Perhaps some of these reasons, ranging from the basic controversy of whether it exists at all through a variety of controversies over treatment and diagnosis. Growing up in the UK I guess I’m influenced by the British opinion described there:
The British Psychological Society said in a 1997 report that physicians and psychiatrists should not follow the American example of applying medical labels to such a wide variety of attention-related disorders: “The idea that children who don’t attend or who don’t sit still in school have a mental disorder is not entertained by most British clinicians.”
Although the article goes on to say that more recently they appear to have accepted that it may be a real condition.
That’s the reason. It’s more debatable if ADHD even exists, and especially controversial given the high rate of medicating children diagnosed with ADHD.
Does the belief that ADHD does or does not exist pay rent? Psychiatric diagnoses are the map; patterns of thought are territory. Society has certain rules that can make it expedient or inexpedient to call a particular similarity cluster a “disease” or “medical condition”, but what really matters is whether a given intervention (medication, psychotherapy, etc.) is or isn’t beneficial.
Does the belief that ADHD does or does not exist pay rent?
A little bit, in as much people who say “ADHD does not exist” are reliably more ignorant on the subject than people who say “ADHD does exist”. It’s far from the ideal way to carve reality but it isn’t completely useless.
What on Earth made you think this is some argument? I was making an observation, that I don’t see why he is fearful of quacks/homeopaths/nutritionists here, this seems like the last place you could find them.
People who assume everything on the Internet is an argument, well it says a lot about them.
I suspect we may attach different meanings to the word “argument”. I meant only “a contribution to a useful discussion”.
mattnewport linked to a section of a Wikipedia article discussing controversies about ADHD, which itself links to a longer Wikipedia article devoted to those controversies. The references there (some hundreds) make it clear that there are in fact controversies about ADHD, even among professionals within the field of psychiatry. Your response is merely to claim that:
ADHD is controversial only among anti-rationalists
I can’t even tell from that whether you think there is such a condition or there isn’t.
Yes, I’m sorry, I had a mini-panic episode. It’s absurd for me to react in these ways, all my posting so far was automatic talk which I didn’t actually think. I’m still recovering from years of untreated anxiety and ADHD. I will post something coherent when I’m better.
I upvoted all your comments, and I understand completely: you’re saying that ADHD is an accepted clinical diagnosis and that you don’t think people here would agree with the bizarre, lunatic-fringe conspiracy theory that it’s just a way of drugging kids who misbehave. Unfortunately, there are even people here who believe in 9/11 conspiracies, so don’t get your hopes too high.
you’re saying that ADHD is an accepted clinical diagnosis and that you don’t think people here would agree with the bizarre, lunatic-fringe conspiracy theory that it’s just a way of drugging kids who misbehave.
Unfortunately, it is both. There are people who have a real clinical disorder who need drugs. But there are also people who are getting diagnosed with ADD or ADHD with minimal justification.
But there are also people who are getting diagnosed with ADD or ADHD with minimal justification.
At a greater rate than for other disorders? Any diagnosis will have a possibility of error, but that’s different than calling into question the entire disorder, which is what the conspiracy theories try to do.
At a greater rate than for other disorders? Any diagnosis will have a possibility of error, but that’s different than calling into question the entire disorder, which is what the conspiracy theories try to do.
Right. I’m not calling the disorder’s existence in question (people who do so are being stupid), but the extreme difference in European and American diagnosis rates suggests that the US has a very high overdiagnosis rate. I don’t think it is useful to compare it to diagnosis rates in other disorders since many other disorders have much more clear cut standards for diagnosis. I don’t know if ADHD has a higher level of incorrect diagnosis compared to other mental health disorders.
the extreme difference in European and American diagnosis rates suggests that the US has a very high overdiagnosis rate
Why wouldn’t it suggest that Europe has a very high underdiagnosis rate?
I don’t think it is useful to compare it to diagnosis rates in other disorders since many other disorders have much more clear cut standards for diagnosis.
Good point; mental disorders are much more blurry. I’m curious, for instance, if there is an ADHD spectrum, like the autism spectrum, and if it blends into normality, or if there is a sharp divide between NTs and people with some degree of ADHD.
Why wouldn’t it suggest that Europe has a very high underdiagnosis rate?
Exactly what I thought when I read the argument in question.
If the studies referenced in the back of Hallowell are to be believed the prevalence of ADHD has been found to between 5% and 8% across 5 continents.
To paraphrase a FAQ in the same source: Is ADHD over-diagnosed or under-diagnosed? Unfortunately, both. In some regions it is over-diagnosed and over-medicated but in others it is underdiagnosed because people (teachers, parents or doctors) “don’t believe in ADHD”.
Good point; mental disorders are much more blurry. I’m curious, for instance, if there is an ADHD spectrum, like the autism spectrum
Very much a spectrum, in a similar way to an autism spectrum. In fact, a majority of people who qualify for an autism diagnosis would qualify for an ADHD diagnosis too if they didn’t have the autism label already.
, and if it blends into normality, or if there is a sharp divide between NTs and people with some degree of ADHD.
There is no sharp divide. There are also many people who have ADHD traits in the extreme who would not be said to have ADHD because their personality (and brain functioning in general) is not interfering with their life. So roughly speaking ADHD means having a certain cluster of traits to a significant degree greater than average or in a way that obviously interferes with your life.
Why wouldn’t it suggest that Europe has a very high underdiagnosis rate?
My conclusion in that regard is based to some extent on anecdotal evidence in that I’ve seen in the US people diagnosed where it seemed clear that they didn’t. I’m aware of multiple cases where a diagnosis was essentially an excuse to get Ritalin as a study aid.
I’m aware of multiple cases where a diagnosis was essentially an excuse to get Ritalin as a study aid.
I wholeheartedly advocate the gaming of the medical system to get what you need or want out of them. Both because i disrespect the competence of that system in giving people what they need and because the institutions and lobby groups in question have no intrinsic right to control access to treatments or collect rent in the process.
My advice to all moderately intelligent patients is to have one (or multiple) doctors that you use for their expertise and another doctor that you go to to get then to scribble on those ridiculous pieces of paper. The latter you lie to as necessary if it helps you jump through the hoops more efficiently.
My advice to all moderately intelligent patients is to have one (or multiple) doctors that you use for their expertise and another doctor that you go to to get then to scribble on those ridiculous pieces of paper. The latter you lie to as necessary if it helps you jump through the hoops more efficiently
Lying to doctors is in general a very bad idea. Lying to them about what drugs you are taking is dangerous. Part of their job is so know what drugs will interact with what other drugs or diseases. Lying to doctors makes them much less likely to be able to do that well.
You could always just tell the truth to your pharmacist. Short of concerns about abortion or birth control, they’re much less likely to impose their moral judgments on you, and collect next to nothing in the way of economic rents.
You don’t have to outright lie, just emphasize different symptoms. For instance, on a diagnostic questionnaire for ADHD, depression, or autism, I could score very high or very low and remain completely honest, just by interpreting the questions in slightly different ways.
Agree, and I expect many people do this unconsciously, primed by whatever their own thoughts are on the subject or what condition they have been primed to consider.
Another way I have ‘not lied’ to doctors is to go to a new doctor and say that I had run out of my existing supply and needed a new prescription. This is true, in as much as I originally got my drugs online, outside of the control of the establishment, passing through customs courtesy of lead lined envelopes. Having confirmed the usefulness of the substance it was then worth jumping through hoops to get a cheaper and hassle free source.
Another way I have ‘not lied’ to doctors is to go to a new doctor and say that I had run out of my existing supply and needed a new prescription.
I would imagine many doctors are on to this, though, especially for drugs like Adderall that people frequently sell on the black market. Does this often work?
I would imagine many doctors are on to this, though, especially for drugs like Adderall that people frequently sell on the black market. Does this often work?
It hasn’t failed me yet. But this relies on a specialized kind of social influence that I somehow seem to be very good at.
In any case getting what you want out of a doctor doesn’t seem to all that difficult (and, barring actual safety risks, nor should it!) The main reason I use an “I need a repeat” approach is that doctors tend to have their own ‘default’ preference they like out of the various options and they sometimes get all insecure and consider it a social challenge if you want a different drug. Say, vyvanse rather than Ritalin or escitalopram rather than fluoxetine (or, god forbid, venlafaxine!). It is just so much easier to frame the request as ‘resupply’ rather than ‘diagnosis’. Especially when the doctor clearly does not understand what the difference is between the drugs or what the modern research suggests. You need a way to get the right outcome without stepping on the poor old guy’s toes.
Another useful and harmless lie is “My sister has been using Tianeptine and it really worked for her. She’s the one who convinced me that I should consider treatement, etc” Throw in the body language of someone who is wary of the whole process and hesitant to concede that they need treatment. For some reason this works better than “Don’t give me SSRIs. SSRIs suck balls for depression with anxiety. Except stuff like venlafaxine that seriously mess you up with ‘discontinuation syndrome’ when you try to come off them. Tianeptine is way better, especially for the anxiety side of things and not only that, it has a much better side effect profile.”
I would imagine many doctors are on to this, though, especially for drugs like Adderall that people frequently sell on the black market. Does this often work?
It hasn’t failed me yet. But this relies on a specialized kind of social influence that I somehow seem to be very good at.
In any case getting what you want out of a doctor doesn’t seem to all that difficult (and, barring actual safety risks, nor should it!) The main reason I use an “I need a repeat” approach is that doctors tend to have their own ‘default’ preference they like out of the various options and they sometimes get all insecure and consider it a social challenge if you want a different drug. Say, vyvanse rather than Ritalin or escitalopram rather than fluoxetine (or, god forbid, venlafaxine!). It is just so much easier to frame the request as ‘resupply’ rather than ‘diagnosis’. Especially when the doctor clearly does not understand what the difference is or what the modern research suggests and you need a way to get the right outcome without stepping on the poor old guy’s toes.
Another useful and harmless lie is “My sister has been using Tianeptine and it really worked for her. She’s the one who convinced me that I should consider treatement, etc” Throw in the body language of someone who is wary of the whole process and hesitant to concede that they need treatment. For some reason this works better than “Don’t give me SSRIs. SSRIs suck balls for depression with anxiety. Except stuff like venlafaxine that seriously mess you up with ‘discontinuation syndrome’ when you try to come off them. Tianeptine is way better, especially for the anxiety side of things and not only that has a much better side effect profile.”
Lying to doctors is in general a very bad idea. Lying to them about what drugs you are taking is dangerous. Part of their job is so know what drugs will interact with what other drugs or diseases. Lying to doctors makes them much less likely to be able to do that well.
I have made it clear that I do not share your faith in the medical priesthood. Adding to what Mass Driver has already said I will suggest that pharmacists are also a whole lot better (on average) than doctors at avoiding potentially dangerous drug combinations.
I make that conclusion partly based on what I discovered while working in medical education. You know, trying to teach evidence based practices to a bunch of middle aged men (for example) who happened to have done a medical degree 25 years ago and since then have been too busy to significantly educate themselves beyond what they read in the edu-tisements from the pharmaceuticals. But if you prefer anecdotal evidence I have personally had to tell a doctor “No, you can’t give me that, I will get Seratonin Syndrome and I will die.) My pharmacology professor also deal with a doctor who was trying to medicate his daughter with a drug that was known to interfere with his daughter’s medical condition. He had to warn the doctor “No. No, it’s NOT safe. If you do not change this prescription I will sue you. By the way, I have a PhD in Pharmacology.”
Doctors are just people. If you want to ensure your optimal health, and your safety you need to take personal responsibility for your own medical treatments. As I originally suggested this will involve finding competent experts you can trust (and even doctors go to other doctors). But it doesn’t mean you are best off submitting to whatever treatment has managed to make (or buy) its way into being the default mainstream practice.
Seeing doctors is primarily about a ritual affiliation with high status people, not about optimal health. When it comes to everyday things like treating infections and identifying common maladies I will take a doctor at his or her word. It is something they deal with every day and deal with well. But when it comes to any psychological condition or any condition that is uncommon you need to both shop around and to do your own research. It is often easy to find correct contrarians. Usually this is either because a) Medical practice has not caught up with research, b) optimal treatment is not in patent, c) formalized traditions (eg. performance metrics) make the payoff for doctors different from optimally treating patients or d) the “nobody ever got fired for buying IBM” effect.
The anecdotes with finding situations where doctors make serious errors could be well counter-balanced with the cases where a misguided patient’s research effort turned up a solution that has an equally bad effect. It’s not at all clear that on the net, serious personal research into a case by a non-doctor is better than a decision of an average doctor. Especially considering that in the more important cases (assuming you recognize the importance), you can ask several doctors independently.
You seem to be assuming a degree of knowledge about medicine that most humans do not have the time, ability or resources to obtain. You also seem to be attacking a strawman argument. I haven’t argued that “you are best off submitting to whatever treatment has managed to make (or buy) its way into being the default mainstream practice” but rather that actively lying to doctors is a bad idea. And I’d extend that to any other common profession that involves expertise. Lying to your lawyer? Bad idea? Lying to your car mechanic? Bad idea. This isn’t an argument related to the apparently high status of doctors. But simply put, most of us do not have the resources to investigate every single detail (just as we can’t all be competent lawyers or car mechanics or plumbers), and actively lying to those people will frequently create problems.
I’m aware of multiple cases where a diagnosis was essentially an excuse to get Ritalin as a study aid.
If someone would benefit from Ritalin as a study aid, doesn’t that mean that they have difficulty focusing and studying as much as they would like? Isn’t that essentially what ADHD is?
If someone would benefit from Ritalin as a study aid, doesn’t that mean that they have difficulty focusing and studying as much as they would like? Isn’t that essentially what ADHD is?
That’s not the definition of ADHD as it is normally defined. Indeed, many (if not most) humans would be more focused if they took Ritalin. But using it so that one can for example waste a few months and then spend 72 hours cramming for a test definitely doesn’t count as ADHD by most reasonable definitions.
But using it so that one can for example waste a few months and then spend 72 hours cramming for a test definitely doesn’t count as ADHD by most reasonable definitions.
In fact, that is something that comes naturally to many people ADHD. “Attention Deficit” would often be better described as “attention variability”. Many of us with ADHD also benefit from overfocus. This can mean extended periods (particularly when under pressure) of enhanced attention that can mean performance well beyond that of a ‘normal’ person with similar IQ.
Ironically, where a neurotypical person may use amphetamines to pump themselves up or so they can waste a few months then cram for 72 hours an ADHD individual would use amphetamines to calm themselves down and so they don’t spend a few months wasting time and then have to cram for 72 hours.
ETA: I agree that the vast majority of people will benefit from Ritalin or Adderall when studying, at least for things that require rote learning or rigid thinking (ie. most exams). Which reminds me—if you want to identify ways to enhance brain function in healthy people a good place to start looking for leads is by browsing the treatments for Alzheimer’s.
Ironically, where a neurotypical person may use amphetamines to pump themselves up or so they can waste a few months then cram for 72 hours an ADHD individual would use amphetamines to calm themselves down and so they don’t spend a few months wasting time and then have to cram for 72 hours.
This sounds pretty binary to me. I’ve heard things like this before, that ADHD medications have opposite effects on people without ADHD. How, then, does the ADHD spectrum work? Are we talking about two different types of brains, or is there a whole spectrum, and how do the medications work on people in the middle of the spectrum?
Perhaps, but it could just be an observation selected for irony and salience and presented in a context where writing an essay on all the complex nuances underlying the situation would not be appropriate.
I’ve heard things like this before, that ADHD medications have opposite effects on people without ADHD. How, then, does the ADHD spectrum work? Are we talking about two different types of brains, or is there a whole spectrum, and how do the medications work on people in the middle of the spectrum?
There are some who make such claims and I would suggest they do not have a naive understanding. As you put it, binary thinking, oversimplified and the sort of thing people present as an opinion and can even operate with effectively despite the fundamental confusion. You will note that in my claim I was careful to include a few intrusive yet important differences so as to satisfy my preference for technical accuracy without getting bogged down in caveats.
Allow me to address a few issues relevant to the examples in question:
What is in a Symptom? Let’s face it. Most ADHD diagnoses are essentially for “Can’t Sit Still and Will Not Do What He Is Told Disorder”. (Unfortunately this means that those people with ADHD who manage to not be a pain in the ass of a suitable authority are often neglected by the system.)
Now, what causes kids to not be able to sit still or adequately seek the approval of authority? Well, one thing is an under-functioning frontal lobe that can not adequately control inhibitions and maintain focus without sufficient stimulus. Ritalin helps boost frontal lobe function; (the teacher’s) problem solved.
What behavior do I expect from people who are abusing methamphetamine for recreational purposes? Well, among other things, excessive energy and aggression. ie. Sitting still and being compliant isn’t a likely outcome but for entirely different reasons than the aforementioned ADHD kid.
How it is used matters. How does an ADHD kid use Ritalin to help him study ahead of time so he doesn’t rely on 72 hours of cramming? He takes small doses regularly over time too boost motivation and attention control when he wants to study. How does someone use Ritalin to cram for 72 hours once they have wasted time for months? They take heavy doses of the stuff to override the need for sleep and maintain some semblance of mental function while they are abusing their mind and body. So the contrast in outcomes is salient, but it is in no way magical.
The inverted J With most drugs (and supplements and even lifestyle choices) having too much, even of a good thing, is worse than none at all. This also applies to brain activity. If you look at SPECT scans of brain activity in ADHD individuals compared to normal individuals you can expect to see significantly less activity in key areas of the brain in most of the ADHD individuals compared to the normal samples. Meanwhile a smaller subset of the ADHD individuals will have significantly more activity in the same areas. They display the symptom of difficulty in maintaining normal attention despite having (very loosely speaking) approximately the opposite cause. Assuming (again, extremely rough reasoning) the optimal level of activity is somewhere between the ‘normal’ level and the ‘overfocussed’ level we can expect moderate Ritalin doses to help most ADHD people a lot, normal people a little and be detrimental in any amount for the overfocussed group. If an excessive dose is given to any of the groups I would expect “ADHD like” symptoms of hyperactivity and inappropriate focus on tasks and contrary behavior, independently of base state.
Stimulants and Anxiety Anxiety and stress are typically direct effect of stimulant use, to at least some degree. They’re stimulants. That is like… the opposite of being ‘calm’. Yet ADHD sufferers sometimes (definitely not all the time) report that stimulants calm them down. Bogus? Not really. Humans are rather good at adapting to their circumstances. Many people with untreated or undiagnosed ADHD cope by working a whole heap harder to achieve what their peers do naturally. They make huge demands on themselves. Anxiety, stress and adrenalin act as the stimulant they need to maintain focus. It works. But if you give them some Adderall their brain quickly realizes “hey… I am functioning well enough that I don’t need to abuse my amygdala and adrenals just to maintain baseline”. That can be huge weight off their shoulders. Amphetamine is a whole lot less anxiety producing than having ADHD traits in an environment that is extremely toxic to you (such as a classroom or office.)
Thanks Nancy, I’ve made a note of that just so I can reference the diagrams.
ETA: And taking a glance at the article he references I now share his outrage. She lists many of the benefits of treatment, the consequences of not having treatment and then goes and explains that she denies access to treatment for her children. Letting that woman reproduce was a crime against humanity. There are very few things I call unmitigated evil but for some reason this is one of them.
I suspect you’re ranting, but I’ll bring up some practical issues.
I doubt it’s possible (except, perhaps in some extreme cases) to tell years in advance what people’s child-raising policies will be.
I’d be extremely cautious about giving an authority permission to say who will reproduce and who won’t.
And I’m tempted to reread her earlier hovels (as Megan Lindholm) to see whether there was a weird authoritarianism (she’s also come out strongly against most fanfiction in them.
It would be more reasonable to read (or reread) her more recent work, except that I got bored by it after the first trilogy, while I liked the earlier stuff.
I suspect you’re ranting, but I’ll bring up some practical issues.
I’m wouldn’t call it ‘ranting’ but I certainly don’t expect “should not be allowed to reproduce” to be taken literally, nor do I often (ever?) observe cases where people mean such claims as anything other than “I disapprove of that behavior and the type of genetic or cultural heritage that produces it”.
But following up on on the topic of eugenics. Any authority who considered they had the right to say who will reproduce and who will not is unlikely to pass my ‘kill test’. That is to say I would (if convenient) kill them. And kill anyone who tried to stop me from killing them if necessary. The means by which they gained the power in question would not necessarily matter (ie. it would not pass the kill test just because people voted on it).
Mind you, there are situations in which I would approve of eugenics. Most of them do not involve ‘authority’ in any conventional human sense. For example… bizarre situations in which:
FAI is not possible (or available in time)
I personally have access to advanced nanotechnology (eg. I have an Asgard core
There is something which provokes the need for me to take overwhelming unilateral action.
If reproduction is not limited it will contribute to existential threat. Perhaps:
Unconstrained breeding will produce people who are likely to create a uFAI before an FAI is possible.
We are progressing along the inevitable competitive equilibrium of a hardscrabble frontier.
Unconstrained breeding will result in humans devolving and losing that which is valuable about our species (with current selection pressure it probably would, not that it matters.)
Without breeding constraints (either number or in quality) humanity will not even survive to reach for the stars or use the universe in some sort of eudemonic manner.
Basically I consider the ability to dictate reproduction over the course of several generations to be equivalent to seizing absolute control and forming a stable singularity. And then act accordingly.
I suspect you’re ranting, but I’ll bring up some practical issues.
I’m wouldn’t call it ‘ranting’ but I certainly don’t expect “should not be allowed to reproduce” to be taken literally, nor do I often (ever?) observe cases where people mean such claims as anything other than “I disapprove of that behavior and the type of genetic or cultural heritage that produces it”.
But following up on on the topic of eugenics. Any authority who considered they had the right to say who will reproduce and who will not is unlikely to pass my ‘kill test’. That is to say I would (if convenient) kill them. And kill anyone who tried to stop me from killing them if necessary. The means by which they gained the power in question would not necessarily matter (ie. it would not pass the kill test just because people voted on it).
Mind you, there are situations in which I would approve of eugenics. Most of them do not involve ‘authority’ in any conventional human sense. For example… bizarre situations in which:
FAI is not possible (or available in time)
I personally have access to advanced nanotechnology (eg. I have an Asgard core
There is something which provokes the need for me to take overwhelming unilateral action.
If reproduction is not limited it will contribute to existential threat. Perhaps one of:
Unconstrained breeding will produce people who are likely to create a uFAI before an FAI is possible.
We are progressing along the inevitable competitive equilibrium of a hardscrabble frontier.
Unconstrained breeding will result in humans devolving and losing that which is valuable about our species (with current selection pressure it probably would, not that it matters.)
Without breeding constraints (either number or in quality) humanity will not even survive to reach for the stars or use the universe in some sort of eudemonic manner.
Basically I consider the ability to dictate reproduction over the course of several generations to be equivalent to seizing absolute control and forming a stable singularity. And then act accordingly.
Thanks for going into so much detail about this. Good point about the stimulants relieving anxiety. So according to this explanation, it’s not that people with ADHD have a different brain chemistry that makes stimulants affect them differently, it’s that the focus from stimulants relieves more anxiety than the stimulants create.
How does someone use Ritalin to cram for 72 hours once they have wasted time for months? They take heavy doses of the stuff to override the need for sleep and maintain some semblance of mental function while they are abusing their mind and body.
I’m not sure that terms like “waste time” and “abuse” are fair in that situation. Someone who has problems focusing, who may have mild ADHD, may have had trouble studying for months, and then take the Ritalin to try to study. This may not be as effective as taking the medication every day, but it’s an attempt to self-medicate and deal with the problem.
If you look at SPECT scans of brain activity in ADHD individuals compared to normal individuals you can expect to see significantly less activity in key areas of the brain in most of the ADHD individuals compared to the normal samples. Meanwhile a smaller subset of the ADHD individuals will have significantly more activity in the same areas.
Is this related to the two types of ADHD (inattentive and hyperactive)? Would a central nervous system depressant then actually be effective for the “overfocused” group?
Perhaps some of these reasons, ranging from the basic controversy of whether it exists at all through a variety of controversies over treatment and diagnosis. Growing up in the UK I guess I’m influenced by the British opinion described there:
Although the article goes on to say that more recently they appear to have accepted that it may be a real condition.
That’s the reason. It’s more debatable if ADHD even exists, and especially controversial given the high rate of medicating children diagnosed with ADHD.
ADHD is controversial only among anti-rationalists, and this is a place for rationalists to gather so… I’m not sure why you said that.
Does the belief that ADHD does or does not exist pay rent? Psychiatric diagnoses are the map; patterns of thought are territory. Society has certain rules that can make it expedient or inexpedient to call a particular similarity cluster a “disease” or “medical condition”, but what really matters is whether a given intervention (medication, psychotherapy, etc.) is or isn’t beneficial.
A little bit, in as much people who say “ADHD does not exist” are reliably more ignorant on the subject than people who say “ADHD does exist”. It’s far from the ideal way to carve reality but it isn’t completely useless.
He said why: the reasons that mattnewport linked to.
But you have given no reason for your opposite view. (Calling people “anti-rationalists” is not an argument.)
What on Earth made you think this is some argument? I was making an observation, that I don’t see why he is fearful of quacks/homeopaths/nutritionists here, this seems like the last place you could find them. People who assume everything on the Internet is an argument, well it says a lot about them.
I suspect we may attach different meanings to the word “argument”. I meant only “a contribution to a useful discussion”.
mattnewport linked to a section of a Wikipedia article discussing controversies about ADHD, which itself links to a longer Wikipedia article devoted to those controversies. The references there (some hundreds) make it clear that there are in fact controversies about ADHD, even among professionals within the field of psychiatry. Your response is merely to claim that:
I can’t even tell from that whether you think there is such a condition or there isn’t.
If after my reply you still can’t tell, then I’d better not post here. It’s better for both me and this community.
Someone other than me should say this, but: please don’t let one person drive you away.
It’s just that the comments you’ve made so far on LW are all at least a step removed from actually telling what you think and why.
Yes, I’m sorry, I had a mini-panic episode. It’s absurd for me to react in these ways, all my posting so far was automatic talk which I didn’t actually think. I’m still recovering from years of untreated anxiety and ADHD. I will post something coherent when I’m better.
I upvoted all your comments, and I understand completely: you’re saying that ADHD is an accepted clinical diagnosis and that you don’t think people here would agree with the bizarre, lunatic-fringe conspiracy theory that it’s just a way of drugging kids who misbehave. Unfortunately, there are even people here who believe in 9/11 conspiracies, so don’t get your hopes too high.
Unfortunately, it is both. There are people who have a real clinical disorder who need drugs. But there are also people who are getting diagnosed with ADD or ADHD with minimal justification.
At a greater rate than for other disorders? Any diagnosis will have a possibility of error, but that’s different than calling into question the entire disorder, which is what the conspiracy theories try to do.
Right. I’m not calling the disorder’s existence in question (people who do so are being stupid), but the extreme difference in European and American diagnosis rates suggests that the US has a very high overdiagnosis rate. I don’t think it is useful to compare it to diagnosis rates in other disorders since many other disorders have much more clear cut standards for diagnosis. I don’t know if ADHD has a higher level of incorrect diagnosis compared to other mental health disorders.
Why wouldn’t it suggest that Europe has a very high underdiagnosis rate?
Good point; mental disorders are much more blurry. I’m curious, for instance, if there is an ADHD spectrum, like the autism spectrum, and if it blends into normality, or if there is a sharp divide between NTs and people with some degree of ADHD.
Exactly what I thought when I read the argument in question.
If the studies referenced in the back of Hallowell are to be believed the prevalence of ADHD has been found to between 5% and 8% across 5 continents.
To paraphrase a FAQ in the same source: Is ADHD over-diagnosed or under-diagnosed? Unfortunately, both. In some regions it is over-diagnosed and over-medicated but in others it is underdiagnosed because people (teachers, parents or doctors) “don’t believe in ADHD”.
Very much a spectrum, in a similar way to an autism spectrum. In fact, a majority of people who qualify for an autism diagnosis would qualify for an ADHD diagnosis too if they didn’t have the autism label already.
There is no sharp divide. There are also many people who have ADHD traits in the extreme who would not be said to have ADHD because their personality (and brain functioning in general) is not interfering with their life. So roughly speaking ADHD means having a certain cluster of traits to a significant degree greater than average or in a way that obviously interferes with your life.
My conclusion in that regard is based to some extent on anecdotal evidence in that I’ve seen in the US people diagnosed where it seemed clear that they didn’t. I’m aware of multiple cases where a diagnosis was essentially an excuse to get Ritalin as a study aid.
I wholeheartedly advocate the gaming of the medical system to get what you need or want out of them. Both because i disrespect the competence of that system in giving people what they need and because the institutions and lobby groups in question have no intrinsic right to control access to treatments or collect rent in the process.
My advice to all moderately intelligent patients is to have one (or multiple) doctors that you use for their expertise and another doctor that you go to to get then to scribble on those ridiculous pieces of paper. The latter you lie to as necessary if it helps you jump through the hoops more efficiently.
Lying to doctors is in general a very bad idea. Lying to them about what drugs you are taking is dangerous. Part of their job is so know what drugs will interact with what other drugs or diseases. Lying to doctors makes them much less likely to be able to do that well.
Accurate Assessment is what the first few doctors are for; the doctor you lie to is explicitly only there for the sake of getting drugs.
You could always just tell the truth to your pharmacist. Short of concerns about abortion or birth control, they’re much less likely to impose their moral judgments on you, and collect next to nothing in the way of economic rents.
You don’t have to outright lie, just emphasize different symptoms. For instance, on a diagnostic questionnaire for ADHD, depression, or autism, I could score very high or very low and remain completely honest, just by interpreting the questions in slightly different ways.
Agree, and I expect many people do this unconsciously, primed by whatever their own thoughts are on the subject or what condition they have been primed to consider.
Another way I have ‘not lied’ to doctors is to go to a new doctor and say that I had run out of my existing supply and needed a new prescription. This is true, in as much as I originally got my drugs online, outside of the control of the establishment, passing through customs courtesy of lead lined envelopes. Having confirmed the usefulness of the substance it was then worth jumping through hoops to get a cheaper and hassle free source.
I would imagine many doctors are on to this, though, especially for drugs like Adderall that people frequently sell on the black market. Does this often work?
It hasn’t failed me yet. But this relies on a specialized kind of social influence that I somehow seem to be very good at.
In any case getting what you want out of a doctor doesn’t seem to all that difficult (and, barring actual safety risks, nor should it!) The main reason I use an “I need a repeat” approach is that doctors tend to have their own ‘default’ preference they like out of the various options and they sometimes get all insecure and consider it a social challenge if you want a different drug. Say, vyvanse rather than Ritalin or escitalopram rather than fluoxetine (or, god forbid, venlafaxine!). It is just so much easier to frame the request as ‘resupply’ rather than ‘diagnosis’. Especially when the doctor clearly does not understand what the difference is between the drugs or what the modern research suggests. You need a way to get the right outcome without stepping on the poor old guy’s toes.
Another useful and harmless lie is “My sister has been using Tianeptine and it really worked for her. She’s the one who convinced me that I should consider treatement, etc” Throw in the body language of someone who is wary of the whole process and hesitant to concede that they need treatment. For some reason this works better than “Don’t give me SSRIs. SSRIs suck balls for depression with anxiety. Except stuff like venlafaxine that seriously mess you up with ‘discontinuation syndrome’ when you try to come off them. Tianeptine is way better, especially for the anxiety side of things and not only that, it has a much better side effect profile.”
It hasn’t failed me yet. But this relies on a specialized kind of social influence that I somehow seem to be very good at.
In any case getting what you want out of a doctor doesn’t seem to all that difficult (and, barring actual safety risks, nor should it!) The main reason I use an “I need a repeat” approach is that doctors tend to have their own ‘default’ preference they like out of the various options and they sometimes get all insecure and consider it a social challenge if you want a different drug. Say, vyvanse rather than Ritalin or escitalopram rather than fluoxetine (or, god forbid, venlafaxine!). It is just so much easier to frame the request as ‘resupply’ rather than ‘diagnosis’. Especially when the doctor clearly does not understand what the difference is or what the modern research suggests and you need a way to get the right outcome without stepping on the poor old guy’s toes.
Another useful and harmless lie is “My sister has been using Tianeptine and it really worked for her. She’s the one who convinced me that I should consider treatement, etc” Throw in the body language of someone who is wary of the whole process and hesitant to concede that they need treatment. For some reason this works better than “Don’t give me SSRIs. SSRIs suck balls for depression with anxiety. Except stuff like venlafaxine that seriously mess you up with ‘discontinuation syndrome’ when you try to come off them. Tianeptine is way better, especially for the anxiety side of things and not only that has a much better side effect profile.”
I have made it clear that I do not share your faith in the medical priesthood. Adding to what Mass Driver has already said I will suggest that pharmacists are also a whole lot better (on average) than doctors at avoiding potentially dangerous drug combinations.
I make that conclusion partly based on what I discovered while working in medical education. You know, trying to teach evidence based practices to a bunch of middle aged men (for example) who happened to have done a medical degree 25 years ago and since then have been too busy to significantly educate themselves beyond what they read in the edu-tisements from the pharmaceuticals. But if you prefer anecdotal evidence I have personally had to tell a doctor “No, you can’t give me that, I will get Seratonin Syndrome and I will die.) My pharmacology professor also deal with a doctor who was trying to medicate his daughter with a drug that was known to interfere with his daughter’s medical condition. He had to warn the doctor “No. No, it’s NOT safe. If you do not change this prescription I will sue you. By the way, I have a PhD in Pharmacology.”
Doctors are just people. If you want to ensure your optimal health, and your safety you need to take personal responsibility for your own medical treatments. As I originally suggested this will involve finding competent experts you can trust (and even doctors go to other doctors). But it doesn’t mean you are best off submitting to whatever treatment has managed to make (or buy) its way into being the default mainstream practice.
Seeing doctors is primarily about a ritual affiliation with high status people, not about optimal health. When it comes to everyday things like treating infections and identifying common maladies I will take a doctor at his or her word. It is something they deal with every day and deal with well. But when it comes to any psychological condition or any condition that is uncommon you need to both shop around and to do your own research. It is often easy to find correct contrarians. Usually this is either because a) Medical practice has not caught up with research, b) optimal treatment is not in patent, c) formalized traditions (eg. performance metrics) make the payoff for doctors different from optimally treating patients or d) the “nobody ever got fired for buying IBM” effect.
The anecdotes with finding situations where doctors make serious errors could be well counter-balanced with the cases where a misguided patient’s research effort turned up a solution that has an equally bad effect. It’s not at all clear that on the net, serious personal research into a case by a non-doctor is better than a decision of an average doctor. Especially considering that in the more important cases (assuming you recognize the importance), you can ask several doctors independently.
You seem to be assuming a degree of knowledge about medicine that most humans do not have the time, ability or resources to obtain. You also seem to be attacking a strawman argument. I haven’t argued that “you are best off submitting to whatever treatment has managed to make (or buy) its way into being the default mainstream practice” but rather that actively lying to doctors is a bad idea. And I’d extend that to any other common profession that involves expertise. Lying to your lawyer? Bad idea? Lying to your car mechanic? Bad idea. This isn’t an argument related to the apparently high status of doctors. But simply put, most of us do not have the resources to investigate every single detail (just as we can’t all be competent lawyers or car mechanics or plumbers), and actively lying to those people will frequently create problems.
Please refer the correct interpretation, as made by Larks earlier.
I suggest, instead that I my response was sufficiently wide ranging as to ensure that some parts of it were simply not a direct reply to you.
Please refer the correct interpretation of my claim , as made by Larks earlier.
Please refer the correct interpretation, as made by Larks earlier.
I suggest, instead that I my response was sufficiently wide ranging as to ensure that some parts of it were simply not a direct reply to you.
Please refer the correct interpretation of my claim , as made by Larks earlier.
If someone would benefit from Ritalin as a study aid, doesn’t that mean that they have difficulty focusing and studying as much as they would like? Isn’t that essentially what ADHD is?
That’s not the definition of ADHD as it is normally defined. Indeed, many (if not most) humans would be more focused if they took Ritalin. But using it so that one can for example waste a few months and then spend 72 hours cramming for a test definitely doesn’t count as ADHD by most reasonable definitions.
In fact, that is something that comes naturally to many people ADHD. “Attention Deficit” would often be better described as “attention variability”. Many of us with ADHD also benefit from overfocus. This can mean extended periods (particularly when under pressure) of enhanced attention that can mean performance well beyond that of a ‘normal’ person with similar IQ.
Ironically, where a neurotypical person may use amphetamines to pump themselves up or so they can waste a few months then cram for 72 hours an ADHD individual would use amphetamines to calm themselves down and so they don’t spend a few months wasting time and then have to cram for 72 hours.
ETA: I agree that the vast majority of people will benefit from Ritalin or Adderall when studying, at least for things that require rote learning or rigid thinking (ie. most exams). Which reminds me—if you want to identify ways to enhance brain function in healthy people a good place to start looking for leads is by browsing the treatments for Alzheimer’s.
This sounds pretty binary to me. I’ve heard things like this before, that ADHD medications have opposite effects on people without ADHD. How, then, does the ADHD spectrum work? Are we talking about two different types of brains, or is there a whole spectrum, and how do the medications work on people in the middle of the spectrum?
Perhaps, but it could just be an observation selected for irony and salience and presented in a context where writing an essay on all the complex nuances underlying the situation would not be appropriate.
There are some who make such claims and I would suggest they do not have a naive understanding. As you put it, binary thinking, oversimplified and the sort of thing people present as an opinion and can even operate with effectively despite the fundamental confusion. You will note that in my claim I was careful to include a few intrusive yet important differences so as to satisfy my preference for technical accuracy without getting bogged down in caveats.
Allow me to address a few issues relevant to the examples in question:
What is in a Symptom?
Let’s face it. Most ADHD diagnoses are essentially for “Can’t Sit Still and Will Not Do What He Is Told Disorder”. (Unfortunately this means that those people with ADHD who manage to not be a pain in the ass of a suitable authority are often neglected by the system.)
Now, what causes kids to not be able to sit still or adequately seek the approval of authority? Well, one thing is an under-functioning frontal lobe that can not adequately control inhibitions and maintain focus without sufficient stimulus. Ritalin helps boost frontal lobe function; (the teacher’s) problem solved.
What behavior do I expect from people who are abusing methamphetamine for recreational purposes? Well, among other things, excessive energy and aggression. ie. Sitting still and being compliant isn’t a likely outcome but for entirely different reasons than the aforementioned ADHD kid.
How it is used matters.
How does an ADHD kid use Ritalin to help him study ahead of time so he doesn’t rely on 72 hours of cramming? He takes small doses regularly over time too boost motivation and attention control when he wants to study. How does someone use Ritalin to cram for 72 hours once they have wasted time for months? They take heavy doses of the stuff to override the need for sleep and maintain some semblance of mental function while they are abusing their mind and body. So the contrast in outcomes is salient, but it is in no way magical.
The inverted J
With most drugs (and supplements and even lifestyle choices) having too much, even of a good thing, is worse than none at all. This also applies to brain activity. If you look at SPECT scans of brain activity in ADHD individuals compared to normal individuals you can expect to see significantly less activity in key areas of the brain in most of the ADHD individuals compared to the normal samples. Meanwhile a smaller subset of the ADHD individuals will have significantly more activity in the same areas. They display the symptom of difficulty in maintaining normal attention despite having (very loosely speaking) approximately the opposite cause. Assuming (again, extremely rough reasoning) the optimal level of activity is somewhere between the ‘normal’ level and the ‘overfocussed’ level we can expect moderate Ritalin doses to help most ADHD people a lot, normal people a little and be detrimental in any amount for the overfocussed group. If an excessive dose is given to any of the groups I would expect “ADHD like” symptoms of hyperactivity and inappropriate focus on tasks and contrary behavior, independently of base state.
Stimulants and Anxiety
Anxiety and stress are typically direct effect of stimulant use, to at least some degree. They’re stimulants. That is like… the opposite of being ‘calm’. Yet ADHD sufferers sometimes (definitely not all the time) report that stimulants calm them down. Bogus? Not really. Humans are rather good at adapting to their circumstances. Many people with untreated or undiagnosed ADHD cope by working a whole heap harder to achieve what their peers do naturally. They make huge demands on themselves. Anxiety, stress and adrenalin act as the stimulant they need to maintain focus. It works. But if you give them some Adderall their brain quickly realizes “hey… I am functioning well enough that I don’t need to abuse my amygdala and adrenals just to maintain baseline”. That can be huge weight off their shoulders. Amphetamine is a whole lot less anxiety producing than having ADHD traits in an environment that is extremely toxic to you (such as a classroom or office.)
A rant about the effects of serious untreated ADHD
Thanks Nancy, I’ve made a note of that just so I can reference the diagrams.
ETA: And taking a glance at the article he references I now share his outrage. She lists many of the benefits of treatment, the consequences of not having treatment and then goes and explains that she denies access to treatment for her children. Letting that woman reproduce was a crime against humanity. There are very few things I call unmitigated evil but for some reason this is one of them.
I suspect you’re ranting, but I’ll bring up some practical issues.
I doubt it’s possible (except, perhaps in some extreme cases) to tell years in advance what people’s child-raising policies will be.
I’d be extremely cautious about giving an authority permission to say who will reproduce and who won’t.
And I’m tempted to reread her earlier hovels (as Megan Lindholm) to see whether there was a weird authoritarianism (she’s also come out strongly against most fanfiction in them.
It would be more reasonable to read (or reread) her more recent work, except that I got bored by it after the first trilogy, while I liked the earlier stuff.
I’m wouldn’t call it ‘ranting’ but I certainly don’t expect “should not be allowed to reproduce” to be taken literally, nor do I often (ever?) observe cases where people mean such claims as anything other than “I disapprove of that behavior and the type of genetic or cultural heritage that produces it”.
But following up on on the topic of eugenics. Any authority who considered they had the right to say who will reproduce and who will not is unlikely to pass my ‘kill test’. That is to say I would (if convenient) kill them. And kill anyone who tried to stop me from killing them if necessary. The means by which they gained the power in question would not necessarily matter (ie. it would not pass the kill test just because people voted on it).
Mind you, there are situations in which I would approve of eugenics. Most of them do not involve ‘authority’ in any conventional human sense. For example… bizarre situations in which:
FAI is not possible (or available in time)
I personally have access to advanced nanotechnology (eg. I have an Asgard core
There is something which provokes the need for me to take overwhelming unilateral action.
If reproduction is not limited it will contribute to existential threat. Perhaps:
Unconstrained breeding will produce people who are likely to create a uFAI before an FAI is possible.
We are progressing along the inevitable competitive equilibrium of a hardscrabble frontier.
Unconstrained breeding will result in humans devolving and losing that which is valuable about our species (with current selection pressure it probably would, not that it matters.)
Without breeding constraints (either number or in quality) humanity will not even survive to reach for the stars or use the universe in some sort of eudemonic manner.
Basically I consider the ability to dictate reproduction over the course of several generations to be equivalent to seizing absolute control and forming a stable singularity. And then act accordingly.
I’m wouldn’t call it ‘ranting’ but I certainly don’t expect “should not be allowed to reproduce” to be taken literally, nor do I often (ever?) observe cases where people mean such claims as anything other than “I disapprove of that behavior and the type of genetic or cultural heritage that produces it”.
But following up on on the topic of eugenics. Any authority who considered they had the right to say who will reproduce and who will not is unlikely to pass my ‘kill test’. That is to say I would (if convenient) kill them. And kill anyone who tried to stop me from killing them if necessary. The means by which they gained the power in question would not necessarily matter (ie. it would not pass the kill test just because people voted on it).
Mind you, there are situations in which I would approve of eugenics. Most of them do not involve ‘authority’ in any conventional human sense. For example… bizarre situations in which:
FAI is not possible (or available in time)
I personally have access to advanced nanotechnology (eg. I have an Asgard core
There is something which provokes the need for me to take overwhelming unilateral action.
If reproduction is not limited it will contribute to existential threat. Perhaps one of:
Unconstrained breeding will produce people who are likely to create a uFAI before an FAI is possible.
We are progressing along the inevitable competitive equilibrium of a hardscrabble frontier.
Unconstrained breeding will result in humans devolving and losing that which is valuable about our species (with current selection pressure it probably would, not that it matters.)
Without breeding constraints (either number or in quality) humanity will not even survive to reach for the stars or use the universe in some sort of eudemonic manner.
Basically I consider the ability to dictate reproduction over the course of several generations to be equivalent to seizing absolute control and forming a stable singularity. And then act accordingly.
Thanks Nancy, I’ve made a note of that just so I can reference the diagrams.
Thanks for going into so much detail about this. Good point about the stimulants relieving anxiety. So according to this explanation, it’s not that people with ADHD have a different brain chemistry that makes stimulants affect them differently, it’s that the focus from stimulants relieves more anxiety than the stimulants create.
I’m not sure that terms like “waste time” and “abuse” are fair in that situation. Someone who has problems focusing, who may have mild ADHD, may have had trouble studying for months, and then take the Ritalin to try to study. This may not be as effective as taking the medication every day, but it’s an attempt to self-medicate and deal with the problem.
Is this related to the two types of ADHD (inattentive and hyperactive)? Would a central nervous system depressant then actually be effective for the “overfocused” group?