T here’s been quite a dust-up at the New York Times website over the issue of ADHD. Is it real? Is it a cultural by-product? Is it a grand marketing scheme by the major pharmaceutical companies? The answer to all of these question is “yes.” “Yes” it is real. “Yes” it is a cultural by-product and “yes” it is part of a grand marketing scheme and, no, these are not contradictory viewpoints.
ADHD is Real: There is a sufficient amount of research to show that there are real measurable neurological differences between an ADHD and non-ADHD brain. These differences negatively impact a cluster of behaviors known as Executive Functions. That is why ADHDers have problems with time management, with working memory, with emotional regulation, i.e., difficulty completing anything on time, difficulty with remembering key details of complex tasks, and difficulty with keeping their anger (or other emotions) in check. (This is a simplified view of Executive Function. See this page for a three minute video explaining Executive Function.)
ADHD is Cultural: In a recent issue of The ADHD Report, Dr. Russell Barkley discussed the social nature of Executive Function (EF). Many of the issues arising from impaired executive functions only become apparent within the context of human interaction. The logical implication, I believe, is obvious. As our lives become more complex and as we live longer lives, the importance of properly functioning EF grows exponentially. Time management, working memory, emotional regulation, self-directed action, that is, the entire cluster of executive functions become essential for survival in our complex culture. Therefore it is not surprising that those people whose neurology hampers the development of their executive functions should have “problems” in a society that taxes everyone’s executive functions.
ADHD is Part Of A Grand Marketing Scheme: There are companies that manufacture drugs that can be used to treat, but not cure, ADHD. [note 1] Those companies would like to make a profit. Therefore they will use various means of marketing to make the medical profession and the public aware of the existence of those drugs and the usefulness of those drugs in the hopes that they will prescribe and purchase those drugs. This is known as “capitalism.” Might a pharmaceutical company skew research in a direction to favor their drugs? Of course. That’s why you need independent oversight and verification.
Questions and Answers:
Q1: Jeff, aren’t you providing an overly simplistic view of all of these issues? How can ADHD be real and cultural and a marketing gimmick all at the same time?
A1: Yes, I have provided a very simplistic view of these issues. In fact, volumes could be written about each of these issues. But I wanted to make the point, without writing an entire encyclopaedia, that each of these viewpoints have some validity, that they are facets of human cultural behavior.
Q2: Wait a minute. If they are “facets of human cultural behavior” then you are really saying that ADHD is a product of culture and doesn’t that imply that it is not real?
A2: Slow down Grasshopper. I will explain by analogy. Does a fish know that it is in water? I would argue that it does not. The fish does not possess the self-consciousness necessary to understand that its existence is completely dependent on the water. Without water there is no fish but the fish does not know that. Does a person know that it is in “culture?” Don’t answer too quickly. In our daily lives we use a very loose definition of culture and, as a result, we lose sight of the depths of the cultural waters that we swim in all day long and that makes us who we are. We need to realize that culture is “that complex whole which includes knowledge, belief, art, morals, law, custom, and any other capabilities and habits acquired by man as a member of society.” (Source) To complicate matters, there is a Heisenberg-like effect that takes place. Our very presence within the culture changes that culture to varying degrees which, in turn, changes us. This is a continuous loop. There is no beginning or end. [note 2] Like the fish cannot jump out of the water (at least not without dying), we cannot jump out of our culture. Therefore it should not be surprising that there is a cultural component to ADHD in the same way that there should not be a surprise for the fish that there is a water component that is essential to its very existence. However, our self-reflexive minds create the illusion that we can stand outside of ourselves and we confuse this illusion for reality (think “fish out of water”). We tend to forget that we are still in the cultural waters. We are very much a product of our culture AND our biology.
I’d like to build on what I’ve said so far by examining the comment I left on the NY Times website. It is reproduced below.
What I never understand when ADHD is “explained away” as some cultural byproduct or the result of savvy marketing by Big Pharma or some such explanation, is how did my father (and his father before him) who clearly exhibited all the signs of ADHD, manage to acquire ADHD characteristics in Poland in the 1930s? I don’t believe he was distracted by his “culture” (poor Jewish family in Poland) nor was he subject to CHADD or Big Pharma. Alternately, how did so many adults, like myself, who were diagnosed when they reached their 50′s or 60′s, somehow have all the classic “problems” of ADHD throughout their lives even though, through much of their lives, ADHD wasn’t on the DSM (or anyone else’s) radar screen? (Source)
My father’s behavior was characterized by anger issues (infrequent but lethal and explosive), foot-in-mouth disease (saying things that were inappropriate and, sometimes, extraordinarily hurtful and insensitive), impulsivity, inappropriate actions, sleep issues, and restlessness. Yet he could also be softhearted and, sometimes, generous to a fault. Here in the United States he was always in business and, with one exception, all of the businesses required physical activity. He did home delivery of seltzer and soda. He drove a taxicab (this is the “exception” because he sat all day long and he hated the taxi) and, finally, he had a snack food franchise. Both the home delivery business and the snack food business required on-going physical activity: driving from place to place; going in and out of the truck (bringing in merchandise; in the case of the snack foods, setting up the merchandise in the store); talking to different people and, most importantly, being outdoors. Many studies have shown the beneficial effects of physical activity for the ADHDer; the beneficial effects of a job that provides variety (driving from place to place; talking to different people etc.); and the beneficial effects of being outdoors. In the 1950′s when my father came to the United States, there were business opportunities that allowed someone to earn a decent living while at the same time engage in a sufficient amount of physical activity and variety of activity to keep an ADHD brain happy (at least for a time).
Now let’s assume that my father grew up in the 1990′s (or later) in the United States, a time when we were well into the swing of deindustrialization and the rise of our service economy and knowledge-based careers. What is a knowledge-based career? It is what I am doing right now: sitting in front of a computer for ten or more hours. I’m motionless except for the rapid movement of my eyes and fingers and occasional cursing (I listen to talk radio through much of the day). Therefore, with the diminished set of career choices available in our country it would not be surprising for someone with my father’s neurology to have a problem finding a business or career that he could excel in. The choices are just not there anymore. He did not have the patience to read anything longer than a few hundred words written on a third grade level (i.e., the local newspaper). He did not have the patience to sit for long periods of time (no computer for him…but he could zone out in front of a television). He did not have the ability to work well in an office environment where decorum was required and foot-in-mouth disease would not be tolerated. In other words, my father would not be able to make it in the work world in the 1990s. Here’s the point. With essentially the same neurology, with essentially the same behavioral characteristics of what we now call ADHD, he would now be considered “a problem.”
So, is ADHD real, that is, is there a cluster of measurable, observable behaviors and biological differences that can define ADHD? Yes. Is ADHD an expression of our culture, a “product” of the modern age? In some sense, yes.
- We do not know how to cure ADHD. It is a neurological “wiring” problem and we do not yet know how to rewire the brain.↩
- Perhaps one may argue that there is a beginning. It is called “birth.” I would not be surprised to learn that in utero the baby may be engaging in rudimentary mental symbol manipulation.↩