realistic self esteem and acceptance,
- Voluntary control of behavior
- True perception of the world
- Sustaining relationships and giving affection
- Self-direction and productivity
Plainly, many of these are highly subjective, and dependent on the environment one find's one in. I will not be digging into these, because I too have my own biases, values, and so on that would color these differently. However, these will be relevant to (4).
In (d), this is self-explanatory: does the individual adhere sufficiently to his environment's social norms? Once more, no subjective judgement is made whether or not the norms are "right," only that they are the prevailing ones.
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For #3, the unspoken justification of providing treatments to the "abnormal" is that it brings benefits to the "normal." Reductively, one only carries out tasks that benefit oneself. These could be financial, social, spiritual, or otherwise, incentives that move one to act for some imagined benefit.
One could make a case for allowing the local community to assist the "abnormal" to "normalcy," because resources are limited, and each member relies on the others to survive and thrive. This can be seen in tight-knit farming communities, where no single individual can realistically survive alone; and the addition of this individual into a beneficial member of the group allows the group access to more resources, ergo increasing its chances of prosperity.
On a more national level, one could make the same case for assistance that is outside of the community, but within the overarching "group" that encompasses all the other groups. For example, institutionalized mental health treatments will allow the populace of a country to contribute to the country's goals, same as they would to their local community.
Now, once again no subjective judgement is made on whether the goals of the local community or the goals of the nation are "right" -- or any philosophical quandary raised about the necessity of adhering to these goals. Readers can decide for themselves what extra-personal goals are useful to their ends.
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For #4, there has never been any widely popular questioning of who should be "right" ones to assist in the "renormalization." Simply, there was a power vacuum, and people (RPR) filled it in to achieve their own ends.
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For #5, yes there have been a plethora of studies and experiments, and so on, to test efficacy of treatments towards various fuzzy ends (e.g. a reduction or increase in certain subjective traits, experiences, and criteria, or that of more objective economical figures). However, there has been no popular questioning of whether or not the tools (medication and the current flavor of physcological therapies) are the best ones to be used.
In the U.S., the institutionalized mental health systems have a near-monopoly on such services. Partly due to their academic roots, all knowledge must be built on what has already been "discovered" and deemed "right." Anything not aligning to the past, will not be given due consideration as legitimate -- thereby artificially restricting the global maximum set of available tools, to a local maximum set of "popular" tools (regardless of their actual substance).
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For #6, we look again at #5, and ask whether the "fuzzy ends" are the right ends to be sought after. No popular discussion has been made here.
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In fairness, "right" can only ever be a personal definition, based upon one's own: values, biases, culture, upbringing, etc. -- and others can either agree, and spur on the legitimacy of a certain definition of "right," or disagree and lower its power.
The main question to be formulated with all this background information is: "are the current treatments for mental abnormalities the best for the individual, or the best for the whole?"
With consideration to all the ideas I've laid out in this post, I believe that the current treatments for mental health abnormalities greatly benefit the larger "whole" rather than the "individual." Medications come with a plethora of side-effects, and potential long-term issues. Likewise, the long-term efficacy, sustainability, and outcomes of behavioral and psychological treatment via therapies are under question by me. Entire livelihoods and industries are built upon the treatment inherently (i.e. institutional mental health services), but also its after-treatment effects (i.e. "you can function at a job, and help grow the economy").
My belief on "right" is to bring about a life to the individual where their mental health abnormalities do not require constant reliance on external forces to allow the individual to live the life that best fulfills his or her own needs. Otherwise, the incentives are grossly weighted towards the external force's ends, rather than said individual's.
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N.B. Whether or not ADHD is legitimate is a subjective discussion -- and one that I believe misses the point. I think it can be further reduced down to: "there are people with a different set of traits that institutional players have decided to umbrella under 'ADHD', with all the various treatments involved. Is this the right way to go about things?"
ADHD is a neurological disorder and can be seen with neurological imaging. They are statistically abnormal variations in the brain that do not correlate with the normal sizes or functions across the rest of the population. This makes them an outlier. There is a long track record of studies showing dysfunction in several areas with these variations that gradually cause harm to those with these conditions. This is not a "right" or "wrong" way to human question. It's a medical condition that makes people's lives harder.
The basic error underlying this line of thinking was covered above, but I will reiterate. And at risk of sounding cliche, without taking the holistic picture into mind, the only thing being observed is a different part of an elephant.
Statistical observation against a greater sample is flawed. That would necessitate that there is an ideal state of human functioning (mentally/physiologically/etc.). While I'm certain there is a local ideal per individual, and that many features for an idealized "perfect state" are shared among many (e.g. proper diet, rest, etc.); psychology is not so simple. Again, dysfunction in the brain would necessitate there being an ideal state of function -- which has not been defined or determined outside of individual traits that have been interpreted to be at odds with various (subjective) ideals of being.
I do realize that certain physiological states make it subjectively harder to exist in one's specific environment. My issue is with taking this as given fact, rather than interpretation -- that there is an abstract and all-encompassing ideal to be reached, regardless of the individual.
This is ignoring the erroneous usage of medical measurements for purposes of "matter-of-fact" and not recognizing that measuring physchological behavior, as by-product of the underlying nervous system and all the other bodily systems, is correlative. To use a simplified example: if you take an EEG of an "ADHD" brain against an average sample of "non-ADHD," yes it will look different. If I were to steelman it, I would swap out "non-ADHD" for those with prefrontal cortex brain damage. Now the results may look similar. However, this doesn't extend to reaching the conclusion that someone with ADHD has brain damage (they may -- but the results are not causative, merely correlative).
Or what I've already written above, that the data measured is the right data to measure.
The environment, the people, their norms, behaviors, and "average" are different depending on the specific geography, and constantly changing. To nail down an "ideal," in spite of the specific circumstances of each individual is -- in my opinion -- misguided. For an off-hand example: a wealthy and erratic person is an eccentric; but a poor and erratic one is clinically insane. Or someone with hallucinations in Western society is a schizophrenic; while in other cultures he may be a shaman.
I want to take a tangential excursion into the various cultures and their implications against an "ideal" a la Quigley and Huntington -- but I've already written too much.
Most of your argumentation fits arthritis equally. Are you so philosophical about arthritis?
I would describe your main point as advocating the social model of disability and completely rejecting the medical model. The social model is a powerful idea. Certainly applying it more would benefit disabled individuals. It is incomplete alone however. And many researchers and practitioners understand the social model better than you seem to think. Ask people who tried for work accommodations if they had problems with their doctor or manager. Ask people with ADHD how it's affected their relationships.
I've skimmed this, but will take some time to give a good response.
I don't want to sound dismissive and I think there are some good discussion points in this comment, but I believe the other posters comment about differences in brain imaging rebuts your overall point because it's proof that ADHD isn't fuzzy.
> 3. That the "abnormal" set of people requires intervention to help move them into the "normal" set
Your whole argument falls apart here already. I don't care about "normalcy". I don't care about improving my productivity at work. I already went through a process that selected me a job where I can perform pretty well with my ADHD, and where I believe my ADHD can actually be my strength (although I do recognize that I've been extremely lucky in this regard).
What I care about is being able to do things I want to do but can't because of my executive troubles. I would like to be able to clean up my desk, so I can actually use it instead of sitting on a sofa with laptop on my laps, hurting my back. I would like to be able to remember that my partner has asked me to bring something upstairs when I go there. I would like to be able to go get my documents from my accountant that they asked me to retrieve years ago. I would like to be able to remember to call back my mom after I noticed that she tried to call me but couldn't do so immediately. I would like to be able to not drive myself into the edge of physical burnout whenever I go into hyperfocus. I would like to remember to drink water when I do so and not suffer for the next week when I don't. I would like to be able to override what I find myself working on when there's a serious need to do so. I would like to be able to return that damned broken UPS I bought before it's 2-year warranty period ends (I think it already might have ended...). I'd even like to be able to finish playing some video games or watching TV series I started long time ago that were too long to keep me focused on them till the end.
Those are not things that happen "sometimes". That's my everyday struggle. I got expelled from the university because I haven't managed to go ask for my old grades to be copied when I switched from full-time to part-time for a whole semester - and I have literally no excuse for that. I could just go and do it, but didn't. I still attended all the other lectures, labs, exams.
Through my life I came up with a set of elaborate habits and tools and self-made appliances that help me go day by day. I found myself an environment where I can get some support. I'm managing to exist and to do things and maintain some relationships. But whatever I'll do in this regard, it will never cover everything that needs to be covered.
I would also like to be able to actually go get myself diagnosed, so I could actually test some meds and see whether they can help me when I struggle the most. I decided to do so more than a year ago, haven't managed to do so yet.
I already have access to some meds as my partner has similar struggles and already managed to get them for themselves (which was a huge challenge, and still is because of shortages), but I'm too afraid to try them on my own without any medical screening, so I don't. Or at least that's the excuse I'm telling myself, perhaps it's just another symptom of executive dysfunction.
The pills are bad, all of them. They will either manor you angry, sad, less creative, less funny, no appetite, no sleep.
The diagnosing is hogwash. There isn’t a scientific test. All ‘psychiatrists’ do is take you in for a visit or two, listen to your story, and write you the prescription.
I used to be ‘unable to focus’, and took pills for it. I even see people addicted to them to the point they take sleeping medication and other pills to make up for those side effects. No thanks!
These are intense drugs, and not the good kind like DMT, LSD, or Marijuana. Which those, actually had a profound effect on me and my way of thinking. For example, weed makes me productive - and makes otherwise shit work - amazing.
Another thing is eating healthy, organic foods, vegetables, and pasture raised meats, along with exercise. These do wonders for your state of mind. Organic foods (and pasture raised meats, eggs, dairy) have up to 200x the nutrient levels compared to non-organic.
Lastly, self discipline. I had to learn to master my mind and truly discipline myself for my actions. And to make the effort to constantly ‘make it happen’, no matter what. It’s a set of values instilled and the courage to back up your own values when no one else is to judge you but your own mind. Don’t let you mind off the hook for so many things - “oh I didn’t make the bed…it’s fine” no, it’s not fine.
So you're projecting, then? You're claiming other people are addicted to Adderall and left it behind, while being addicted to other drugs. You didn't actually solve the problem here, you exchanged it for another and are angrily lashing out at other people.
I'm not gonna knock people for smoking weed or whatever on their free time to deal with the bullshit of life, but it makes you an asshole for trying to knock people down who legitimately need Adderall to function while pushing your own woo bullshit.
Hard to take that serious on my side of the fence.
Ritalin allowed me finally to succeed.
I don't think you can really understand to want to learn, prepare everything, eat well, cut out any distractions, doing sport and than sitting in front of a perfect learn env and not being able to start at all.
Sitting there for an hour and than closing the book again.
Vs.
Taking Ritalin and than (still with a paper thin wall) breaking through and actually learning.
The last paragraph reads similar to the "depressed people should just drink water, exercise, touch grass and walk in the sun while trying to be more cheerful" advice that could be seen every so often, but since I haven't seen them recently, I thought we were past it.
This is inevitable because there's no physiological test for ADHD; the only diagnostic criteria are how you behave and how you describe your experience. If you couldn't get treated with a convincing lie, you also couldn't get treated if you needed it.
Actually some of the modern computerized continuous performance tests are getting pretty good (a friend of mine in Germany had to undergo one prior to a diagnosis).
Its insanely easy in the US too. I abused it early in my career (have talked about it in previous posts). "Doctor" offices all over NYC and SF have 5 minute appointment blocks where you utter "I can't concentrate at work or school", and by the time you walk to Walgreens, your RX is filled. Its even easier now with the websites that do it.
As someone with ADHD (but not in a major city), it's been hard for me.
Every psychiatrist won't prescribe them unless I'm seeing a therapist that they personally know. The pharmacies often can't fill the prescription, and insurance requires significant pestering to pay for it.
> Its even easier now with the websites that do it.
Wait, as someone who super-duper probably has ADHD but is nearing 40 without having ever gotten a diagnosis or meds, despite getting partway there a couple times, because [list of reasons in other posts here complaining about how hard it is to navigate the ADHD medication dance when you have ADHD]... they've got what now? Is there like an ADHD version of the easy, fake-but-gets-the-job-done online medical screenings for medical weed cards? Because if so I'm doing that today (um, haha, maybe).
“Its even easier now with the websites that do it.”
Ha. I just tried this and was told I didn’t score high enough on their assessment, mainly due to not having issues as a child in school.
For some reason, saying “school was easy for me because I was two to three levels ahead of the rest of the kids and I never had to do any real work” wasn’t a reasonable excuse.
Also, I talked about concentration issues at work but then was asked if I make careless mistakes. I explained it’s not really possible to make mistakes due to the nature of the job. This also meant that I don’t have ADHD, I guess.
Doctors avoid the "I can't concentrate" metric these days and care far more about your upbringing and the effects in your daily life beyond study/work.
I also believe that those that abused drugs to advance in their careers need help as well, just not ADHD meds, and so the stigma can be reduced both ways.
"I can't concentrate" is a very shitty metric in the first place. I can concentrate perfectly well, probably even better than most people, thank you. What I can't control is when and what I concentrate on.
If I was diagnosing someone, hearing "I can't concentrate" with no additional qualifiers would be a significant yellow flag for me.
> I mean, he says "I can forget things, I fidget, I will on occasion zone out of long meetings" but that's true of every human being to some extent.
I feel like the difference is whether you can decide "I need to pay attention to this meeting even though it's boring" and then are able to actually do it.
With ADHD it's more like "oh crap! oh crap! I did it again.. I'm not paying attention to this meeting. I'm going to do it now. But man I suck for falling into not paying attention again. How could I prevent this in the future? Oh I can improve sleep by getting a sleep mask. grabs phone to order sleep mask on amazon"
Meanwhile the meeting has ended and your co-worker you eat lunch with asks "are you coming?" and you lookup to say "huh" with a dazed look.
You should believe the patient unless they threaten your trust in the system. Then you should attack the patient's knowledge of themselves and their medical situation casually, and imply that this stupidity indicates something sinister about their character.
> When I was 14, I witnessed the aftermath of my sisters being knocked down by a car. Ailis survived, Claire - who was 11 - died. Almost 17 years to the day, my dad died unexpectedly. I was a different person after those events. The reason I am sharing this is because I was told the effect of such trauma can sometimes manifest itself into symptoms similar to ADHD.
> A friend of mine - who had been privately diagnosed with the condition - had once suggested to me that I might have it too.
The No-ADHD diagnosis was done by a professional whos pay depends on dispensing a No-ADHD diagnosis, while the 3 professionals offering a Yes-ADHD diagnosis depend on positive diagnosis of things to get paid.
I haven't verified whether or not the No-ADHD diagnosing psychologist was paid or not, but I will say that just the fact that the reporter told them what they were doing is a huge confounding factor on the scale of making their conclusion pretty useless.
"I don't have migraines, but three private clinics say I do, and offered me medication"
"I don't have chronic pain, but three private clinics say I do, and offered me medication
Yes, medicine does not have any real way to read thoughts right now, and medicine instead has to trust patients to give a reasonably accurate description of their own mental state. Really hard-hitting journalism, there.
The criticism is that the claims of the patient are not adequately verified by the prescribing doctor. Some people have to undergo a lengthy doctor-administered screening process to receive an ADHD diagnosis. Others fill out a straightforward questionnaire. To use your example, you'd hope that a doctor would verify that a patient actually had something wrong with them before, say, prescribing them something addictive like painkillers.
What would more hoops possibly accomplish other than denying care to real patients through attrition and exhaustion? It's trivial for a person to lie in an interview as easily as on a questionaire.
Does it really matter if you have or don’t have ADHD? It seems like what should matter most is if taking the medication improves your overall health and well-being (after accounting for any side-effects). I could only imagine it being a negative if it masks some other underlying phenomenon which left unaddressed prevents you from attaining your global maximum of life satisfaction.
It seems likely the amount of harmful abuse prevented by stricter policies would be overshadowed by the amount of positive treatment which is no longer dispensed. If you’re diagnosed and you don’t find medication helpful, you’re not obligated to continue taking it. You discuss it with your provider, you look into alternatives, and you keep eliminating things until you find the best way to cope with whatever issue you have.
That being said I’m totally biased, I had a pretty bad experience with trying to find treatment myself. The first nurse practitioner I saw didn’t diagnose me with ADHD and I ended up dealing with it for another two years until being frustrated enough to follow up again. Then, the first appointment I made was abruptly canceled by the doctor, who sent a message saying that I can schedule another appointment but that they weren’t likely to disagree with their colleagues assessment. This put me off for another few months, led me to waste time seeking out-of-network alternatives who intended to charge me absurd amounts of money for assessments, until I finally managed to find a doctor at the original clinic who was pretty appalled at their colleagues message, and looked at my original responses and didn’t understand why the first practitioner hadn’t diagnosed me with ADHD. She figured exploring if medication would alleviate my symptoms and improve my quality of life that it was worth pursuing. I started on Vyvanse and life is definitely a lot more manageable now.
When did everyone suddenly start spending what seems to be a non negligible amount of time worrying if they are affected by this or that or that or this?
To be clear: I do not mean to belittle / deny the right or need of people who are genuinely affected by certain conditions.
But I do worry (as a parent of teenage children) as to whether this sudden (a few years? max a decade old) wave of "I'm pretty sure I have <INSERT_ACRONYM>" or "I'd better get tested for <INSERT_ANOTHER_CODE> before X or Y happens" is real or not. In some cases, could it be a fad?
As the insensitive bastard that I am (to almost quote my eldest the other day... :) my god I love this child), I cannot help but conflate this with how overwhelmingly present "mental health" issues have become. Twitter? Check. The BBC? Check. Instagram and YT? Check. Everywhere.
Like it or not, the "me-me-me-I'm-a-victim" also feels like a very trendy thing nowadays.
Whatever happened to toughing it out and becoming better/stronger in the process? Has such a view of things and self-betterment in adversity completely fallen out of fashion? Have we all become babies to be nannied? Is this now all viewed as "male, pale and stale"?
I cannot help but think (the "300x" is made up, but you will get the idea I hope):
. either genuine mental conditions have started to plague humanity 300x times more in the past 30 years
. or today's physicians have started to worry 300x more about it, hence diagnose it 300x more often
. or physicians from 30 years didn't give a flying flamingo about it
. or all of the above
What times we live in. We all have our small (or larger) problems -- and I do worry about the the system's influence on my children's ability to become beautiful, responsible and independent adults in the future.
> When did everyone suddenly start spending what seems to be a non negligible amount of time worrying if they are affected by this or that or that or this?
I don't spend time "worrying if I may be affected". Who does?
My reaction to reading up on the topic was "oooooh, so many things that didn't make sense about my behavior suddenly make sense now". It was a happy moment.
Reading up more, I started to find advice that actually works. Which was extremely refreshing, as most of the advice I was getting before outright failed, regardless of how hard I tried to implement it. Now I know why.
Are you sure you aren't fighting a straw man?
Mindlessly "toughing it out" is exactly how you end up with people who aren't responsible and independent and have no slightest clue on why or how to change it.
> I cannot help but conflate this with how overwhelmingly present "mental health" issues have become.
Just because they are more present doesn't mean they are being faked. I believe that mental health issues were largely ignored before.
Now people are paying attention, so more cases are caught.
> To quote: "The busy bee has no time for sorrow".
The busy bee I picture when you say this also lives with high stress, is easy to anger, and doesn't talk about their feelings in a health way or at all.
A lot of discussion in this thread is centered around whether ADHD is "real" or not.
When someone comes to me thinking that they might have ADHD I start by asking them how messed up their life is. How many jobs have you been through? How many colleges have you dropped out of? How many good relationships have you cycled through?
ADHD is a disorder and it can be debilitating. It's not about some 1% efficiency improvement at work. It's the difference between being able to function as an adult in society with a job or being homeless/in prison.
Almost anybody, ADHD diagnosis or not, will feel and perform better on low dose amphetamine like Adderall. It's not surprising there's a demand for it — and actors who know how to profit from it.
man to man, no, but arguably they lost it tactically because their troops/pilots kept taking the pills, without rest and getting worse and worse, until they were wiped out, which lost them almost all of their experienced troops/pilots, whereas the western allies rotated their troops/pilots out of combat.
> but arguably they lost it tactically because their troops/pilots kept taking the pills,
I don't think you'll find a single mainstream historian who would agree with that take.
Germany lost the war because they lacked the logistics to sustain a multi-front war against the combined military and industrial power of the USSR, the United States, and Great Britain. No amount of pervitin added or subtracted from this equation would have changed that outcome.
strategically yes, but i think historians of the luftwaffe would agree that it was fataly dammaged because its pilots never got a rest. didn't help that the rest of german high command, up to hitler himself, were all on pills/injections. you can't imagine eisenhower getting into such a state.
Again, the pills are not the decisive thing here. The Luftwaffe had to counter constant allied bombing of cities and industry both day and night, while also supporting advancing troops on the front. All the while, the allies are running a successful campaign to eliminate Germany's sources of petroleum which eventually all but neuters the operational capacity of the Luftwaffe.
Frankly, it sounds to me like you've let Norman Ohler's pop history book, Blitzed, disproportionately color your perception of the second world war.
But the pilots were taking pills and never getting rest because the army had to cover two war fronts while lacking the resources to do so..
using pills and not resting enough was a symptom of the problem of having to fight a war in two fronts, not resting and taking pills was not the problem itself..
stories of amped up pilots in the US military are common as well. i don't think it was just the germans, so trying to say that was the thing that didn't work well for the germans is just falling flat.
No one said it was just the Germans. But it is well-documented that the Germans distributed amphetamines on a mass scale which had harmful effects. The US did not distribute on a mass scale.
Almost is a huge caveat for your comment. Maybe it's lack of practice, but whenever I've attempted to work while "medicated" in logic intensive workflows like coding or other things like maths or other sciency stuff, my output is much less coherent. Being "medicated" doing more creative type work is the only time I actually enjoy working in that state.
I see it claimed a lot, but if so I'm surprised there isn't more open discussion in places like HN with people saying "I did the research and boosted my productivity by taking drug X".
Even if it only makes you feel better, there were people talking about micro dosing LSD for a while when that was fashionable.
And no surprise how people in this thread rush to defend amphetamine usage.
As someone who was diagnosed several times with “adhd” - there is zero science to it. No medical tests to prove its existence. You’ll just get a drug after the first or second visit and who doesn’t want to defend their addiction online?
If you want focus, don’t take drugs. Exercise, eat healthy, self-discipline yourself
This is objectively false. There are medical tests to prove its existence, there have also been numerous studies highlighting the differences in ADHD brains and those without it, one of them being far slower development of the pre-frontal cortex. Not just a couple of weeks or months, we're talking years of delay. The FDA has also approved testing to assess for brain wave ratios, specifically theta and beta, in which ADHD brains have much higher count.
For most people with ADHD, staying on the drug is the hard part. On top of all of this, there are ADHD drugs that aren't stimulants if one reacts negatively to it. It's not the 70s anymore. Pushing stereotypes is a horrible thing to do, please refrain from it in the future.
There's a misunderstanding here, you're asking about medical tests from the perspective of a doctor diagnosing their patient in the office. I am talking about doctors/researchers assessing the existence of ADHD through medical test studies, brain scans, and so on. Hopefully in the future as this continues we're able to make this more widely available.
> And no surprise how people in this thread rush to defend amphetamine usage.
The same thing happens on opiate threads. The people who have been on opiates for a decade explain that their pain is the real kind that can only be helped by opiates. Take anyone with no pain at all, put them on opiates for ten years, and they'll say the same thing.
Because it's true. If you take away the opiates, they will be in all kinds of agony. They may have created deficiencies in their reward system that will never recover. That's not the same as saying that opiates are helping people (in the long term), or that pain is a deficiency of opiates.
edit: and there's no way out of this other than stopping big pharma from funding patients' rights groups, either directly or indirectly, and/or lobbying through them. Patients' rights groups from the 80s on were the Patient Zero of non-profits acting as political front groups for large financial interests.
Many of the people who have been on opiates for a decade explain what they tried before opiates and the difference in their quality of life. The issue would be simpler if we could dismiss them as junkies and useful idiots however.
There's something similar for testosterone. Many, if not most, doctors use the current average testosterone levels to diagnose if a person has some kind of hypogonadism. But there are also doctors who use the historical baseline before the secular testosterone decline, and thus virtually every man who walks in their door gets meditated for low testosterone. Coincidentally the latter clinics tend to charge cash and present much more of a medi-spa than a clinical experience.
The latter method isn’t necessarily wrong, however.
I have genuine low testosterone (using the current, quite broad, range). When I first tested I was at…352? And the low end of the range was 350. The doctor wouldn’t prescribe me anything but let me see an endocrinologist. That endocrinologist let me test again, and that time I came in close to 200.
I had actual symptoms that made me test in the first place and testosterone supplementation has greatly helped with that. The downsides aren’t great for most though. It’ll wreck your fertility and you very well may suppress you levels even further without supplementation for life.
All that said, we’re living in a time where we know levels are low for men - and they very well might be for women. Teens are having less sex than ever, many identify as asexual or trans, etc. Sperm counts have absolutely ranked.
A lot of that could very well have the same root cause and we need to figure it out. Testosterone supplementation is a cudgel but it’s basically all we’ve got right now.
So is there a new billionaire pushing this narrative or something? We've seen the US start to restrict access to Adderall in the US and now the BBC is funding and pushing narratives claiming that clinics are overprescribing and pushing Adderall on people.
I'm very curious where this sudden change in political opinions is coming from.
I recently learned almost all of my coworkers are on ADHD medication and I'm hardly surprised because my workplace is extremely competitive. I have since started taking Adderall myself and I have no shame in doing so because it's the only way I can meet expectations.
I have every possible marker for ADHD but the top Adult ADHD specialist psychiatrist in the country diagnosed me as the "least ADHD person he's ever met", presumably because I showed up for all my appointments in plenty of time with all the things I needed, and a few other minor things like "no history of stimulant drug use" (uh, dude, you know I said I drink two or three pots of coffee in the morning with the first one before I've even got dressed?).
So, I'm starting to think it's all a bit of a fraud.
Why does it work this way with ADHD but doesn't work with obesity?! No one wants to prescribe Wegovy to me with BMI of 27, i'm almost ready to offer a bribe.
It's very easy to get ADHD medication. Fill out the mental questionaire aka check all the boxes that would match having ADHD symptons, say you can't focus on anything and in short order you will get your prescription.
Is it really that easy to get ADHD medication over there? Here in the US it took me ~4 years of navigating bureaucracy, seeing different specialists and undergoing different evaluations.
On one hand it makes it easy for people that don’t have ADHD to get the medication. On the other, I’m under the impression that one of the best ways to confirm you actually have ADHD is by taking a stimulant.
If you make it significantly harder those who actually need help might not get it, and the harm from a limited stimulant supply for everyone else isn’t all that bad compared to even things like alcohol, weed, etc.
Little kids are another thing entirely, though I know someone in my family in the US had to go through quite a lot until their 8 year old son was given medication. That included things like therapy with coping strategies.
Ugh, my sister got convinced she has had ADHD her whole life (now 40) by one of these pop-up adderall shilling companies.
Now she has insomnia, but refuses to acknowledge that it could be her newfound "ADHD" is just a pill shill program and that adderall makes everyone perform better at their job.
The real failure here is that there's a market for these clinics in the first place, despite supposedly having a "national health service" for which we have to pay (quite high) taxes for. The NHS is not fit for purpose and hasn't been for a long time.
My logic is that those clinics shouldn't be able to remain in business if the NHS did its job and was fit for purpose. Nobody pays £500+ if they have an equivalent, free alternative.
The reason he was able to get a diagnosis from the NHS is because he is a BBC journalist, and is able to navigate any bureaucracy as part of his work day and get paid for it, and ultimately does not suffer from the disorder and thus doesn't really care how long it takes for him to get seen by the doctor.
The average person would be stuck in a kafkaesque maze of bureaucracy and months-long waiting lists before they get anywhere close to a diagnosis (which is even worse if you actually do have a disorder and is impeding your day-to-day life and/or work) - that's why these private clinics have business.
Because the waiting time for an ADHD assessment on the NHS is currently >2 years, which is why he was talking to the director of services rather than an actual practitioner at an actual assessment, and there are therefore private entities providing the service the NHS should be providing. As far as I’m aware the NHS actually sends most of its patients to the three profiled to be assessed, so really I’m not sure what an “NHS assessment” actually is.
Modern doctors stick to an affirmation-only model in profitable situations where the symptoms could be psychosomatic, malingering, and/or hysterical. Saying someone doesn't have ADHD is a violation of their civil rights and basically genocide. You're denying their existence. The only justifiable grounds for denying someone ADHD medication is that they can't pay for it.
- (mis/ab)use of drugs to artificially increase work output (with lower quality), causing the rest of the team to have to: fix the (mis/ab)users mistakes, and deal with the political fallout of appearing to be slacking relative to the (mis/ab)user
- mismanagement of prescriptions, either by the prescriber or the prescribee: very easy to slip into psychosis or not understand that you shouldn't "feel" the drugs, and that you don't necessarily need to increase the dosage just because the initial high wore off. If your life is being held together sufficiently well on your current dosage, and whenever you forget to take your meds your life falls apart, then your dosage is perfectly fine. Easy to not realize your sleep has been severely impacted, but is being masked by the stimulants, i.e. you're riding on the edge of "psychosis."
- disregard for lifestyle modifications that synergize with ADHD and medications (e.g. good sleep hygiene, better diet, regular exercise, meditation, etc.)
We both know that's not the most charitable, good-faith interpretation of my comment.
I think I've made it clear that I have personal experience in this area; but if it wasn't, I'll add in a disclaimer: I've been diagnosed with ADHD as a child; I have taken and continue to take stimulant medication. I've been through the ringer, passed around from one mental health professional to another -- along with personal research and experimentation.
I do not like stimulants. I think they are useful for masking unresolved underlying issues, where necessary. Other times, I detest their usage as PEDs in the workplace.
I think there are better ways to "treat" ADHD. Unfortunately, many times one does not have the resources or information to do so well.
Currently I'm working through CPTSD treatment to resolve what is essentially a constant inability to relax or focus, or maintain a "productive" and "well put together" life, or not self-destruct every time things take a poor turn. If you're being treated for ADHD solely by stimulant medications, I would urge you to explore further.
Bingo. These conditions were almost non-existent until recent history and have risen sharply with white collar employment/globalization. Hell, the "father of ADHD" even said it was made up on his deathbed - https://www.snopes.com/fact-check/work-of-fiction/
> These conditions were almost non-existent until recent history
That's a myth, actually. ADHD has been studied and described for well over 100 years under different names: "Clumsy Child Syndrome", "Minor Brain Damage", and "Moral Failing".
Being present in medical literature for over a century actually makes it one of the better known mental medical conditions.
Saying that only people with ADHD should get ADHD medication sounds similar to me as saying that people who are shit at sports should be allowed to use exogenous testosterone so that they are able to compete. As far as I've understood, ADHD medication works the same way whether you have ADHD or not. In my analogy, the only difference between sports performance and ability to focus is that we don't call bad sport performance a "Muscle Deficiency Disorder" because we lack renounce the idea that everyone should be able to perform at the top level in sports.
It’s easy to get medication because you don’t have ADHD (or are high functioning). The rules that have formed around ADHD medication are designed to prevent abuse, but in reality are one huge ADHD obstacle course that is incredibly difficult to navigate for someone who actually has ADHD.
Many of the steps you take to get on medication when you don’t need it seem trivial. To someone with ADHD, each of those steps is a barrier that they have a high chance of failing to clear because they “just forget” or “don’t follow up.”
Needing to setup and coordinate appointments amplified by the regular required checkins, the monitoring of “steady use” in filling your prescriptions, on-again off-again potentially impacting your eligibility. Needing to coordinate migrating your entire diagnoses and treatment history over (including childhood) to get a new prescription from a new doctor. Etc.
I don’t like being on ADHD medication because of the side-effects and the impact on how I communicate. So I frequently fall off the wagon. As soon as I’m off my prescription, the obstacle course starts over and I have to navigate it to get back on my medication.