There's a tendency to for diagnoses to double duty, both as description and explanation. Why does he do those things? Because he's autistic. And why do we call him autistic? Because he does those things.

It's especially bad for things which are defined by "at least n of these m things", including depression, addiction, and a ton of other psychological diagnoses. Are we getting any wiser from such definitions at all?

(But there's the issue of insurance, or rationing assistance more generally, which compels us to keep using these non-explaining diagnoses.)

This was actively damaging to me; I didn't get diagnosed (and subsequently receive help) until I was 33 because I'm ADHD-PI and was only familiar with stereotypical ADHD-PH, which is very much NOT me. I really hope there's more differentiation someday.

Yeah, pretty common AFAIK with the 'twice exceptional' (gifted and have other issues). The medical system is not as focused on helping people who are getting by well enough and there isn't anything obviously wrong with them.

There are lots of incentives at play towards making ADHD as vague and broad as possible.

Part of this (from what I understand) is that casting a wide net and offering treatment can be an incredible preventative for children. So long as you aren't by default shoveling meds into the patient or telling them something is wrong with them (thus making false-positives almost certainly destructive diagnoses), a lot can be gained by guiding people with ADHD towards treatments.

There is a staggering amount of progress and recovery to be made, or damage to be avoided, by diagnosing ADHD. I'm all for a wide net so long as people getting caught in it are treated properly on an individual basis.

This is true, because the purposes of diagnosis by clinicians is to help the patient.

However, when it comes to research, its because delineating the various causes of X is very very very hard and long research process.

The incentives are not aligned that way. It might be true that diagnosis helps patients, but diagnoses also helps the clinician by providing a patient. This is the dark side of mental illness research.

Ideal for patients would be receiving the attention of a non-specialist who can be very broad in understanding what sequence of specialist attention is needed, when to pull the plug on that attention, and how to track the overall health and well being of a particular patient especially in regards to anything psychiatric. Virtually no MDs/GPs are going to do that.

The incentive "these people clearly need help of some sort" isn't bad, I think.

But it's bad if we have to pretend we understand something better than we do for people to get the help they need.

I think psychologists largely admit ADHD is a bit of a black box. Maybe genetic, maybe not, specific individual treatments are required, etc. Even meds won't work consistently from patient to patient. That's all fine though because generally some awareness that there's something neurologically aberrant occurring is one of the greatest tools to help cope and strategize. This is where the psychologist can really shine, offering families insight into how to live with ADHD. Whether it be a child, spouse, parent, whatever.

No psychologist I've spoken to or read a book from has claimed to have a firm grasp on what ADHD is. They even admit the diagnosis is very much done "by feel", requiring as much history and cross-reference of family and friends' experiences to be certain.

Well yeah, because it's a social construct.

There are many significant findings about the atypical anatomical and neurological development of people diagnosed with ADHD. For example, parts of our brains seem to be smaller [1] and there appears to be less blood flow to the prefrontal regions of our brains [2]. It's well known that our ability to utilize and regulate dopamine efficiently is not on par with our peers - this is why someone with ADHD responds quite differently to stimulants than a neurotypical person does. Otherwise there seems to be various genes associated with ADHD, though that area of research is young. The same can be said with autism.

The pathogenesis of ADHD isn't completely understood, but hard evidence of consistent anatomical, neuronal, and chemical differences is only increasing. There is something real happening without much doubt - the task now is to figure out what and why.

Maybe I'm misunderstanding you when you say social construct, though. I'm not sure if you mean "ADHD isn't real" or "It's a bucket we throw similar types of disorders into". If you mean the latter, I'd agree - I wouldn't be surprised if in 10-15 years we see that sub types can be distinctly identified in some way. I have no idea if at that point we'll need to overhaul these categorizations, but, I suspect we will at least understand the pathology better.

[1] https://www.thelancet.com/journals/lanpsy/article/PIIS2215-0...

[2] https://www.jpn.ca/content/35/5/330

I'm saying that the term "ADHD" is a social construct. We humans have constructed in our mind a category of human behaviors and drawn some fuzzy lines and planted a flag down saying "this is ADHD." Certainly, as you mention, you can draw trends between the two categories (ADHD vs non-ADHD), just as if you were to move from South Africa to Egypt you might notice that most of the people look different. But that doesn't make "Egypt" or "South Africa" any less of a human construct.

The idea that ADHD is some abberant way of being that ought to be medicated into a teleological more ideal way of mental being is also, completely, a human construction - you can't get that conclusion just by looking at brain blood flow or anything like that.

I see where you’re coming from. I’m not sure where you’d draw the line with things being human constructs, and I’m not sure if it being a construct really detracts from it much.

I do agree about it not inherently being a problem that needs to be medicated. I personally only use meds when I need to be more “normal” and cut through the fog that daily life and tasks seems to generate for me. Sometimes I will develop a backlog of tasks and it’s helpful to cut through it.

I get the feeling that I was born in the wrong place at the wrong time, so to speak. It seems ADHD is present but much more tolerated in some cultures such that it doesn’t cause the person with ADHD as much stress or anxiety as they grow older. Like you suggest, these people are just people and though they’re different in some ways, it’s still within the bounds of normality.

It seems to be once you put ADHD brains into uncomfortable environments that it becomes problematic. Otherwise there is plenty of potential for it to be advantageous in many ways.

I'm sorry, just to be clear, do you mean that ADHD is a social construct?

Yes - ADHD is a social construct. But this is not unique to ADHD among mental disorders.

If dermatologists worked like psychiatrists they wouldn't be able to tell acne and chickenpox apart (and they'd treat both with face powder).

One of the worse example is schizophrenia, which is attributed if you have at least two symptoms out of a list of five (meaning that people with totally distinct symptoms end up with the same diagnosis). There were genome-wide association studies in the 2010's that identified 7 or 8 distinct transcription factor networks with polymorphisms associated with a risk of schizophrenia. Every network is associated with the same symptoms.

In other words schizophrenia is likely at least 7 distinct diseases that are so orphaned they don't have a name.

Another example is eating disorders, where both bulimia and anorexia are probably underpinned by the same pathology that involves an auto-immune response following a cross-reaction to a bacterial protein that mimics a satiety hormone.

I've heard some discussion around reclassifying certain mental illness into clusters - things like depression and anxiety have extremely high levels of comorbidity.

> I think ADHD and it's subtypes is probably a description of something like 8 different actual neurological causes, which all show up as 'ADHD'.

This is the case with I believe probably the majority of psychological illnesses that have not yet been nailed to a clear biological cause.

Schizophrenia definitely has a bunch of sub-types. As does anxiety. As does whatever is sociopathy/psychopathy. ADHD included.

Over time, individual types of each of these mental illnesses will be carved out from the general type and tied to specific biological causes, thus making the vague categories even smaller.