Readers keep the popular thread going:
It’s remarkable how to me how much of the ADHD discussion has focused on people who seem to have been, even before diagnosis and medication, abnormally high achievers: elite college graduates, law school graduates, medical students.
But only about a third of this country attains the level of a bachelor’s degree. I think a large part of people’s knee-jerk skepticism about ADHD stems from the fact that, at least anecdotally, this condition seems to disproportionately afflict people at or near the top of the income/education distribution. I don’t doubt the sincerity of your readers who describe what a life-changing experience it was to start taking amphetamines, and I’m sure their diagnoses have allowed them to thrive in the rarefied ranks of fast-paced, high-pressure fields like law and medicine. But it’s the preponderance of ADHD cases among exactly those kinds of people that causes the suspicious looks from the pharmacists and the eye rolls from people like me.
Is it not worth considering the possibility that the pressures and expectations of modern-day elite occupations are, for lack of a better word, insane?
That the person who can simultaneously excel and be happy under the typical demands of, say, a medical resident or first-year law associate is a very rare psychological outlier? My sense is that the strong feelings some people have about the (over)diagnosis of ADHD has to do with the fear that we’re trying to medicate our way out of an existential crisis: most people were simply not designed to thrive under the conditions that society holds up as the very height of achievement.
Update from a reader:
There’s been a lot of great posts in the discussion, but your latest email alerted me to something that is probably just an inherent bias of your readership. Yes, lots of “high performers” are likely seeking stimulant meds when they run up against adversity, and these are accounting for a lot of the diagnosis “explosion.” But the other side to that coin that I’ve turned up in research for my own book (I was RX’d as ADD when I was 8 and am now 37) is the “explosion” of diagnosis in the poor, impoverished, foster children and minority populations.
I feel like one responder touched briefly on this, but it deserves more attention. These are kids who are living in modern “war zones” where they are exposed to violence, hunger, and any number of other emotionally and psychologically damaging social experiences on a daily basis. But somehow they’re supposed to sit and pay attention and attend to their school work just like their classmates. And when they can’t, or they act out, the course of easiest action and least resistance is usually something like an ADHD diagnosis and stimulant RX. Sometimes these kids may really have ADHD that is made worse by their circumstances, but often it’s the psychosocial trauma alone and until that is addressed, we’re doing more harm than good by giving them pills and a label.
Another makes a broader point:
Your reader states, “I think a large part of people’s knee-jerk skepticism about ADHD stems from the fact that, at least anecdotally, this condition seems to disproportionately afflict people at or near the top of the income/education distribution.” I have a condition, endometriosis, which also seems to disproportionately afflict people at or near the top of the income/education distribution. It takes, on average six doctors and over ten years to accurately diagnose (definitive diagnosis requires endoscopic surgery and a doctor who doesn’t dismiss the problem as ‘just really bad cramps’). My condition has been periodically debilitating, but was manageable until this last year when it caused me to take two months of medical leave. If I had not had the excellent health insurance that I do and an employer with a very generous medical leave policy, I would likely not have gotten a correct diagnosis and found one of the few doctors who knows how to effectively treat this condition while leaving my fertility intact.
My point is that sometimes, things that seem to disproportionally affect wealthier people are just as prominent in the general population, but most don’t have the resources to push until they find accurate answers. I am fortunate that I did, and my hope is that the more of us that do, the fewer people will have to in the future.
The Dish 