Who I am
The sixth version of the International Classification of Diseases (ICD 6) was published in 1949 and deemed that mental disorders were in fact classified as diseases. This blanket statement encompasses all mental disorders, but are all mental disorders truly diseases? In this module we learned about “the disease concept,” and I plan on using this to identify one known mental disorder that should not be classified as a disease.
When I was a child, I was told that I had Attention Deficit Hyperactive Disorder (ADHD). This was the DIAGNOSIS given to me by a medical professional. Naming a disease allows them to group PATIENTS who suffer from similar ailments together. Until fairly recently, ADHD was considered a disorder affecting children that was outgrown by the end of adolescence and the beginning of adulthood. This is no longer the case as adults are not only exhibiting the same behaviors as when they were younger, but in fact being diagnosed over the age of 17. It has been diagnosed in roughly 3 times as many males as females giving it a more prevalent demographic. That being said, just because a condition has been given a name, and a group of people who it affects, doesn’t make it a disease.
A disease must have SYMPTOMS. In one Journal, symptoms of ADHD in adults include talkativeness, unable to make decisions, procrastinating, and being disorganized. This is a list of common personality traits, not an indication of a disease. Many people can have any or all of these personality traits without being considered as having ADHD just as many diagnosed individuals can have none of these. If I had heard only these symptoms, I might believe you are simply describing an extrovert or a teenager in their first year of university.
The problem with the proposed idea of ADHD is that there is no real test for it. As one Journal states, “ADHD is currently diagnosed by a diagnostic interview, mainly based on subjective reports from patients or teachers.” There is no concrete method of determining if an individual even has ADHD. If we can’t prove that they have it, maybe we can look at how they got it. The exact CAUSE of ADHD is unknown with speculations including genetics, behavioral, neurochemical, and even food. Without knowing how people develop ADHD there is no real way to prevent it.
If the test is subjective to determine if someone has ADHD and there is no way to prevent it, we should consider the OUTCOMES of those diagnosed (or misdiagnosed) with ADHD. Roughly 85% of the adult population who meet the criteria for ADHD go undiagnosed. They live their entire lives unaware that there may be a problem with them and are no worse for it in the context of their health. Some could argue that the previously mentioned symptoms of ADHD may not affect health, but may affect one’s ability to succeed in life. Diagnosed celebrities including comedian Howie Mandel, superstar Justin Timberlake, and Olympic record holder Michael Phelps would probably disagree.
Lastly, let’s consider the TREATMENT. While some believe ADHD symptoms can be treated with diet alone, the majority of the population look at using drugs in an aim to reduce symptoms. As we previously discussed, most of the symptoms are social traits and characteristics. Is being talkative necessarily a bad thing? This also brings up the ethical dilemma that changing an individual’s character traits can be seen as changing their personal identity.
When I was a younger, I was prescribed Ritalin to help manage my ADHD. Even though I was a child, my parents wanted to know how I felt about taking this medication. The doctor explained to me that Ritalin would “get rid of the excess noise and allow me to focus on the tasks at hand.” It was essentially explained to me that this drug would block some of my thoughts. Even at my early age, I was able to realize that there was no way for them to guarantee the thoughts being “blocked” wouldn’t be my best ides or my most creative inspirations. In my eyes, this is the way I am and how my brain operates. I am educated with a BSc in Math and Physics, I have friends and family that I love and whom love me, and I am completely infatuated with my work. There is no reason to believe that I am being negatively by the way that my brain is wired and potentially even benefit from it.
In conclusion, Attention Deficit Hyperactive Disorder is not in line with the Disease Concept, it does not necessarily have a negative impact on one’s quality of life, and therefore ADHD is not a disease.
For an interesting video on some of the science behind ADHD and how it can be beneficial watch: https://www.youtube.com/watch?v=n2EVEYmeSqg
RESCUE
Braganza, S.F., Galvez, M.P., Ozuah, P.O., 2006. When parents ask about diet therapy for ADHD: Part two. Contemporary Pediatrics 23, 47-.
Friedman, J., 2017. What is a disease? Rhode Island Medical Journal 100, 8–9.
Kyeong, S., Park, S., Cheon, K.-A., Jae-Jin, K., Dong-Ho, S., Kim, E., 2015. A New Approach to Investigate the Association between Brain Functional Connectivity and Disease Characteristics of Attention-Deficit/Hyperactivity Disorder: Topological Neuroimaging Data Analysis. PLoS One; San Francisco 10, e0137296. http://dx.doi.org.proxy.queensu.ca/10.1371/journal.pone.0137296
Shoot, B., 2011. The Stars Who Aligned ADHD with Success. ADDitude.
Valente, S., Kennedy, B.L., 2012. Recognizing and treating Adult ADHD: The Nurse Practitioner 37, 41–46. https://doi.org/10.1097/01.NPR.0000411105.20240.8c
I think you have quite a compelling argument here Michael, excellent blog post. I would encourage you to look beyond just a single article when talking about diagnosis and instead look at the clinical diagnostic criteria of ADHD. This certainly doesn’t take away from your argument, more just a point of clarification that the practice guidelines are what we use (https://www.caddra.ca/practice-guidelines/).