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The "neurodiversity" viewpoint here is that what we call "ADHD" is part of the natural variation in how human brains work, and that it's a category error to thi
by djur 5y ago
The "neurodiversity" viewpoint here is that what we call "ADHD" is part of the natural variation in how human brains work, and that it's a category error to think of it as a malfunction to be repaired, but rather as a difference to be accommodated. That accommodation may or may not be via medication and therapy, but that shouldn't necessarily mean that the underlying neurological state is a diseased one.
A good analogy would be height: a person who is several standard deviations from the mean will face challenges in life that require various forms of intervention, but we don't generally think of them as having a _disorder_ unless there's an identifiable biological cause that usually has other effects.
Another good point of comparison is vision. We can accurately measure vision and create medical devices to correct unwanted variation. As someone with myopia, I find it to be only slightly medicalized -- going to get an eye exam doesn't feel much like visiting a doctor, and people don't tend to talk about it as one does a medical condition. I imagine that if we were able to make a similar kind of standardized assessment of whatever neurological basis there is for ADHD, we would consider medication for it more akin to a stepladder or a pair of glasses (or even an antihistamine) than a treatment for a mental illness.
- girvo 5y ago> and people don't tend to talk about it as one does a medical condition While I basically entirely agree with your comment, my partner (who is an optometrist here in Australia) would often point out to me that myopia is a big risk factor for retinal degeneration and detachment, open angle glaucoma, and cataracts at a young age. So while we definitely shouldn't treat mild myopia (like I, and likely you have) as some horrific medical condition, she also gets a bit frustrated by general practitioners and retail optoms who don't treat a lot of the eye diseases she handles with the gravity some of them actually should bear. Anyway this is a massive tangent, just was something interesting I wanted to share!
- photojosh 5y agoFascinating. Seems to me that it would be a comorbidity with a common cause though, rather than the myopia being the causative factor? My (somewhat loosely informed) intuition suggests to me that in the same way that not spending enough time exposing the eye to light outdoors increases the severity of myopia, it would likely be causative in those other degenerations. Use it or lose it! Not that I know anyone who spent all of their childhood with nose in a book then graduated to a computer, cough... I say this having quite mild myopia, although I wear glasses still, can't stand a blurry world.
- girvo 5y agoSo I just asked my partner, and what she explained was myopia is basically caused by/a symptom of axial elongation of the eye, which is also what can cause the bigger diseases I spoke about initially! Ortho-K/myopia control as a kid/young adult can help fix/arrest the continued development of this, though thats now well outside what I understand of the topic haha
- strken 5y agoI'm several standard deviations above the mean in height and it absolutely is a disorder. I can point to the exact hormonal pathway that led to it along with a specific biological root cause, but even if I couldn't, I think it would be disordered. I'll die earlier than a shorter person, have joint and bone problems, have cardiac issues, and nightclubs are way less fun when you can see the entire room. More to the point, I don't think I'd consider it very offensive if someone called my height a disorder, because it's not core to my identity in the same way thinking is. Calling ADHD (or autism, etc.) a disorder feels like telling someone they're personally deficient, because the person is inextricable from the condition. Growing really tall in your teens is something that happens to you; having ADHD your whole life is something that you are. Note that this is true even if their thinking does meet the criteria to be a disorder.
- jrapdx3 5y agoYou're right, defining a "disorder" is hardly a boolean question. ADHD has been studying extensively and there is substantial evidence for biological origins. For one, heritability very high, reported to be somewhere between 0.75 and .9, only slightly less than traits such as height. Significant differences in brain neurophysiology are well-documented in ADHD (vs. non-ADHD people), and show genesis of the condition is multi-factorial. Calling ADHD a "disorder" implies the condition has physiological origins but is not attributable to a narrow/distinct range of factors like a condition termed a "disease" (such as viral illness, etc.). The issue of diagnosis conceptually reflects a state where "malfunction" and "maladjustment" or "maladaptation" coincide. IOW malfunction is relevant when it's maladaptive, that is lacks fitness to a problem-space. In a computer application a bug (malfunction) can lurk undetected as long as the code containing the error is not invoked. But when some refactoring exposes the bad code to invocation, that code is maladaptive and the result is dysfunction of the application. An example is an ADHD individual with trouble prioritizing who takes longer than peers to complete tasks. Not a problem when deadlines are minimal. But thrust into a role where timely performance is required risks failure, loss of a job, etc. The individual's malfunction is then maladaptive, which could prompt the person to seek help to mitigate malfunction and improve adaptability to realities of employment. Consequently there's no across the board right or wrong answer to the "correct" way to regard ADHD characteristics. Also I agree with you that "mental illness" is a misleading term that could profitably be expunged from our vocabulary. However were that to happen the conditions that are labeled as such are still very real and will in many cases continue to need treatment regardless of the labels we apply.
- refurb 5y agoBut than the logical conclusion is there are no disorders only a failure to accommodate? If someone is psychotic and disconnected with reality are we just applying our neurotypical filter? Should we just accommodate people who hear voices?
- krono 5y agoA cost/benefit analysis is how we usually find these answers. It's a harsh truth.
- deleted 5y ago[deleted]
- astrange 5y agoThose people can be useful as shamans if you're lucky.
- chrsig 5y ago> Should we just accommodate people who hear voices? We should do a better job than we do now.
- refurb 5y agoNo, should medicate them because most people don’t want to hear voices.
- girvo 5y agoThat depends on your cultural filter. https://www.sbs.com.au/news/article/comment-when-hearing-voices-is-a-good-thing/mcl8rq1ej https://www.sbs.com.au/news/article/comment-when-hearing-voi... https://www.google.com/url?sa=t&rct=j&q=&esrc=s&source=web&cd=&ved=2ahUKEwiM3LLh0ML3AhUi73MBHa--AcUQFnoECAYQAQ&url=https%3A%2F%2Fmhfa.com.au%2Ffile%2F428%2Fdownload&usg=AOvVaw1CLX7jwVaxjS8SBt9vV57e https://www.google.com/url?sa=t&rct=j&q=&esrc=s&source=web&c... (Excuse the google link, its a direct PDF file download annoyingly) > Be aware that it is common for the experiences of Aboriginal people (such as seeing spirits or hearing voices of deceased loved ones) to be misdiagnosed or mislabelled as mental illness when they are not in fact ill. Fear of misdiagnosis can be a strong barrier to help-seeking for Aboriginal people. For these reasons, you should take great care not to simply assume that the person is developing a mental illness or suffering a mental health crisis.
- GavinMcG 5y agoThat viewpoint makes the same strawman argument: > <X> is part of the natural variation in how human brains work, and ... it's a category error to think of it as a malfunction to be repaired No! No one is saying that everyone at one end of the spectrum has a disorder. It is specifically not a category error because the term "disorder" is not applied based on the variability, but rather based on whether the variation meaningfully disrupts the individual's life. That's why the only change the author needs to make here is to say he has an attention deficit rather than saying he has a disorder.
- photojosh 5y agoYes! I would just add that I like to refer to it as "attention dysregulation" rather than 'deficit'... my experience I can focus on one singular task to the exclusion of all other needs and demands (even base biological ones), to point of being in pain and exhaustion and causing myself harm. Staying up for 40 hours programming... running trails for hours and hours... I have more than enough attention.
- cbfrench 5y agoThat’s a major reason why Dr. Russell Barkley refers to it as Executive Function Disorder. We actually don’t have a problem with attention; we have a problem prioritizing what we attend to. Everyone with ADHD is familiar with the hyperfocus phenomenon. We can pay attention (even sustained, abnormally intense attention) to activities that provide a healthy dopamine payout, but we don’t really control what those activities are. It’s helpful if they happen to be socially useful activities!