8 ms·

I remember a panel on a news program years ago where the one guest was a psychologist who was treating "untreatable" drug addicts by getting them "hooked" on ru

I remember a panel on a news program years ago where the one guest was a psychologist who was treating "untreatable" drug addicts by getting them "hooked" on running or weightlifting or martial arts. They would stop drugs but would instead be doing martial arts for hours a day or running 20 miles every morning. Then he would start treating the addiction personality and causes, but in many cases the patients would just stop coming and live three or more hours of every day in the gym. The other guests were various degrees of horrified. His patients went from literally living on the street as heroin addicts to doing 3 hour gym sessions and holding down a job; and his peers thought he shouldn't be allowed to practice. Recently I was reading a book on ADHD and the author was quite adamant that you could only be diagnosed with ADHD if your life was worse than "the norm". In this view, if you have symptoms of ADHD but can, for instance, hold down a good job then by definition you don't have ADHD. I deleted the book from my Audible account.

frickenhamster 5y ago
Crabs in the bucket
mlyle 5y ago
> In this view, if you have symptoms of ADHD but can, for instance, hold down a good job then by definition you don't have ADHD. I deleted the book from my Audible account. This may overstate the point a little bit. But there's a kernel of truth here: if you don't require some degree of significant impairment of functioning, a whole lot of criteria for mental illness would apply to huge swaths of the population. E.g. this is why the diagnostic criteria for ADHD include: "There is clear evidence that the symptoms interfere with or reduce the quality of social, academic, or occupational functioning."
- thaumasiotes 5y ago
  > if you don't require some degree of significant impairment of functioning, a whole lot of criteria for mental illness would apply to huge swaths of the population. E.g. this is why the diagnostic criteria for ADHD include: "There is clear evidence that the symptoms interfere with or reduce the quality of social, academic, or occupational functioning." Wouldn't this just tell us that these categories are completely meaningless?
  - stavros 5y ago
    No, why? "Illness" sometimes is about the quantity, not the quality. If you enjoy the odd glass of wine once a week, you're fine, if you drink every hour of the day, not so fine.
    - thaumasiotes 5y ago
      But that's an orthogonal concern. Two people can easily display exactly the same quantity of, shall we say, ADHD-like tendencies. If one of them is a success for separate reasons, and the other one is a failure for separate reasons, why do we want to say that the failure, in addition to his other problems, also has ADHD? What do we learn from that? If the success has a lot more ADHD-tendency than the failure, how do we defend the idea that the failure has ADHD, and the success doesn't?
      - StavrosK 5y ago
        It's not about whether the person is "a success" or "a failure", it's about whether the person feels that their condition is materially impacting their daily life. If I feel that my gaming habit is impacting my job because I can't resist playing games during work hours, that can be classified as a disorder. It's just shorthand for "this is something we'd like to fix".
      - hluska 5y ago
        What if you try looking at it like this: You have two people with ADHD-like tendencies. One person feels they have found their own ways to adapt to their ADHD-like tendencies and that they are successful. Another person feels that they have not found ways to adapt to their ADHD-like tendencies and their life could be better if they found ways to adapt. In this case, the actual magnitude is less important than how individuals adapt.
      - mattkrause 5y ago
        Someone could certainly be a billionaire and also have ADHD. The criteria is more like “but for this tendency, the patient would be/feel better, all else being equal.” A software engineer making $$$ could meet the criteria if their inability to focus keeps costing them promotions, launch their own company, or whatever their goal might be. A neurotypical buggy whip maker who can’t find or hold a job doesn’t qualify, even if he is obviously worse off overall.
gwbas1c 5y ago
> could only be diagnosed with ADHD if your life was worse than "the norm" Because ADHD is a real situation for some people, and for others it's a way to legally take class-B stimulants. Yes, people really do try their friends' ADHD medication, enjoy it, and then shop around doctors to find someone who will prescribe it. It's called "drug seeking," and doctors do flag patients who do it. This, BTW, is what happens with medical marijuana. There are people who really need it, there are people who think they need it, and then there are people who who tell everyone but their doctor that it's recreational.
- dantheman 5y ago
  Let people take whatever medicine they want.
  - kaibee 5y ago
    So like, in theory, yes, but in practice, now everyone has to take Adderall just to be able to keep up with their coworkers.
    - caslon 5y ago
      Seems like the free market at work to me.
      - aaroninsf 5y ago
        That's about the shortest, but most on-point and total, take down of the free market I've seen in some time.
    - Zababa 5y ago
      Would you apply the same reasoning to caffeine and nicotine? Should we ban both? You're also seeing the world as a competition between people ("keep up with their coworkers") but I believe most people are actually trying to make a living (no need to take adderall if you are already satisfied with what you have).
    - 5y ago
pmichaud 5y ago
Do you remember the name of the psychologist or any info I might use to look him up?
- thequux 5y ago
  Scott Alexander. He used to post on slatestarcodex.com, but has since moved to astralcodexten.substack.com .
  - dwarfsandstuff 5y ago
    You do realize that Scott Alexander slatestarcodex astralcodexten are all acronyms, right?
    - renewiltord 5y ago
      Probably, but Scott Alexander writes on the latter two things so realizing this is nothing but a curiosity. Dearest Claxton is also an anagram and as it so happens dearestclaxton.substack.com is not written by Scott Alexander. Or anyone really.
  - AgentME 5y ago
    That's the author of the article in this thread. Are you mixing things up or are both of these things separately about him?
  - pmichaud 5y ago
    I doubt this is right. Scott doesn't do stuff like podcasts or panels generally. He likes to write, and avoids real time stuff. Can you provide a link or something?
fpgaminer 5y ago
> Recently I was reading a book on ADHD and the author was quite adamant that you could only be diagnosed with ADHD if your life was worse than "the norm". In this view, if you have symptoms of ADHD but can, for instance, hold down a good job then by definition you don't have ADHD. I deleted the book from my Audible account. IANAP, but that sounds correct to me. I recall the DSM requiring negative impact on one's lifestyle as one of the criteria for diagnosis of any mental disorder. And even if I'm misremembering that, that's what psychiatrists look for in practice. They not only query what symptoms you're feeling, but also the impact they have on your day to day life. Which makes total sense. Treatment of any disorder, especially mental ones, carries a (sometimes significant) risk. It would be unethical to subject someone to that risk for no possible benefit.
- michaelkeenan 5y ago
  The same psychiatrist from the hair dryer incident in the link has written about this. He's skeptical about ADHD being a discrete condition, and generally thinks that if ADHD drugs will help you focus, taking them is reasonable whether you're diagnosed with ADHD or not: > Psychiatric guidelines are very clear on this point: only give Adderall to people who “genuinely” “have” “ADHD”. > But “ability to concentrate” is a normally distributed trait, like IQ. We draw a line at some point on the far left of the bell curve and tell the people on the far side that they’ve “got” “the disease” of “ADHD”. This isn’t just me saying this. It’s the neurostructural literature, the the genetics literature, a bunch of other studies, and the the Consensus Conference On ADHD. This doesn’t mean ADHD is “just laziness” or “isn’t biological” – of course it’s biological! Height is biological! But that doesn’t mean the world is divided into two natural categories of “healthy people” and “people who have Height Deficiency Syndrome“. Attention is the same way. Some people really do have poor concentration, they suffer a lot from it, and it’s not their fault. They just don’t form a discrete population. > Meanwhile, Adderall works for people whether they “have” “ADHD” or not. It may work better for people with ADHD – a lot of them report an almost “magical” effect – but it works at least a little for most people. There is a vast literature trying to disprove this. Its main strategy is to show Adderall doesn’t enhance cognition in healthy people. Fine. But mostly it doesn’t enhance cognition in people with ADHD either. People aren’t using Adderall to get smart, they’re using it to focus. From: https://slatestarcodex.com/2017/12/28/adderall-risks-much-more-than-you-wanted-to-know/ https://slatestarcodex.com/2017/12/28/adderall-risks-much-mo...
hinkley 5y ago
Doctors are really good at cognitive dissonance. I think it's a professional hazard of having to compartmentalize. Those same doctors are probably perfectly fine with handing out methadone prescriptions to addicts.
novok 5y ago
I really don't like 'the norm' as the base point. If you have the mental abilities of someone with 140 IQ with serious untreated ADHD, but your life is 'just ok', that is wasted human potential. That 'just ok' person could do so much more for society's and their own benefit.
- Ensorceled 5y ago
  That's pretty much why I threw away the book. I wouldn't meet his criteria for treatment, but I look at how much better my life is this past year and half since my diagnosis and said ... "F this".
colechristensen 5y ago
Psychology has the sizable problem that everything is a disorder but very little is actually known about any of them. You can't say "ADHD is this" and point at a definitive cause, tis just a bag of related symptoms that is geared more towards consistent diagnoses (i.e. you go to five different doctors and they all diagnose the same thing) rather than attachment to a common underlying cause or consistent treatment plan and success phase. This isn't to say psychology is useless, many people find great help in it... but when it comes down to it, it is scientists (who as a whole have some of the biggest problems in being good at being scientists) trying to describe malfunctions of the highest abstraction on the most complicated class of things known to exist... and just scratching the surface. The last D is for Disorder... it's a value judgment and the question does need to be asked: if something isn't causing significant problems, is it a disorder? The answer isn't clear cut and people are going to draw the line in the wide grey area in different places. The solution must be neuroscience continuing to advance to higher levels and replacing the vagueries of psychology with justifiable cause and effect explanations. It is advancing but still a far way off.
- BirdieNZ 5y ago
  > You can't say "ADHD is this" and point at a definitive cause There's plenty of existing and on-going research that demonstrates differences in brain structure and development in people clinically diagnosed with ADHD. In other words, ADHD is caused by parts of your brain being underdeveloped or damaged. There is on-going research applying machine learning to MRI brain scans to try to predict ADHD through brain scans rather than only clinical diagnosis.
m463 5y ago
This goes hand in hand with many laws in california. There's a law that governs the treatment of mental illness and basically, it's not against the law to be mentally ill, and as long as you're a not "a danger to self or others" they will have to leave you alone, even if you clearly need help. This is particularly heartbreaking for many people with some form psychosis, because anosognosia is frequently correlated with it. This is basically an inability to have insight into your own mental illness (sort of like a powerful form of denial). So there are lots of mentally ill people in california, and they usually end up homeless, or eventually in jail.
trhway 5y ago
>Then he would start treating the addiction personality and causes, but in many cases the patients would just stop coming and live three or more hours of every day in the gym. one can speculate why addiction hasn't been selected out - may be because it probably provides significant advantage when channeled right. Some achievements/mastery/etc. require tremendous focus and huge amount of persistent work which probably may be not doable on rational motivation alone, without the primal dopamine [over]drive.
dionidium 5y ago
Similarly, the modern medical view of addiction is basically something like, "continued use in the face of adverse consequences." Laypeople really hate this definition, preferring to think of addiction as primarily a physio-chemical phenomenon, but the American Psychiatric Association has to say: "Substance use disorder (SUD) is complex a condition in which there is uncontrolled use of a substance despite harmful consequence." Source: https://www.psychiatry.org/patients-families/addiction/what-is-addiction https://www.psychiatry.org/patients-families/addiction/what-... Most organizations that deal with addiction now operate using a similar definition.
mhh__ 5y ago
I'm in the process of doing something about my symptoms that as far as I'm aware are ADHD, and people have said that to me, but I reckon I could be at least 5x more productive with help. The number of unpushed branches on my machine is proof of that.

frickenhamster 5y ago

Crabs in the bucket

mlyle 5y ago

> In this view, if you have symptoms of ADHD but can, for instance, hold down a good job then by definition you don't have ADHD. I deleted the book from my Audible account. This may overstate the point a little bit. But there's a kernel of truth here: if you don't require some degree of significant impairment of functioning, a whole lot of criteria for mental illness would apply to huge swaths of the population. E.g. this is why the diagnostic criteria for ADHD include: "There is clear evidence that the symptoms interfere with or reduce the quality of social, academic, or occupational functioning."

thaumasiotes 5y ago
> if you don't require some degree of significant impairment of functioning, a whole lot of criteria for mental illness would apply to huge swaths of the population. E.g. this is why the diagnostic criteria for ADHD include: "There is clear evidence that the symptoms interfere with or reduce the quality of social, academic, or occupational functioning." Wouldn't this just tell us that these categories are completely meaningless?
- stavros 5y ago
  No, why? "Illness" sometimes is about the quantity, not the quality. If you enjoy the odd glass of wine once a week, you're fine, if you drink every hour of the day, not so fine.
  - thaumasiotes 5y ago
    But that's an orthogonal concern. Two people can easily display exactly the same quantity of, shall we say, ADHD-like tendencies. If one of them is a success for separate reasons, and the other one is a failure for separate reasons, why do we want to say that the failure, in addition to his other problems, also has ADHD? What do we learn from that? If the success has a lot more ADHD-tendency than the failure, how do we defend the idea that the failure has ADHD, and the success doesn't?
    - StavrosK 5y ago
      It's not about whether the person is "a success" or "a failure", it's about whether the person feels that their condition is materially impacting their daily life. If I feel that my gaming habit is impacting my job because I can't resist playing games during work hours, that can be classified as a disorder. It's just shorthand for "this is something we'd like to fix".
    - hluska 5y ago
      What if you try looking at it like this: You have two people with ADHD-like tendencies. One person feels they have found their own ways to adapt to their ADHD-like tendencies and that they are successful. Another person feels that they have not found ways to adapt to their ADHD-like tendencies and their life could be better if they found ways to adapt. In this case, the actual magnitude is less important than how individuals adapt.
    - mattkrause 5y ago
      Someone could certainly be a billionaire and also have ADHD. The criteria is more like “but for this tendency, the patient would be/feel better, all else being equal.” A software engineer making $$$ could meet the criteria if their inability to focus keeps costing them promotions, launch their own company, or whatever their goal might be. A neurotypical buggy whip maker who can’t find or hold a job doesn’t qualify, even if he is obviously worse off overall.

gwbas1c 5y ago

> could only be diagnosed with ADHD if your life was worse than "the norm" Because ADHD is a real situation for some people, and for others it's a way to legally take class-B stimulants. Yes, people really do try their friends' ADHD medication, enjoy it, and then shop around doctors to find someone who will prescribe it. It's called "drug seeking," and doctors do flag patients who do it. This, BTW, is what happens with medical marijuana. There are people who really need it, there are people who think they need it, and then there are people who who tell everyone but their doctor that it's recreational.

dantheman 5y ago
Let people take whatever medicine they want.
- kaibee 5y ago
  So like, in theory, yes, but in practice, now everyone has to take Adderall just to be able to keep up with their coworkers.
  - caslon 5y ago
    Seems like the free market at work to me.
    - aaroninsf 5y ago
      That's about the shortest, but most on-point and total, take down of the free market I've seen in some time.
  - Zababa 5y ago
    Would you apply the same reasoning to caffeine and nicotine? Should we ban both? You're also seeing the world as a competition between people ("keep up with their coworkers") but I believe most people are actually trying to make a living (no need to take adderall if you are already satisfied with what you have).
  - 5y ago

pmichaud 5y ago

Do you remember the name of the psychologist or any info I might use to look him up?

thequux 5y ago
Scott Alexander. He used to post on slatestarcodex.com, but has since moved to astralcodexten.substack.com .
- dwarfsandstuff 5y ago
  You do realize that Scott Alexander slatestarcodex astralcodexten are all acronyms, right?
  - renewiltord 5y ago
    Probably, but Scott Alexander writes on the latter two things so realizing this is nothing but a curiosity. Dearest Claxton is also an anagram and as it so happens dearestclaxton.substack.com is not written by Scott Alexander. Or anyone really.
- AgentME 5y ago
  That's the author of the article in this thread. Are you mixing things up or are both of these things separately about him?
- pmichaud 5y ago
  I doubt this is right. Scott doesn't do stuff like podcasts or panels generally. He likes to write, and avoids real time stuff. Can you provide a link or something?

fpgaminer 5y ago

> Recently I was reading a book on ADHD and the author was quite adamant that you could only be diagnosed with ADHD if your life was worse than "the norm". In this view, if you have symptoms of ADHD but can, for instance, hold down a good job then by definition you don't have ADHD. I deleted the book from my Audible account. IANAP, but that sounds correct to me. I recall the DSM requiring negative impact on one's lifestyle as one of the criteria for diagnosis of any mental disorder. And even if I'm misremembering that, that's what psychiatrists look for in practice. They not only query what symptoms you're feeling, but also the impact they have on your day to day life. Which makes total sense. Treatment of any disorder, especially mental ones, carries a (sometimes significant) risk. It would be unethical to subject someone to that risk for no possible benefit.

michaelkeenan 5y ago
The same psychiatrist from the hair dryer incident in the link has written about this. He's skeptical about ADHD being a discrete condition, and generally thinks that if ADHD drugs will help you focus, taking them is reasonable whether you're diagnosed with ADHD or not: > Psychiatric guidelines are very clear on this point: only give Adderall to people who “genuinely” “have” “ADHD”. > But “ability to concentrate” is a normally distributed trait, like IQ. We draw a line at some point on the far left of the bell curve and tell the people on the far side that they’ve “got” “the disease” of “ADHD”. This isn’t just me saying this. It’s the neurostructural literature, the the genetics literature, a bunch of other studies, and the the Consensus Conference On ADHD. This doesn’t mean ADHD is “just laziness” or “isn’t biological” – of course it’s biological! Height is biological! But that doesn’t mean the world is divided into two natural categories of “healthy people” and “people who have Height Deficiency Syndrome“. Attention is the same way. Some people really do have poor concentration, they suffer a lot from it, and it’s not their fault. They just don’t form a discrete population. > Meanwhile, Adderall works for people whether they “have” “ADHD” or not. It may work better for people with ADHD – a lot of them report an almost “magical” effect – but it works at least a little for most people. There is a vast literature trying to disprove this. Its main strategy is to show Adderall doesn’t enhance cognition in healthy people. Fine. But mostly it doesn’t enhance cognition in people with ADHD either. People aren’t using Adderall to get smart, they’re using it to focus. From: https://slatestarcodex.com/2017/12/28/adderall-risks-much-more-than-you-wanted-to-know/ https://slatestarcodex.com/2017/12/28/adderall-risks-much-mo...

hinkley 5y ago

Doctors are really good at cognitive dissonance. I think it's a professional hazard of having to compartmentalize. Those same doctors are probably perfectly fine with handing out methadone prescriptions to addicts.

novok 5y ago

I really don't like 'the norm' as the base point. If you have the mental abilities of someone with 140 IQ with serious untreated ADHD, but your life is 'just ok', that is wasted human potential. That 'just ok' person could do so much more for society's and their own benefit.

Ensorceled 5y ago
That's pretty much why I threw away the book. I wouldn't meet his criteria for treatment, but I look at how much better my life is this past year and half since my diagnosis and said ... "F this".

colechristensen 5y ago

Psychology has the sizable problem that everything is a disorder but very little is actually known about any of them. You can't say "ADHD is this" and point at a definitive cause, tis just a bag of related symptoms that is geared more towards consistent diagnoses (i.e. you go to five different doctors and they all diagnose the same thing) rather than attachment to a common underlying cause or consistent treatment plan and success phase. This isn't to say psychology is useless, many people find great help in it... but when it comes down to it, it is scientists (who as a whole have some of the biggest problems in being good at being scientists) trying to describe malfunctions of the highest abstraction on the most complicated class of things known to exist... and just scratching the surface. The last D is for Disorder... it's a value judgment and the question does need to be asked: if something isn't causing significant problems, is it a disorder? The answer isn't clear cut and people are going to draw the line in the wide grey area in different places. The solution must be neuroscience continuing to advance to higher levels and replacing the vagueries of psychology with justifiable cause and effect explanations. It is advancing but still a far way off.

BirdieNZ 5y ago
> You can't say "ADHD is this" and point at a definitive cause There's plenty of existing and on-going research that demonstrates differences in brain structure and development in people clinically diagnosed with ADHD. In other words, ADHD is caused by parts of your brain being underdeveloped or damaged. There is on-going research applying machine learning to MRI brain scans to try to predict ADHD through brain scans rather than only clinical diagnosis.

m463 5y ago

This goes hand in hand with many laws in california. There's a law that governs the treatment of mental illness and basically, it's not against the law to be mentally ill, and as long as you're a not "a danger to self or others" they will have to leave you alone, even if you clearly need help. This is particularly heartbreaking for many people with some form psychosis, because anosognosia is frequently correlated with it. This is basically an inability to have insight into your own mental illness (sort of like a powerful form of denial). So there are lots of mentally ill people in california, and they usually end up homeless, or eventually in jail.

trhway 5y ago

>Then he would start treating the addiction personality and causes, but in many cases the patients would just stop coming and live three or more hours of every day in the gym. one can speculate why addiction hasn't been selected out - may be because it probably provides significant advantage when channeled right. Some achievements/mastery/etc. require tremendous focus and huge amount of persistent work which probably may be not doable on rational motivation alone, without the primal dopamine [over]drive.

dionidium 5y ago

Similarly, the modern medical view of addiction is basically something like, "continued use in the face of adverse consequences." Laypeople really hate this definition, preferring to think of addiction as primarily a physio-chemical phenomenon, but the American Psychiatric Association has to say: "Substance use disorder (SUD) is complex a condition in which there is uncontrolled use of a substance despite harmful consequence." Source: https://www.psychiatry.org/patients-families/addiction/what-is-addiction https://www.psychiatry.org/patients-families/addiction/what-... Most organizations that deal with addiction now operate using a similar definition.

mhh__ 5y ago

I'm in the process of doing something about my symptoms that as far as I'm aware are ADHD, and people have said that to me, but I reckon I could be at least 5x more productive with help. The number of unpushed branches on my machine is proof of that.