Yes, Virginia, ADHD Is Real

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.

 

  1. 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.
  2. 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.
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  • http://arianebenefit.com Ariane Benefit

    Great points, but I don’t want my brain rewired…I love my ADHD brain exactly as it is.  I believe people need to become more tolerant of cognitive differences AND we need to provide people with better understanding of how to manage the challenges of having a different kind of brain and how to accommodate and cultivate their strengths and design a life that fits their needs. Many people with ADHD don’t “suffer” from it.  The big difference?  They were cultivated and supported instead of punished for being who they are. p.s.  love your ADHD brain just as it is too!

    • Gina Bina

      Ariane, many people DO suffer from it, despite being “cultivated” (whatever that means in this context) and supported. 

      The saddest cases I see are college kids who were “cultivated and supported” — but not medicated — throughout school only to flop in college. Their self-esteem often doesn’t recover from failing as freshman.

      Being “more tolerant” of cognitive differences is all well and good, but when it involves behavior that can be destructive to the individual, the family, and society, it’s better to wear our Reality Glasses.

      • http://arianebenefit.com Ariane Benefit

        I agree Gina. I believe medication is part of the answer for a lot of people, myself included. That is part of the support to me. I suffered most of my life…but I learned ways to accomodate, be myself and get results my own way.  When ADD becomes “destructive” I believe it’s because the individual has been traumatized rather than taught how to deal with it.  When we don’t understand what our brains are doing it’s like having a wild horse stomping on you…but my point is the horse can be tamed.  but the taming process does need to be customized to the horse.  One size saddle doesn’t fit all horses. Barring physical or extreme situations, I believe most people can recover from failing. I was PTSD and chronically depressed most of my life….but it’s been a non-issue for over 8 years  now. I’m not trying to minimize the suffering just add a voice for hope and the idea that we are whole people with strengths that if cultivated could outweigh the difficulties. 

      • Katy R.

        Oh Gina…hi, raising my hand as a living example. And so was my mother before me…we are both exceptionally bright people who flopped as undergrads, suffered from intense anxiety, and graduated with GPAs that didn’t reflect our intelligence, but certainly reflected something else and it wasn’t laziness. I worked full time all the way through school, I excelled at theater and music performance (physical activities) and flailed in classrooms. My parents always supported me, which was a HUGE gift, and I was lucky, after confusing elementary school teachers, and getting kicked out of the honors program in junior high (for failing grades) to end up at a high school where my teachers simply accepted me as I was and worked with me. I got to college and just imploded on so many levels. Some of it was good learning but much of it was just pain. Pain that it’s taken me years to forgive myself for when really, I didn’t do anything wrong. I struggled and underperformed. I nearly dropped out and my self-esteem was nearly entirely crushed by the time I was done. When I got a 96th percentile score on my grad school entrance exam (and I never thought I would go to grad school) I sobbed. I sobbed because a piece of paper was telling me I was smart but I wasn’t sure I believed it. It would still have been hard with a diagnosis in place, but I think it all would have been less confusing…

        • http://jeffsaddmind.com Jeffs ADD Mind

          Katy, this sentence jumped out at me – “getting kicked out of the honors program in junior high (for failing grades)” – because I was *also* kicked out of an honors program in junior high school. For me, it was problems with authority and when I told one of the teachers to go eff herself, the only thing they could do was pull me out of the program. I’m actually thankful they did that because it helped to shape the next decade of my life: drug use; truancy; petty crime; dropping out of high school.

          Interestingly I got my high school equivalency degree, got into a local college, graduated Phi Beta Kappa, got into grad school and then…when it came near the end…I said “fuck it” and left graduate school. In a sense, I repeated the pattern that was set for me by “the system” fifteen years earlier when I was encouraged (yes, **encouraged!!**) to drop out of high school.

          • Katy R.

            Oh Jeff…I say failing grades but part of it WAS a problem with authority if you want to get to the down and dirty heart of the matter. I was reading by the time I was in kindergarten…but in the 8th grade I failed a reading class. Because I was sure as hell not going to jump through a hoop that stupid. I knew I could read (I was in the honors program after all) and I figured if those asshole teachers couldn’t see it without me doing weekly book reports on books that were so far below my reading level it wasn’t funny, then fuck ‘em. Oh wait, fuck ME, I’m the one that got kicked out of the program. The other killer was the poetry program we were working on…I got behind in class and didn’t know how to organize myself to get caught back up so I flailed and failed. Oops. Again, fuck me :) I have worked HARD to not let disorganization become a pattern but…well let’s just say it’s always challenging and I have to pick my battles.

          • http://arianebenefit.com Ariane Benefit

            Jeff – I was also a high school dropout after getting expelled.  My father who was probably undiagnosed, untreated ADHD plus a few other diagnoses put my mother in the hospital many times and I won’t start on what he did to us kids.  He went to prison eventually.  I Was put in drug rehab at 14.  Then to foster homes. Then alternative school for one year (my saving grace) Then GED then on to college where I tried suicide twice…but somehow…I managed to finish my degree.   
            But only because they respected me enough to let me substitute courses and create a “multidisciplinary” degree. 

            I know the suffering is real.  I still believe in the story of hope, though.  Call me crazy.  I probably am.  You kind of have to be to try and change the world, right?

            If we could find a way to make it a norm to respect people like us in schools instead of degrading us – like the alternative school I went to did – we could change so much.  We have to tell our stories. And we much insist on not letting them oversimplify the issue by thinking they can just medicate us and call it a day.  They MUST change the schools and the teachers TOO.  I insist.  

            • Katy R.

              Haha, I eventually graduated with a multi-disciplinary degree too….

            • http://jeffsaddmind.com Jeffs ADD Mind

              It’s amazing you are here to tell us your story and what’s fascinating are some of the common threads of troubles in your story, my story and Katy’s story.

              “I still believe in the story of hope” – Let’s be honest. If I didn’t also believe in the story of hope would I still be writing about these issues and grappling with these issues? My struggles, shared through my blog, are my contribution to the “story of hope,” to the possibility of understanding and healing and growth through communication.

              • http://arianebenefit.com Ariane Benefit

                Yes, I know you are part of the story of hope and of illuminating the real issues. And I really appreciate that you do!  Most of my clients have stories of incredible trauma like ours…that is what has made me so passionate about cultural reform. 

                Our culture does not tolerate misfits of any kind very well, much less support our rights to be different.  We talk a lot about it…but the tension and bullying are getting worse.  

                So…on with the mission we go!  

    • http://jeffsaddmind.com Jeffs ADD Mind

      Ariane, I agree that we need to be more tolerant of cognitive differences and need to help people to understand the challenges that come with those differences. However, those who don’t suffer from ADHD had to go through some period of suffering in order to get to the “promised land” of acceptance. But even then, though they may not brood over it, no one is an island and even the best adjusted ADHDers, though they may put on their happy face, though they may give it a positive spin, they still struggle with some aspect of ADHD at some point in their life. ADHD never goes into remission.

      • http://arianebenefit.com Ariane Benefit

        True…everyone suffers..what I’m getting at is whether or not you “define” your life by the suffering aspects or by your ability to reduce your own suffering.  People without ADHD also struggle.  They can’t do things we can.  They get frustrated too. I guess what I’m seeing here seems like you feel that if people suggest focussing on how we are able to function better,  we are discounting or denying the painful aspects…is that accurate?  I feel like I’m trying to be realistic and embrace the full spectrum.  My ability to see pattern comes with the challenge that being on time is painful and stressful – I have to put a lot of effort into being on time.  It’s as distressing to me to try to be on time as NOT being on time is for linear thinkers.  Their pain is accomodating to us.  Our pain is trying to accomodate them.  My suggestion – which works for most of my clients and is to help the other person understand this difference and acknowledge that our right to not ALWAYS be on time is equally valid as their right to pursue being on time.  Being on time is not morally right or wrong.  It’s a negotiable point.  My husband, for example was shocked to learn that being on time was more painful to me that being late was for him…plus it consumed my whole day’s energy. So we designed time RANGES.  I get to ask for when I need a Time Window instead of time deadline.  Lots of pain and suffering avoided.  Same with school and work.  I negotiated with every boss I ever had about what time I would arrive at work.  They could not find anyone with my talents who ALSO excelled at arriving on time to work.  So they gave in.  The couple who did not negotiate with me…well then I had to move on.  But overall, the skill of advocating for your right to be different is very powerful and reduces a lot of pain – but not ALL.  

        • http://jeffsaddmind.com Jeffs ADD Mind

          “if people suggest focussing on how we are able to function better,  we
          are discounting or denying the painful aspects…is that accurate?  I
          feel like I’m trying to be realistic” – There’s no reason to not look for ways to function better and looking does not mean denying the painful aspects of ADHD. But it takes time to shift one’s focus and it’s important to acknowledge that pain, to understand it, to work through it and THEN you can focus on how to function better. I believe you need to know the full extent of the wound before you can heal the wound.

          • Katy R.

            Yes…I needed to know what “it” was before I could decide how to live with it. Without that knowledge, I routinely chastized myself for being crazy or lazy or “bad” somehow.

  • Gina Bina

    GREAT JOB, JEFF!  Thank you for saving me the time of attempting to write all that.  (I have my own rebuttal blog post in the works.)

    As I wrote to the New York Times about their abysmal choice in panelists, “The  assembled panel is akin to a “Debate Evolution” panel comprised of Michelle Bachmann, Pat Robertson, Cleo from Psychic Friends, the head of the Creationist Society, and Bozo the Clown (if Bozo had a book to flog). They would never dismiss other aspects of science the way they do neuroscience.

    • http://jeffsaddmind.com Jeffs ADD Mind

      Thank you! And you hit the nail on the head, re: panelist choices. Perhaps you could also have a representative from the Flat Earth Society. ;)

  • http://www.facebook.com/people/Scott-Hutson/100000576144521 Scott Hutson

    I would love to have my brain rewired. I don’t enjoy any part of the neurological fact that Executive Functions are affected in the way mine are. Yeah, I have good days when I don’t screw up. But I have to face the facts of life with ADHD every morning, follow(at least try very hard too) the rules(take meds, read my lists of things to do,…..etc.) and hope for the best.

    But I’m not complaining, because I know it could be worse than it is today. Because I have help from my friends and family, I do better(or they lie and tell me I am). But the fact that I need help and have to follow rules……Catch 22 (logic).  It could be worse though. :)

    • http://jeffsaddmind.com Jeffs ADD Mind

      If it could be done without screwing things up…I think I’d take the rewiring job too.

      • http://arianebenefit.com Ariane Benefit

        If you’d asked me this 10 years ago…I’d have gone for the rewiring too.  If someone had told me that I could learn to love the brain and body I was born with, with all it’s flaws, I’d have resisted.  It’s not easy to figure this acceptance to love progression out.  Learning to love myself just as I am made it possible for me to allow other people to love me as I am, to fly my freak flag and embrace being rejected by people I really didn’t want in my life anyway.  I wouldn’t be married today if I hadn’t figured out.  I wonder if you have “hyperfocus” and if so if you experience it the way I do?  For me, it’s like ecstasy…better than crack (yes, I’ve done crack, but lets not go there.)  I’m addicted to my own hyperfocssing.  That’s why I wouldn’t want to give up my wiring.  I rewired my life to fit it instead. 

    • Katy R.

      I don’t even know what I would do with myself re-wired. I’m just so used to being me the way that I am. And while I won’t say ADHD is a gift, some of my ADHD quirks have taken me to some interesting places in life. I guess I’d take the bad with the good and keep the screwy brain :)

  • Katy R.

    Wow, how did I miss this…maybe I was too busy having my mind
    manipulated by a large pharmaceutical company or something…thanks for
    writing this Jeff. I’m sick and tired as you know, of being told I’m not
    real. And like you, I have family members of past generations and from
    other locales who clearly demonstrated the traits we now call ADHD. I
    also have family members now who absolutely cannot fit into many of the
    modern molds that define a person’s worth. Our family history is ripe with stories that make people react with “did that REALLY HAPPEN?! did that person REALLY say/do that?!” and the answer of course is yes…yes I do live in a family of larger than life people with larger than life actions and reactions. I myself sit on an awkward
    line between being able to work to “pass” and having to be honest about
    the level of stress that it causes me to do so. I don’t even like
    phrasing it that way because it makes it sound like “if you have
    control, then it’s not a disorder”…it’s not control, it’s coping, and
    it’s stressful. And more importantly, it’s REAL.

    • http://jeffsaddmind.com Jeffs ADD Mind

      “it’s not control, it’s coping, and it’s stressful. And more importantly, it’s REAL.” – Absolutely agreed. Unfortunately this economy has added several more levels of stress to an already stressful situation.

  • Katy R.

    OMG I just clicked the link to see what NYT post you guys were talking about (I knew I was in no space yesterday to look) and I’m cracking up now because I totally posted that on my Facebook page because I found it interesting, but hadn’t read the comments. Now that I’ve read a page of them I know I shouldn’t have read them at all, LOL. More of the same…with a few trolls mixed in. Fruitcakes, haven’t they got anything better to do all day than write crazy stuff just to piss people off? So a thank you from me too Jeff…for taking the time to respond to that shizz.

    • Katy R.

      I do love this comment “Stimulants have replaced nicotine and booze as remedies for ADHD.” EXACTLY. Jesus. And personally, I think it’s great because stimulant meds that I take during the day to improve my life don’t interfere with my relationships and ruin my life like booze easily could (and did for previous generations of my family).

      • Katy R.

        AH, saw the next blog post and your comment…now THAT tripe really got me going…sorry, I’m done commenting on my comments…

  • Jimmyflatbush

    Gina- 

    You should go to botox to mask your obfuscations and your hideous face. Maybe you can get a part in the next Batman movie. Such a villain, you are.

    Your two-party false paradigm that has ruined this country will no longer exist after the revolution. Make sure you have a front row seat.

    • http://jeffsaddmind.com Jeffs ADD Mind

      Perhaps you already know that the surest way to lose an argument is to simply engage in personal insults. If you have a constructive argument to make, go for it. I have no problem with that. What you have written, however, is not an argument.

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