The Myth of ADHD as a Mental Disease

Image courtesy of Psychology Today

A very bold statement, I know, but one I fully believe the evidence supports.  The diagnosis of children with ADHD is growing every year in America and Canada and similar beliefs are starting to infect the rest of the world (as most things coming from the US have a tendency to do).  You could argue this is because no one understood it before and so now we are more aware.  You could also argue, as I do, that it’s because it doesn’t really exist.  Biological explanations such as genetics or neurochemical imbalances are more the realm of pop psychology and drugs designed to adjust those balances are an unnecessary cost that does not permanently address the issue.  This goes for most groupings of behavioral patterns currently defined as mental disorders, not just ADHD.

The spread of the disease model of certain behavioral patterns also has negative effects on how children perceive themselves, on how much responsibility we take for effective change, and for an over-reliance on pharmaceuticals instead of addressing our problems.

Below I’ll show some convincing arguments as to why this is the case, but first a few caveats.  I’m not arguing that the behaviors generally described in the DSM IV are a myth, I’m saying that the conceptualization of these behaviors as a chronic, possibly incurable disease, is not correct.  I’m also not saying that pharmaceutical drugs don’t provide some positive results (especially short-term), I’m saying there are better options for long-term, positive results.

-  My first argument comes from experience.  Working in a domestic abuse shelter, every child there was diagnosed with ADHD, usually among a host of other mental disorders.  We referred to the box of pills each child had as their treasure box since there were so many different pills in each box to be taken at different times throughout the day.  Parents and teachers alike complained that these children couldn’t focus for long periods of time.  Yet, these same children that I was told could not focus in class or at home, would sit and read Harry Potter books for up 2 hours at a time.  They’d read the entire book within days of picking it up.  To me, that states that the lack of focus had far more to do with their interest in the subjects adults wanted them to focus on rather than a general lack of ability to focus.

-  Following from the above, it became very clear to me that environment is key.  It should come as no surprise to most of us that children growing up in troubled homes have a host of behavioral issues.  In the same respect, while I was working at a university daycare, we could almost always tell who the professors’ children were and who the students’ were.  The professors’ children were invariably better behaved and had a stronger background in things like the alphabet or shapes.  It was also not uncommon for some of the more difficult children to come from single-parent homes.  All of this really shows to me that environment has an overriding influence on how children behave.

-  Many mental disorders, or at least their manifestations, as defined in the US are culturally bound.  Take for example that anorexia was unheard of in Hong Kong before 1994, but, after foreign newspapers latched onto a story of a girl who died from not eating, cases started popping up all over the place.  Or the fact that mental disorders like koro only exist in some East Asian cultures.  Or how about the fact that schizophrenia is much more common in developed rather than developing nations and that schizophrenia is episodic and disappears over time in developing nations, while in the US schizophrenia is more likley to be non-episodic and lifelong.

Scientific America – Foreign Afflicions:  Mental Disorders across Country Borders

NY Times – The Americanization of Mental Illness

Academia.edu – Schizophrenia across Cultures

PBS – Culture and Schizophrenia

-  Mental States are not defined by genetics.  In pop psychology, the average person’s understanding of genetics is based on a simplistic Mendelian model learned in high school biology class.  However, genetics are far more complicated than what we looked at in the simple pea experiments in our high school text books.  Genes do not determine behavior.  Mutliple genes interact in very complex ways (for example, eye color is determined by at least 3 primary genes and several secondary ones), gene expression is not a guarantee, changes over time, and is affected by outside (environmental) influences.

Stanton Peele – Genetics Can’t Save Us

Genetic Influences on Human Behavior and Development

-  The current argument for ADHD as a mental disease states that it is a result of inherited neurochemical imbalances.  However, there are hundreds of neurochemicals in the brain and they are still largely poorly understood.

Furthermore, neurochemical balances are constantly changing.  We have different balances when happy, sad, mad, etc.  The idea that an “imbalance” is a permanent state is simply not correct.  Additionally, chemical balances do not determine behavior.  For example, when someone steals your favorite pencil, you may get angry.  However, how you deal with that anger will vary by individual.  Some people will yell, others may get physical, others will hold a grudge, and others will talk it out.  In fact, how we deal with that anger and to what level we allow it to be expressed are all controllable.  The same goes for focus or any other mental practice.

Linking the influence of environment over determinstic biological explanations, we can look at alcoholism rates in some Native American tribes vs. some East Asian Americans.  Interestingly enough, some members of both ethnic groups lack a certain enzyme that processes alcohol.  This is why they tend to get drunk quicker and get red in the face when drinking.  However, incidences of alcoholism in some Native American populations, especially on reservations, is much much higher than among East Asian-American groups.

The truest fact about the brain is that it is constantly changing.  As the neurologists say, it’s plastic.  What we learn, the way we learn, how we behave, all these things can change depending on our internal and external environment.  Schizophrenia is a well-researched example that proves the point.  Despite many Americans viewing it as a permanent illness, according to one study, 58% of schizophrenics had a full long-term recovery after treatment.

Ultimately, there is not a single piece of evidence that has been shown that can physically identify a brain with a mental disorder from one without.  That’s why the DSM classifies disorders by groups of behaviors, not medically testable criteria.

The Huffington Post – Are Addiction and Mental Illness Really Brain Diseases?

National Empowerment Center – Evidence that People Recover from Schizophrenia

Pseudoscience in Psych

-  My final argument is actually a counter argument.  Some of the greatest supporters of disease models are the diagnosed themselves.  It’s not uncommon for those with ADHD or Depression to cite the drugs as a huge help in their life.  As I mentioned above, it’s not that psychiatric drugs can’t help individuals attain a place to more easily address their issues, it’s that we can come to rely on them without addressing the real problem or building the skills to change our mental states in the future.  Like in my example from the domestic abuse shelter, medicating the children will not address the problems occurring at home nor teach the child how to better deal with those issues in healthy ways.  People drink alcohol to forget about their problems, too; it doesn’t mean it’s a good idea.  It’s easy enough to go through life using alcohol or other drugs to cope with difficult situations, but it doesn’t help actually solve the problem.  In the same way, drugs like Ritalin can help us focus, but they don’t help us develop the skills we need to do so on our own.

Additionally, there is very little evidence that current drugs prescribed for various mental disorders have any strong positive effects.  Stanton Peele points out that studies which use a psychoactive placebo indicate an average of 5% increase in positive behavioral outcomes vs. the actual drug.  That’s not much and it’s a pretty strong argument that mental outlook goes a long way to changing behavior.  As further evidence, there are a number of rigorously conducted studies that indicate positive results from cognitive behavioral therapies that didn’t use psychiatric drugs.

Psychology Today – Can Talk Therapy Help Persons with Schizophrenia

What’s really tough with all of this is that it puts the responsibility for children’s behavior on the main role models in their life, mostly the parents and teachers.  Taking responsibility for something we perceive as negative is never easy, but the truth is not always the easiest pill to swallow.  For adults (in cases like adult ADHD), it puts the responsibility on us and the loved ones in our life.

To summarize, I’m not denying that behaviors associated with ADHD or other disorders exist, but that they are simply behaviors or mental states that we can change with the help of those around us, just like any other behavior, emotion, or attitude.  Maybe in the future psychiatric drugs can help as one part of a treatment plan, but we currently don’t have enough evidence to support such use and it’s clear that traditional support and counseling can work better.  For children or anyone else to be healthy, contributing members of society, we need people who take responsibility for themselves and others, who can solve problems on their own, and who can develop the skills that will help them throughout their lives.

Now it’s your turn.  What do you think and what research do you have to support your opinions?

More Further Reading and References:

Prozac Nation – An Interview with Lawrence Kirmayer on Mental Illness across Cultures

Washington Post – Culture and Mental Illness

Science Daily – No Single Gene for Eye Color

Genetic Influences on Alcohol Drinking and Alcoholism

ADHD is  Myth with Professor Spillane

Joel Turtel – The Myth of ADHD

BBC – Louis Theroux Looks at America’s Prescription Culture

The Onion’s take on things