Sunday, May 19, 2013

"Disease" as Identity

"Although ADHD is becoming commonplace in our society..." begins the opening sentence in an article I recently read in a popular psychology blog. It says much more than the writer realizes. The real question is why is ADHD becoming commonplace? Is there an epidemic? Is it viral? In the water? In the air? Or, perhaps, it's another triumph of marketing for BigPharma. Perhaps the epidemic is one of over-diagnosis based on the broadening of diagnostic criteria to include just about every difficulty in attention, concentration, and behavioral focus?

I have long been concerned with the pathologizing of normal human experience and the over-simplification of human problems into “brain disease.” The notion that distressing emotions are always indicative of a “chemical imbalance” is brilliant marketing rather than brilliant science. The epidemic of what I call “identity diseases” – ADHD and bipolar disorder most prominently – reflects BigPharma advertising and insurance company profit seeking. I frequently encounter people who have taken on these diagnoses as a core part of their identities, see themselves as “their disease,” and use it, to their great detriment, to explain everything in their lives and behavior. “My bipolar made me do it.” “My ADHD keeps me from doing the work.” They often sincerely believe, as they have been taught, that they cannot change their behavior themselves and the only solution is the latest, highly profitable medication. Psychiatry has a vested economic interest in reinforcing this belief. It is both tragic and immoral that other mental health professions have bought into this idea and promote it to an unsuspecting public.

The risk of dependency and addiction with some of the medications used to treat these “diseases” has been well demonstrated empirically and in practice. Even more concerning is the use of these medications in children as young as four or five. The use of amphetamines and, increasingly, antipsychotics in developing brains to control mood and behavior has not been established as safe. The long term effects are simply not known. There is strong, replicated, cumulative evidence (see Whitaker, Angell, et al) that the use of these medications alters the brain and creates or exacerbates the very conditions it purports to treat.

This is not to say that ADHD or true bipolar disorders do not exist. It is clear that there are some people whose ability to attend, focus, concentrate, and sit still, or to regulate their mood and behavior, is impaired, some to the point where their lives are greatly disrupted. What is not clear is the cause, despite the overblown and unsupported ads for "brain disease" and "chemical imbalance.” It is also clear that many people diagnosed with ADHD and bipolar disorders have normal range problems with these behaviors. Convincing them their brains are incapable of self-regulation and turning them into lifelong patients forever in need of medication is both disenfranchising and disempowering. Not all behavioral or emotional problems reflect a "disease” and the pathologizing of all normal variations in ability is both dangerous and a disservice to us all.

1 comment:

  1. Amen, brother. I believe the drug companies play a role, but also the mindset that we have to diagnose everybody we see with *something" - and therefore treat them. I believe some psychiatrists over-diagnose these things (ADHD and BPAD) because they are considered in the mainstream to be organic chemical problems. These same psychiatrists document long monologues in treatment records about how their medication changes are based on supplementing serotonin this, and abating norepinephrine that, like a frazzle-haired wizard in a white coat scientifically titrating subtle concoctions of chemicals in a patient's brain. These are the docs who think of zebras when they hear hoof beats. Meanwhile this poor patient with an abusive childhood, poor sleep, "mood swings", and a tendency to spend money as retail therapy gets to embrace the "bipolar" excuse while taking a handful of semi-poisonous medications that will not treat what is actually going on.

    Um, yeah, kind of a pet peeve of mine...