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> 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 Audi

by 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.
- adambard 5y ago
  The essay [1] from which the hairdryer anecdote is quoted has the thesis that categories (in general) are instrumental, and don't have much value separated from their context. ADHD is a category of psychiatric diagnosis; psychiatric diagnoses exist to address deficiencies in function. Separating the one from the other, as you perceive, renders it meaningless -- or perhaps, useless. If one happens to have some of the traits of ADHD but it doesn't affect their life negatively, so what? [1] https://slatestarcodex.com/2014/11/21/the-categories-were-made-for-man-not-man-for-the-categories/ https://slatestarcodex.com/2014/11/21/the-categories-were-ma...
- kdmccormick 5y ago
  No. It's a misconception that mental disorders are meant to categorize folks by sets of character/personality traits, whether or not they negatively impact someone. No, you do not have "a bit of OCD" if disorganization simply stresses you out. On the contrary, mental disorders are labels expressely intended to inform and enable treatment of distress. Disorder and treatment are inextricably linked. This is all according to how the DSM defines things, of course. Others may have opinions on how mental disorders should be defined.
  - thaumasiotes 5y ago
    You're elaborating on how the categories are intended to be meaningless, but you're not doing much to claim that they are in fact not meaningless. If someone has low occupational functioning, you could call that a disorder. But why would you call it "ADHD"? Why would you call it ADHD for some people and OCD for other people? Suppose you have two lists of symptoms: Attention Deficit Hyperactivity Disorder - Patient has an active mind. - Patient has a crummy job. Borderline Personality Disorder - Patient rubs me the wrong way. - Patient has a crummy job. And you have several people who display every combination of mental activity, mental lethargy, likeability, unlikeability, good jobs, and bad jobs. You say everyone with a good job has no mental disorder, unlikeable people with mental lethargy and a bad job have borderline personality disorder, likeable people with mental activity and a bad job have ADHD, and unlikeable people with mental activity and a bad job have borderline personalities _and_ ADHD. Likeable people with mental lethargy and a bad job have a disorder as yet unnamed. What did you learn about the reasons why people with bad jobs (your primary diagnostic criterion, after all!) have bad jobs?
    - lazide 5y ago
      That is definitely not how it is defined through - it seems to be a straw man? The criteria is essentially ‘you meet these criteria AND it causes clear problems with your ability to live your life’. It doesn’t mean you have a bad job and X, therefore you have ADHD. Rather, you show ADHD traits and they get in the way (and cause you distress) in doing a job you otherwise would be entirely capable of doing. Or consistently fail (and have distress) on social environments you’d otherwise be perfectly fine in, etc. If you don’t have a criteria like that, there is no useful criteria at all, since practically all medicine is oriented towards fixing things that aren’t working correctly/causing problems. It’s the same type of criteria used for evaluating everything from heart disease to stroke to a broken bone. Or in other words ‘if it ain’t broken, then it isn’t broken.’
- Zarel 5y ago
  The problem is that it's a matter of degree. Like another comment mentioned, having some wine every few months isn't being an alcoholic. Being distracted sometimes is completely normal, being distracted too much is a disorder. So it has to be a line you draw somewhere. And it's not like you can just count them or something. It's not like you can say "5.2 distracto-particles is normal, but 5.3 distracto-particles is ADHD". And traditionally, "too distracted to hold a job" is a common place you might draw the line between "normal" and "ADHD". So yeah, you might have to draw the line somewhere arbitrary, but that doesn't mean that the thing it's trying to measure doesn't exist. Any line you draw between "short" and "tall" will be arbitrary, but that doesn't mean height doesn't exist.

by mlyle 5y ago

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.
adambard 5y ago
The essay [1] from which the hairdryer anecdote is quoted has the thesis that categories (in general) are instrumental, and don't have much value separated from their context. ADHD is a category of psychiatric diagnosis; psychiatric diagnoses exist to address deficiencies in function. Separating the one from the other, as you perceive, renders it meaningless -- or perhaps, useless. If one happens to have some of the traits of ADHD but it doesn't affect their life negatively, so what? [1] https://slatestarcodex.com/2014/11/21/the-categories-were-made-for-man-not-man-for-the-categories/ https://slatestarcodex.com/2014/11/21/the-categories-were-ma...
kdmccormick 5y ago
No. It's a misconception that mental disorders are meant to categorize folks by sets of character/personality traits, whether or not they negatively impact someone. No, you do not have "a bit of OCD" if disorganization simply stresses you out. On the contrary, mental disorders are labels expressely intended to inform and enable treatment of distress. Disorder and treatment are inextricably linked. This is all according to how the DSM defines things, of course. Others may have opinions on how mental disorders should be defined.
- thaumasiotes 5y ago
  You're elaborating on how the categories are intended to be meaningless, but you're not doing much to claim that they are in fact not meaningless. If someone has low occupational functioning, you could call that a disorder. But why would you call it "ADHD"? Why would you call it ADHD for some people and OCD for other people? Suppose you have two lists of symptoms: Attention Deficit Hyperactivity Disorder - Patient has an active mind. - Patient has a crummy job. Borderline Personality Disorder - Patient rubs me the wrong way. - Patient has a crummy job. And you have several people who display every combination of mental activity, mental lethargy, likeability, unlikeability, good jobs, and bad jobs. You say everyone with a good job has no mental disorder, unlikeable people with mental lethargy and a bad job have borderline personality disorder, likeable people with mental activity and a bad job have ADHD, and unlikeable people with mental activity and a bad job have borderline personalities _and_ ADHD. Likeable people with mental lethargy and a bad job have a disorder as yet unnamed. What did you learn about the reasons why people with bad jobs (your primary diagnostic criterion, after all!) have bad jobs?
  - lazide 5y ago
    That is definitely not how it is defined through - it seems to be a straw man? The criteria is essentially ‘you meet these criteria AND it causes clear problems with your ability to live your life’. It doesn’t mean you have a bad job and X, therefore you have ADHD. Rather, you show ADHD traits and they get in the way (and cause you distress) in doing a job you otherwise would be entirely capable of doing. Or consistently fail (and have distress) on social environments you’d otherwise be perfectly fine in, etc. If you don’t have a criteria like that, there is no useful criteria at all, since practically all medicine is oriented towards fixing things that aren’t working correctly/causing problems. It’s the same type of criteria used for evaluating everything from heart disease to stroke to a broken bone. Or in other words ‘if it ain’t broken, then it isn’t broken.’
Zarel 5y ago
The problem is that it's a matter of degree. Like another comment mentioned, having some wine every few months isn't being an alcoholic. Being distracted sometimes is completely normal, being distracted too much is a disorder. So it has to be a line you draw somewhere. And it's not like you can just count them or something. It's not like you can say "5.2 distracto-particles is normal, but 5.3 distracto-particles is ADHD". And traditionally, "too distracted to hold a job" is a common place you might draw the line between "normal" and "ADHD". So yeah, you might have to draw the line somewhere arbitrary, but that doesn't mean that the thing it's trying to measure doesn't exist. Any line you draw between "short" and "tall" will be arbitrary, but that doesn't mean height doesn't exist.