I bet if you knew your house would burn down if you didn't do "normal" things you would have done them no problem.
Stimulants make otherwise unenjoyable things enjoyable? Who would have thought? Do you think people that do "normal" things enjoy them? Is it necessary to enjoy everything all the time?
Getting yourself to do things in a boring situation that you might only do in an exciting situation is a big challenge in ADHD management
If everything was a "house on fire" level emergency, many ADHDers would get more done but would eventually collapse from running around on adrenaline for days
These problems are not easily solved
To pretend that humans are hedonic beasts incapable of cognitive adaption is ridiculous. We do not operate purely on impulse save for pharmaceutical intervention. We can force ourselves to give things more or less importance regardless of the actual stakes.
People were constantly bombarded with death, disease, things like starvation were near term risks, violence was everywhere, etc.
You're also overestimating the prevalence of alcoholism. Alcohol consumption was largely driven by safety and necessity, not abuse. Alcoholism was arguably more of a social stigma historically than it was today, certainly with harsher criminal penalties in many societies.
People with ADHD cannot all just "force themselves" to function. Novelty, excitement and interest can help, some of the time, but the rest of the time it's disaster. Depending on severity, the result of not getting the treatment they need can often include things like an inability to keep a job, homelessness, prison sentences, and accidents/injury. Those kinds of outcomes are pretty damn important to avoid, extremely stressful (exciting) to experience or be in imminent danger of, and certainly more than enough to motivate people to do the best that they can, but some percentage of people will never be able to avoid those outcomes by trying to will themselves into "cognitive adaption".
Others may be able to stave off the absolute worst outcomes without medication, but only through exhaustive efforts that prevent them from accomplishing the things they want in life. Why should someone constantly and needlessly push themselves to their absolute limit just to accomplish what comes easily for most people? For what? Bragging rights about how they reshaped their brains by sheer force of will? If medication for a mental condition can make people's lives better they should be free to take it.
To whatever extent you've been able to function without medication, that's great. Don't assume that what worked for you is applicable to everyone else, or even to most other people.
Edit: by chaos I mean things breaking down, going wrong, catching fire, etc. I accomplish things easily once I've taken so long to get to them, that they're seriously urgent.
Why do you think that is?
Asian Americans are so successful that they certainly must not have disproportionately higher rates of suicide right? That might be a sign of some "impairment" going unaddressed! Or maybe you see the rate at which they're killing themselves as yet another metric of success? Those scrappy East Asians are just so good at doing stuff!
They outperform by the metrics that matter for a clinical diagnosis and the West is so quick to jump to the conclusion that they're "under diagnosed", it's a uniquely Western and especially American conclusion.
Because you talk like one, with no apparent empathy for the neurodiverse, except perhaps people with profound issues. "We shouldn't treat any problems except the catastrophically bad." Gross.
> I bet if you knew your house would burn down if you didn't do "normal" things you would have done them no problem.
This is not arguing in favor of your stance, but rather in favor of mine. You're essentially saying "ADHDers can't get shit done without being in dangerous situations, and THAT IS ACCEPTABLE." And yet you think this supports your idea that non-catastrophic disorders shouldn't be treated.
No I'm saying you lack the impulse control and self discipline to perform tasks unless the stakes are high. But you're not an animal, you can do something about that without medication. You can accept the discomfort and move through it just like you do when the stakes are actually high. Just like I do. The idea that everything in life should induce minimal discomfort or that "it's hard" is an excuse is a completely modern, first world problem, to speak of privilege.
Mindfulness and thinking about your thoughts are proven as effective or more effective than medication for a wide range of psychological disorders, including ADHD, or CBT if you want to formalize it.
Your story can be summarized as "I was bad at doing things that made me feel discomfort, but now I'm on stimulants and I don't feel discomfort anymore." What else did you try? What areas of life did you accept discomfort for the sake of long term growth? If there were any, what made them different?
Like yes, I do things that are unpleasant - ADHD doesn't mean I live a life of ease, avoiding unpleasantness all day long.
Have you ever considered that the things which you find doable or even trivial might be incomprehensibly more difficult for other people? You mentioned being diagnosed with ADHD higher up, but part of the diagnostic criteria for ADHD is quite literally about severity of the symptoms:
DSM-5: "There is clear evidence that the symptoms interfere with, or reduce the quality of, social, school, or work functioning."
ICD-11: "Several symptoms of inattention/hyperactivity-impulsivity that are persistent, and sufficiently severe that they have a direct negative impact on academic, occupational, or social functioning"
Being capable of pushing through basic adult responsibilities, regardless of discomfort and difficulties (without burning yourself out!), and failing to do so to the degree that it severely negatively affects your life is the defining line between "order" and "disorder".
If you have a very demanding job then you might experience symptoms that are consistent with ADHD. That's why the diagnostic process is supposed to verify that there's a clear history of symptoms ranging back to your teenage years (or earlier) and that your symptoms aren't being caused by general life stressors.
> The idea that everything in life should induce minimal discomfort or that "it's hard" is an excuse is a completely modern, first world problem, to speak of privilege.
No, the idea is that people should receive help if we have a neurodevelopmental disorder that is severe enough to significantly impact our quality of life. Just like with any other medical condition.
> Mindfulness and thinking about your thoughts are proven as effective or more effective than medication for a wide range of psychological disorders, including ADHD, or CBT if you want to formalize it.
False:
> CBT is best used within a multi-modal treatment approach and as an adjunct to medication as current research does not fully support the efficacy of CBT as a sole treatment for adult ADHD [274,[316], [317], [318]]. Most controlled studies have been conducted in patients taking ADHD medication and demonstrate an additional significant treatment effect [313,[318], [319], [320], [321], [322]]. The largest controlled multi-center CBT-study to date has demonstrated that psychological interventions result in better outcomes when combined with MPH as compared to psychological interventions in unmedicated patients [228]. In a systematic review of 51 pharmacological and non-pharmacological interventions [316], the highest proportion of improved outcomes (83%) was for patients receiving combination treatment.
https://www.sciencedirect.com/science/article/pii/S092493381...
"Quality" is an arbitrary definition that means nothing, that's one of the problems we're talking about in psychiatry. The OP clearly mentioned that there was minimal impact on academic, professional, or social functioning other than internal discomfort, for example, yet was prescribed anyway.
>False, regarding CBT
Wow it's almost like the replication crisis is a real thing and we have no idea what we're talking about. Look at these completely disparate results when examining a different population group.
https://www.sciencedirect.com/science/article/abs/pii/S01651...
Why is that a problem? It's not completely objective but it's the best we have. That criteria is typically combined with more objective neuropsychological testing for a well rounded assessment.
> The OP clearly mentioned that there was minimal impact on academic, professional, or social functioning other than internal discomfort, for example, yet was prescribed anyway.
They didn't say that, they said that they weren't suffering "catastrophic failures", which is distinctly different from "minimal impact". They also said they had high intellectual abilities which is entirely consistent with the ICD-11 description:
> The degree of inattention and hyperactivity-impulsivity is outside the limits of normal variation expected for age and level of intellectual functioning
High-IQ can mask ADHD, but that doesn't mean they haven't been experiencing challenges associated with ADHD.
You find it problematic that the other person was diagnosed with ADHD simply because their life wasn't a total disaster but I'd like to remind you that it's an attention deficit/hyperactivity disorder and not a "Can't Hold Down a Job" or "Total Failure At Life" disorder and your desire to have it redefined it in those terms wouldn't help anyone.
It's something that persistently prevents someone from living a "normal" life, which is also defined far too narrowly.
You're absolutely insistent that virtually any amount of "negative effects" is sufficient for diagnosis and pharmacological intervention which is absolutely not the case.
Nobody is saying it's easy or the discomfort and difficulties aren't real.
There you go again, I'm doing nothing of the sort. They complained of severe difficulties and called some of them "torture".
You took that, minimized their complaints and accused me of wanting to medicate anyone suffering "virtually any amount of negative effects" which apparently includes the person who self-described it as torture.
Getting sleep right helps a lot. Getting sunlight helps a lot. etc But in the end a notable problematic aspect of it remains.
Like many other biological systems, neurological wiring is multidimensional and not a natural fit into our arbitrary culturally defined abstractions, or even language. And the dimensions themselves are multifaceted expressions of multiple genes and environmental factors. I am happy to hear stories like yours, of people who can ultimately achieve "normal" functional parity without medication.
Have you considered if that would have been possible without the journey? Had you, on day 1, cancelled that first therapist appointment and decided to grit your teeth and "try" instead, could you have "accepted discomfort" on your own? Or is it possible that the methylphenidate created supportive conditions that improved your chances?
I ask because there is a body of well reproduced research demonstrating not only that ADHD patients have specific genetic and neurobiological differences from neurotypicals in areas associated with executive function, but that long term ADHD medication use can permanently bring the neurological differences into line with neurotypical controls. Something like 20% of medicated childhood ADHD patients can ultimately stop medication without losing points in functional testing or the associated brain structures. It's a lower percentage in adults and less well studied, but still exists. It's a big difference from the results of every non-chemical intervention we've studied, which have single digit efficacy percentages if they beat P at all.
I'm interested in your feelings about this because ADHD is by far the most-studied psychological disorder in the world, and ADHD medications as a group are not only equally well studied, but also the most successful and least harmful of any psychiatric drug. There are more safety and efficacy studies for ADHD medication than for ibuprofen.
So... if you feel your recovery was not helped by the neurogenetic compensations provided by methylphenidate, you should know that you are flying so far in the face of some of the best-validated medical science, that you imply invalidity of pharmaceutical or medical science as a whole.
... which is fine of course - it's your body and brain! But I bet it would help readers to know how you think this aligns with the science, or maybe what you think of medical science altogether. Questions like "Do you take ibuprofen?" And "Do you vaccinate?" Become relevant.
You're leaving out the part about being "well studied" paired with your conclusions is almost exclusively in American and Western European populations, things are significantly less clear in other populations and cultures.
For those with ADHD they turn on the prefrontal cortex which reduces or removes the feeling of utter torture and pain from doing chores.
It's sort of like taking a drug that takes away the fear and almost physical inability to to touch a hot stove most people have. Normally that'd be bad. Except here the hot stove is actually harmless and useful to touch.
Edit: ok, that was vallium. ;)
Benzodiazepines, opioids, stimulants, opioid-like substances like carisoprodol (there is a reason why people call it Soma). these are the first that come to my mind. contrary to popular belief, downers often give you euphoria.
There also is a good chance I don't have children because just being alive and by myself was super exhausting before I got diagnosed in my late 30. Having children was unthinkable until then.
But was it catastrophic? I don't know. I finished college except it took two times as long and got a job where I of course suffered pretty much the whole time.
But that was all very normal for me, just the way I was, at least that's what I used to believe.
This is a very privileged view of the mind. I have ADHD (and autism). But I also have a quite high IQ, if one cares about such things. I'm pretty successful, professionally.
But it took until around 40yo to get the ADHD diagnosis and get a prescription for medication that has been life-altering. Was I suffering from catastrophic failures? Absolutely not: married, have kids, in the 1%, etc.
But have the meds had an incredibly positive influence on my life? Hell yes. I can do things that everyone else acted like was normal, but I straight up couldn't do it before. Housework is a prime example. It was like torture. Sitting around waiting for people to finish their sentences because they're "talking as slow as molasses" made for often unenjoyable social experiences.
But with the meds, this stuff is either tolerable or fun. My life is significantly better thanks to medical interventions. Instead of my wife blowing up because I didn't do something like mop the kitchen floor, I actually get it done (without meds I straight up cannot hold that kind of task in my mind if I'm not in the room looking at the mess; I will flit between ten other things in a different part of the house, then walk through the kitchen to get into my car to pick up the kids, see the kitchen, and think "ah, fuck me")
I'm happy that you're neurotypical and have a great life, but that's not true for a lot of us, and the idea that "only catastrophic mental issues should be dealt with by professionals" is you just telling on yourself and your ignorances.