ADD And Defining Normal

1212mentalhealth-RWWhen Mark Twain’s hero Huckleberry Finn was forced to study spelling for an hour every day, he said, “I couldn’t stand it much longer. It was deadly dull, and I was fidgety.” His teacher, Miss Watson, threatened him with eternal damnation if he didn’t pay attention. Huck admits it didn’t seem like such a bad alternative. “But I didn’t mean no harm. All I wanted was to go somewhere; all I wanted was a change, I wasn’t particular.”

If that had happened today, Huck would have been diagnosed as ADD, put on Adderall, and forced to attend school, while the book about his adventures would never have been written.

The American Psychiatric Association invented the term ADD in 1980 to give kids with hyperactivity, impulsivity, short attention span and easy distractibility a diagnosis. Who would have thought that 28 years later, the National Center for Health Statistics would report that over 5 million American kids (8%) between the ages of 3-17 would receive this diagnosis. That’s 1 out of 12, with about half of those on medication.

William Evans, PhD, with the Journal of Health Economics found that a huge predictor for the diagnosis of ADD was the age of the child with respect to their grade. In other words, younger children in a given grade, have more ADD symptoms than older ones.

No surprise there – younger kids clearly are more restless and less able to concentrate on a topic, or sit quietly in a classroom all day long. According to his research, “approximately 1.1 million children received an inappropriate diagnosis and over 800,000 received stimulant medication due only to relative maturity.”

Let me quickly point out, that I’m not opposed to medication to treat those with severe symptoms, but do 1 out of every 12 kids really have ADD?

I wish this was just about ADD, and though that clearly is the most grievous example; bipolar disorder, OCD, generalized anxiety, social anxiety and other diagnoses also illustrate the over-diagnosing, over-treating and over-medicating of psychiatric problems throughout America. The first psychiatric diagnostic manual, DSM-I, in 1952 had 106 disorders listed. The revised DSM- IV in 2000 had 365!

The National Institute of Mental Health has found that 26 percent of Americans (1 in 4) have a diagnosable psychiatric illness. The only word for that is “ludicrous”. A disorder of any kind is by definition something wrong, screwed up, malfunctioning.

A mental disorder is an irregularity in the functioning of the brain. If the brains of one quarter of the U.S. population are disordered then something is very, very wrong with the human mind. Or with our mental health system.

In a Wired magazine interview in January 2011, Allen Frances (lead editor of the Diagnostic and Statistical Manual for Mental disorders –IV) blamed the DSM-IV itself. “We made mistakes that had terrible consequences,” says Frances. One of these consequences, the article notes, is that diagnoses of ADD have skyrocketed.

“Frances thinks his manual inadvertently facilitated these epidemics— and, in the bargain, fostered an increasing tendency to chalk up life’s difficulties to mental illness and then treat them with psychiatric drugs.”

Here’s the problem: The profession of psychiatry has taken on the role of defining ‘normal’ in our society. Even Webster’s dictionary defines normal as being, “free from a mental disorder”. As we purposely shrink the box called normal and it gets smaller and smaller, the abnormal universe expands to include almost everyone. But we say, “don’t worry, we can fix that with a pill and make you normal just like everyone else”.

My profession has not only redefined mental health by over-diagnosing and over-medicating an ever-expanding number of diagnoses, we are also taking away the hope of human nature by telling our patients that they are inherently “abnormal” and need to be fixed.

The psychiatrist’s office has gone from being the place no one would be caught dead visiting…to the place where a pill could fix anything. And psychiatry itself has gone from being stigmatized to glamorized.

Psychiatric conditions don’t come with an on/off switch, but rather occur along a continuum. High levels of any given trait may represent a severe psychiatric diagnosis requiring medication, BUT in small to medium doses, these very same traits can represent your greatest strengths.

On a scale of 1-10, what separates an ADD 7 from an ADD 10? Who gets medicated…..and why? How could one person use a set of “symptoms” as a springboard for success while another with the exact same symptoms needs meds and therapy?

How are CEO’s like Richard Branson (Virgin Airlines), John Chambers (Cisco), and Charles Schwab able to parlay their ADD into tremendously successful careers, while others are searching for a magic pill and a cure?

David Neeleman, founder of Jet Blue has said that if he found a magic pill to make his ADD go away, he wouldn’t take it. Creativity and innovation are hallmarks of those with ADD.

When a child first presents with symptoms, why aren’t we telling them that they are three times more likely to form their own business, will thrive in disruptive situations, will embrace adventure and are adept at multi-tasking, as opposed to giving them a diagnosis and a pill?

We must stop thinking how to give the “patient” what they think they want and start taking a look at what’s good about what they have. We must empower individuals to think it’s ok to be “not normal” and change the mindset that everything can be “fixed” with a pill or a few therapy sessions. We must help them understand that what they perceive as their worst trait, may in reality be their best.

“It’s time for a new order of business in mental health, based on the premise that when you try to conform to a perceived “normal,” you lose your uniqueness—which is the foundation for your greatness.”

by Dale Archer, M.D.

11 thoughts on “ADD And Defining Normal

  1. I’m 20 years old and I was just officially diagnosed with ADHD this year, but I always knew I had it, because I knew I was different, but I wasn’t sure how. At school, and at my first job, I was always messing up and failing at things, and it affected my life in a very negative way for my first 18 years. When I graduated, I started doing something I loved and was really good at. I started my own jewelry business and now I’m making more than anybody else I know my age… reflecting back on my life, I know things would have been radically different if I did not have ADHD, and I never realized until now, after researching more about it, how much it has affected and shaped my life. Thanks for this article, I found it very informative, and never knew any of this. I wrote about this and my experience growing up with ADHD in my journal, at mtgrl.wordpress.com

  2. Fantastic blog! I’ve thought this for ages now and I’m not a professional in psychiatry by any stretch. This needed to be said, and I’m very happy to hear it from someone with your credentials.

  3. I have been thinking along these lines myself lately. Having recently been diagnosed with anxiety, depression & OCD it is a strange feeling to perceive yourself as normal but going through a rough time, then to suddenly be labelled with a disorder. Essentially I think it helps to remember the scale of severity, and that everyone fits on that scale somewhere. The decider is ultimately how much that trait affects your life. If it doesn’t affect it at all, then you have no problem.

  4. I find this fascinating… I wonder often about misdiagnoses, as a relative of mine has 2 sons who were labelled ADD when they were very young, now after much medication and many years later the doctors are thinking that the younger son is not ADD but rather has asperger’s… I also have a friend in the states that went through a very similar situation with her eldest daughter… both feel very frustrated with the system and wonder what things would be like had the original diagnoses been correct….

    I also have a friend whose daughter in her early 20’s got into raving… then was diagnosed with bipolar, one of the questions that has come up over and over again in therapy for them is, did she already have the disorder and the rave drugs hastened / revealed her symptoms or did the drugs actually cause the disorder… (I am not a doctor so I can only wonder myself)

    There are so many people out there who do not seem to have effective coping mechanisms for dealing with life, but does that mean they have a mental illness? Does that mean they need to be medicated? Perhaps they need counsel to assist them with learning effective coping mechanisms. I think sometimes when the brain/body has experienced something overtly emotionally traumatic it will “shut down” or “short circuit”. I do not think that in all cases this represents mental illness but rather it is a temporary malfunction or overload that needs to be stabilized and corrected.

    We truly know so little about the human brain and how it really works… IDK I suppose I am just thinking ‘out loud’ here…

  5. Most of those diagnosed with ADD are male. This indicates a shift in society’s thinking – that unless you can sit and work quietly and produce a particular product in a particular way, you are “abnormal”. We need to start recognizing that there are a lot of Huck Finns out there, and their built-in talents and abilities are being systematically stunted by a society that places a huge emphasis on conformity. We are starting to fail our boys.

  6. Excellent article that should be taken seriously. In the case of OCD, while I agree that those with the disorder are often over-medicated, I’m not sure it would fall into the category of being over-diagnosed. In my experience, and from what I hear from others, it is still often misdiagnosed, or not diagnosed at all. The other point that I’m not sure I agree with is that psychiatry “has gone from being stigmatized to glamorized.” In my experience, many people still will not see a psychiatrist because of the stigma associated with it. All in all, a great article that we need to pay attention to. Thanks!

  7. I think we are a deeply disordered species, and probably 1/4 of us are not able to function well in the society we have created for ourselves. People blame this society, but if we have created the wrong society for our own welfare, that is our own fault, and an indication of underlying disease. The idea that normal = well is a false equation.

  8. Thank you for this post. Our oldest does get fidgety and gets distracted easily as well. My husband and I have considered testing him for ADD since my husband had/has it. However, now I can flip that around thanks to your post! As a business major, I can see his potential. I need to let him have breaks in our homeschool program to tinker with his Legos and build whatever his mind comes up with.

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