Challenging the Narrative around ADHD

Photo by Sies Kranen on Unsplash

Chapter 13

About ten years ago, I devised a play with the teenagers in my youth theatre, which we called 'Compliance'. The premise was that those who didn't comply with societal norms were injected with a drug called 'Compliance' which would make them comply. Initially, it was used only on the seriously deviant but as time went on, it was used for more and more petty misdemeanors. All bar one of the cast thought it was a terrible idea - but the one who did couldn't see why such a drug wasn't being researched and created. As far as she was concerned, it would solve an inordinate number of problems.

Far more recently, I read 'Klara and the Sun' by Kazuo Ishiguro, a moving and also terrifying novel. In this, children can be 'lifted' by their wealthy parents. The process is never explained and most children seem to be unscathed and intellectually more capable as a result. Again it is unsaid, but there is a suggestion that the central character and her dead older sister may have been damaged by the process in a life-threatening way. It is, however, the norm. Another central character has not been 'lifted' and is almost, if not quite, a social pariah as a result.

Am I completely out of order in suggesting something broadly similar is going on with the use of central nervous system stimulating drugs such as Ritalin for so many who are diagnosed with ADHD?

I have worked with young people who have been diagnosed with ADHD. It has been obvious and cruelly debilitating. Focus has been wildly scattered or extraordinarily intense. Conversation has been a struggle, dodging here and there and exhausting to follow. The effort of sitting on a chair for a period of time has been phenomenal and for some, impossible. Fitting into a school setting and relating to a peer group has been desperately difficult. This is a real condition and one that is justifiably and compassionately seen as a disability. For children and young people such as these, medication can be a real life-changer: I have no gripe with that.

Unfortunately, a growing number of adults are now jumping on what seems to have become a bandwagon. At a recent webinar on the topic that I attended, someone wrote in the chat 'I've had ADHD since the menopause'. I'm sorry, but I disagree. ADHD, is, in my understanding a type of neurodiversity - you don't suddenly become neuro-diverse when you hit the menopause! If your concentration is shot or you are suddenly struggling to juggle the multitude of tasks women usually (and fantastically) manage, that's more than likely one of the many effects of the menopause, not ADHD. The list of things I personally have heard adults blame on ‘their ADHD’ is extraordinary, amongst them:

Always being late

Not finishing tasks/being unreliable

Sleep issues

Affairs

Addictions of all sorts

Procrastination

The speaker at the webinar produced a list of all the adverse effects of ADHD which varied in gravity from organisational difficulties to criminality. He said, 'Every time we look for something (in people with ADHD) we find it.'

Forgive me but no shit, Sherlock! Surely every time I look for something in people in general, I think I'm likely to find it! Looking at his list, his clients seem to be suffering from the vicissitudes of life! 'Life is difficult,' wrote M Scott Peck on the first page of 'The Road Less Travelled', way back in 1978. Essentially, he then tells you to get over it. Harsh but ultimately, very helpful. He wasn't being original. He acknowledges his debt to the Buddha.

There seems to be an epidemic of adults in mid-life, reflecting on how little they've achieved or how dissatisfied they are with themselves who have suddenly found a convenient 'reason' in ADHD. How much better they then feel when they have something to blame for their lack of a stellar career, their unfinished degree, the book they still haven't written etc. Not my fault - I'm just a victim of my neurodiversity. Huge sigh of relief. Of course, we have a diagnosis catch-up situation going on here and some of these adults will genuinely have been struggling with ADHD all their lives and it will have led to some or all of the difficulties cited - but in the numbers flocking to be diagnosed? I question it.

What's my gripe if it makes them feel better? Am I just being mean and curmudgeonly? (Always possible in my case, I have to admit.) And what's the link to achievement addiction?

Firstly, if you are not addicted to achievement, you are not going to need an excuse for all the lacks in your life. Nobody needs an excuse for not getting a gold star, if they've let go of the drive for gold stars already. If I can simply accept that my life is OK, even if I didn't max out in all the areas I have been brainwashed into thinking I have to, can I not relax and accept myself as I am, with all my quirks and differences? OK is, after all, OK.

Maybe this is an appropriate moment to quote the much quoted Mary Oliver in ‘Wild Geese’:

You do not have to be good
You do not have to walk on your knees for a hundred miles
through the desert on your knees repenting
You only have to let the soft animal of your body love what
it loves

Or maybe we might prefer to look at it a different way, beloved of psychologists?

Temperament can be measured by five variables, commonly abbreviated by the acronym OCEAN:

Openness

Conscientiousness

Extraversion

Agreeableness

Neuroticism

If, say, I am high in openness and extraversion, I'm going to be wanting to be out there doing stuff - I'm not going to be so keen to settle to something, especially if I'm low in conscientiousness. If I'm low in agreeableness too, then I'm going to be less compliant (remember that word?), so again I'm going to be less likely to settle to a given task. If I'm high in neuroticism, as well as low in agreeableness, then I'm going to be more likely to suffer social anxiety and other relational difficulties. How do I label myself? All psychological diagnoses are merely descriptions of observable features. How am I to distinguish between the temperamental variation I've just identified and ADHD? And do I need to? Why does it matter so long as I'm ready to accept myself for who I am and not persist in striving to achieve some random societal norm such as maximising my potential and achieving gold stars?

I'm not for a moment advocating that we all sit around doing nothing at all with our gifts and talents and privileges, holding out cupped hands to the state for benefits, whilst we enjoy our relaxed and accepting mode of being. Taking responsibility for looking out for ourselves as much as we can is a civic duty, in my view. The sense I get from those suddenly labelling themselves as having ADHD, however, is that mostly they are not struggling along on the poverty line. On the contrary, they are actually functioning rather well, just not well-enough in their own estimation when they browbeat themselves with toxic, dominant messages such as making the most of themselves.

My second gripe is about where this leaves young people like those I have worked with, who have a very real and blatantly observable disability and for whom medication could be a life-changer. Already, we have a situation where the relevant medication is in short supply - and we know what happens when anything is in short supply - the price goes up, hence depriving those in real need. Are we looking at a situation where being able to access medication for ADHD becomes yet another perk for the rich, almost a drug of choice for the privileged?

My third gripe returns us to 'Compliance' and to 'Klara and the Sun.' Both explore the concept of 'fixing' a societal difficulty by some sort of medical intervention. It's not as crude as lobotomizing people but aren't we in the same sort of territory? We don't like life as it is with all the difficulties it creates so we find a way to simplify things - but like so many of the 'fixes' we create, there may be unintended consequences that we do not foresee. I'm not against medical interventions or taking drugs per se - but where do we draw the line? What is a merciful intervention, almost guaranteed to relieve suffering and what is simply an avoidance of the hand life has dealt us, which could be accommodated given an accepting mindset and a willingness to tolerate the fact that life is difficult in different ways for us all - and that, hence, people are different and potentially difficult to deal with? It seems we already have a situation in which ADHD is being over-diagnosed in young children. Our school system wants students who are compliant- so, actually, do our universities - is it too far a stretch to link this with 'no-platforming'? Are we going to reach a situation where it will be expected that, if your temperament doesn't fit the required norms, you will be expected to take medication? Are we already half-way there?

I am not a philosopher. I don't have an answer. I merely have a concern and an uneasiness and a hunch that if we smooth out too many of life's difficulties, our lives may become uniform and anodyne and less worth living at all. Worse, if we reach a stage where the expectation is that we medicate ourselves into compliance with society's illiberal norms, we will have brain-washed ourselves into an irretrievable loss of personal freedom. Through our addiction to our own achievements we will, by a drug-mediated route, have destroyed our authentic selves.

Better, far better, in my view, to simply accept who we are, whatever our challenges and difficulties and stop chasing the gold stars of a perfection that can never exist.