[andoando]

The diagnostic criteria is entirely subjective. "Often loses thigns", "Often doesn't pay attention" isn't exactly objective. How do we even know what "often" is?

But more than that what is the condition, if the only means we have of defining it is a subjective biased interpretation by an individual?

I am sure there are differences in brain chemistry that make one more stimulated, more long term goal oriented, and etc, but given the complexity of the human brain, and our lack of understanding/tools to measure, its not clear to me we should be so sure given any patients failure can be directly attributed to a singular condition.

[MathMonkeyMan]

So much of psychiatry is like this, though. There are the extreme conditions where everybody agrees "yes, something is wrong with his brain," or "clearly his mind was broken by circumstances and now he needs help," or "that's the most severe case of autism I've ever seen," but there are also more nebulous conditions: anxiety, depression, AD(H)D, autism spectrum, personality disorders, etc.

This isn't to say that those conditions aren't precisely defined or that they aren't real, but they might be at least partially a product of our society.

Your skepticism about whether an issue "can be directly attributed to a singular condition" is just good medicine. As conditions are studied more, often it's discovered that it's actually a few different conditions that share some symptoms. Maybe all of these sometimes wishy-washy "we didn't have this when I was a kid" conditions are just medicine learning more about the mind.

[ty6853]

Fundamentally we want to be adapted to our environment. As the conditions for success change, what was prior adaptive is now maladaptive disorder. Being institutionalized in a school after spending hundreds of thousands/millions years out in nature/fighting/hunting/building shelter has consequences.

Much of disorder is likely just maladaptive for, as uncle Ted put it, the post industrial revolution.

[pcthrowaway]

> Maybe all of these sometimes wishy-washy "we didn't have this when I was a kid" conditions are just medicine learning more about the mind.

I think it's likely that as well as a healthy dose of "the world was way different when I was a kid, and didn't have as much of X, Y, Z, which contribute to the formation of maladaptive neurological patterns"

[pcthrowaway]

I have ADHD (diagnosed ~28 years ago, so well before "it was cool"), and honestly might kind of agree with you in that it could easily be a collection of neurodivergences that just get labelled ADHD. Add to that, lots of overlap with Autism spectrum[1], which probably has the same issue, and likely leads to misdiagnosis of one vs. the other, comorbid diagnosis, and the blunt categorization of neurological conditions which could very well be distinct, and at the very least sometimes have very different collections of symptoms into broader "ADHD" and/or "autism" categories.

[1]: https://neurodivergentinsights.com/misdiagnosis-monday/adhd-...

[WA]

Yes, and at the end of the day, these diagnosis aren't there to pathologize people, but to actually provide help, even if critics don't believe so.

This is something you only understand if you dealt with neurodivergent people. Suddenly it all makes sense, once you learn that their brains filter and process information in a somewhat different way, resulting in all kinds of different observable symptoms.

[cmorgan31]

They used the TOVA test to diagnose mine. It measures what part of the attention paradigm may be deficient or overactive. AFAIK that test isn’t purely subjective.

[andoando]

I heard of this. My immediate criticism, is that even those with diagnosed ADHD aren't just deficient in focus/attention and impulsive in all aspects of their lives. They can drive a car, play video games, read subjects they are interested in, have long conversations, etc. That is to say, focus/attention/arousal are rather complex phenomenons that vary greatly based on circumstances, and aren't simple numbers we can say one is deficient in.

Testing someone in a completely artificial environment (sitting in an office during a diagnosis playing some tasks clicking on a computer screen) is hard for me to believe is exactly an accurate metric for revealing any of these things. Most especially, when a lot of people are actively seeking this diagnosis, and are motivated to alter their behavior to get the result they are looking for.

Im really curious how this company decided these tests are accurate at all. I assume they did some studies to find some variability in the test results and those who were already diagnosed and then determined those variability were indicative of ADHD. So what test is really doing IMO is just reinforcing the standard diagnostic criteria.

[vector_spaces]

People with ADHD actually have an increased risk of motorvehicle accidents, and don't perform as well in certain kinds of games compared to people who don't have ADHD (when you account for experience playing video games etc). The TOVA test is essentially a simple video game -- it's a computerized test that checks reaction times to a targeted stimulus that appears on a computer screen. There are different classes of error that correspond to different kinds of executive dysfunction

You are right that attention is a complex phenomenon, but keep in mind that people who evaluate ADHD are aware of the limitations -- that is why TOVA isn't typically the only mechanism used for diagnosis. ADHD evaluation often involves multiple sessions in which other possible explanations are ruled out or explored, along with questionnaires from friends and family who know the person -- incidentally some of the questions on the ones I collected from my friends/family were about my driving!

Even with this, there are still limitations, but there's no need to throw the baby out with the bathwater -- the goal is to produce an actionable explanation that we can use to reduce suffering, and for many people this explanation does exactly that.

[andoando]

>Even with this, there are still limitations, but there's no need to throw the baby out with the bathwater -- the goal is to produce an actionable explanation that we can use to reduce suffering, and for many people this explanation does exactly that.

So did shamens, tarot readers, and psychics. The "actionable" part of all this is prescribing stimulants. Why can't we just focus on prescribing stimulants to those who would benefit from stimulants? Is the "ADHD" part of it really necessary?

[vector_spaces]

The actionable part includes stimulants, but also self-awareness and structure. Stimulants alone won't usually lead to the kinds of changes that improve quality of life. Virtually any clinician and expert on this topic agrees with this point

I don't understand your question about whether or not the "ADHD" part is necessary. Yes, we should have words for complex ideas.

The comparison to shamans and tarot readers comes off as dismissive and uninformed, and generally in poor taste. Ultimately you are questioning a diagnostic framework that you don't understand very well given your other comments. There are critiques to be made and even aspects of your position that I agree with but you really need to understand the framework you intend to tear down before tearing it down

[andoando]

My point is giving people any explanation for their problems - so long as its backed by authority helps them - it says nothing to the truthfulness of those explanations.

Anyway youre being really dismissive too instead of just responding to my points. If you think Im being dumb fine Im just not interested in an emotionally heated argument.

I apologize if I seem dismissive of people's mental health - not my intention Ive been dealing with them my whole life. Take care.

[andoando]

>People with ADHD actually have an increased risk of motorvehicle accidents,

Does this mean that you identified a definite cause, or does this mean as part of an ADHD diagnosis, you managed to capture a group of individuals with specific traits like being more impulsive, taking higher risks, etc?

I can for example, make up 9 seemingly related symptoms, and given a large enough population millions of people will fit it. Then I assure you I can do a wide range of studies that will find that my group of people will deviate from the norm in X,Y,Z.

Also weirdly enough, I noticed I make a lot more mistakes while driving while on adderall.

[vector_spaces]

I'm not sure what your point is -- but you might look into Chesterton's fence. It's a metaphor that illustrates a common trap that lots of smart people fall into.

[andoando]

Is this like the sophisticated version of negging? I think itd have been easier to just give me few worss to look into.

I bought into the whole "I have Adhd thing thats why Im failing at school" thing 13 years ago and have since then spent countless hours thinking and talking about it.

Im glad it helps people, but unless someone can prove definitive facts about my brain, I have all the answers I need as to why I am who I am or why I do what I do. And yes stimulants help sometimes when Im forced to do shit I have zero interest in for prolonged periods of time, simple as that

[vector_spaces]

There are indeed several widely used objective metrics that can be used to identify hallmark symptoms of ADHD. The difficult part isn't really identifying those symptoms so much as distinguishing from other conditions that can cause many similar symptoms. But OP is not correct in suggesting that there aren't objective metrics -- ADHD probably has more of these than any other psychiatric illness.

In any case, I still think of ADHD and a lot of psychiatric diagnoses as models. We try to make these models useful to relieve suffering. They are far from perfect, but it doesn't make sense to throw the baby out with the bathwater and discount the many people who have been helped

[andoando]

>But OP is not correct in suggesting that there aren't objective metrics -- ADHD probably has more of these than any other psychiatric illness.

What am I missing?

>In any case, I still think of ADHD and a lot of psychiatric diagnoses as models. We try to make these models useful to relieve suffering. They are far from perfect, but it doesn't make sense to throw the baby out with the bathwater and discount the many people who have been helped

This is what it keeps getting down to every time I have this discussion. But I really feel like the discourse is hindering having an deeper understanding of the topic. The mental model and the resulting language, like people saying "I HAVE X,Y,Z" seems to be somewhat philosophically askew. Everything I read seems to point more to "X is a real objective thing, and were trying to find better ways of diagnosing it", rather than "X is what we call these assortment of symptoms alot of patients seem to exhibit which is helped by Y"

From a patient standpoint I think its a monumental difference with people saying things like "I am like Y because I HAVE X", as if X, what was the observed collection of (possibly unrelated) symptoms, now being a cause in itself.

[vector_spaces]

RE what you are missing -- from your other comments I feel you haven't done much prior reading on the topic. There's lots out there, so go for it!

There has been lots and lots of writing on the phenomenology of mental illness and modern mental health culture. There is lots to not like: for instance it tends to encourage excessive rumination and negative feedback loops and over-identification with these designations, as you say. This is why I prefer to think of my diagnoses as models -- they are approximate descriptions of my behavior, and the treatments prescribed are also approximations, and it's up to me to use these as tools to improve my life. But you might enjoy reading some prior art on the topic

But in any case, if the tools aren't useful, then discard them -- I was diagnosed with PTSD in my early 20s, and at the time it was a tremendously helpful and eye-opening -- it hadn't occurred to me that the violence I experienced was impacting me so many years later, but when someone pointed it out to me, I was able to adjust the ways I related to myself and other people, and for the most part, my symptoms are in remission today. I no longer think of myself as "someone with PTSD" -- it's no longer a helpful lens through which I can understand myself

[cmorgan31]

Perhaps you’d find Stephen Grossbergs models on how the ADHD brain processes information interesting. I can’t disagree that ADHD might be too wide an umbrella and I find the medicine is best taken on an as needed basis to augment other coping mechanisms.