ADHD is Real (Like All Mental Disorders Are)

I recently came across an unintentionally funny op-ed piece by John Rosemond, a family psychologist known for his controversial views on attention deficit hyperactivity disorder (ADHD) and other childhood behavioral issues. In the piece, he laments how he was disinvited from a recent speaking engagement because of his views.

In short, he says, “Those facts include that ADHD, oppositional defiant disorder (ODD), and bipolar disorder of childhood are not realities; rather, they are constructs.”

Yes they are constructs. But so is nearly everything we’ve created to navigate human existence.

Rosemond is known for being skeptical when it comes to the diagnoses of ADHD and other childhood disorders. In a sense, I don’t blame him. Childhood disorder diagnoses have increased over the past two decades, leading some to claim there is an overdiagnosis of ADHD. A few years ago, I examined these claims and came to the conclusion that there may be increased diagnoses of these kinds of childhood disorders, but it’s hard to say it’s an “over” diagnosis.

Harried doctors do dispense sloppy mental health diagnoses (and the resulting ADHD medications), and that is a very real concern.

But it’s a long jump to make from these complicated issues to then claim, “Well, these aren’t even real disorders.”

You Can See a Tumor After All!

Rosemond provides a simple example to illustrate his proof that mental disorders aren’t “real:”

If a physician tells a patient that he has a tumor growing in his left lung, that can be verified with data obtained from body scans, biopsies, and other medical means. The same cannot be done with the behavior disorders in question. A therapist who diagnoses ADHD cannot provide any evidence that the child in question “has” anything. The child’s behavior is unquestionably problematic in certain ways and contexts, but that is all that can be factually ascertained.

Unfortunately, Rosemond’s argument skates over two very important points:

  • Most medical diagnoses cannot be verified by a specific laboratory test or scan. They are made from a simple review of the patient’s symptoms and matching them to a list of potential diagnoses, and then doing their best to rule out diagnoses that don’t fit the pattern. It’s a common misperception that every medical condition has a straight-forward test that either confirms or denies the condition’s existence.
  • Diagnostic criteria for mental disorders is based upon some 40+ years of scientific research to differentiate between them and come up with (somewhat) reliable categories. It’s just not accurate to claim there is no evidence for an ADHD — or any other mental health disorder — diagnosis.

Just as in medicine, mental health clinicians go through a list of symptoms to discern or rule out a possible diagnosis. And just as in medicine, there isn’t a blood test or “body scan” that can pick up every diagnosis.1

The latest medical diagnostic manual — the ICD-10 — has more than 67,000 diagnostic codes compared to ICD-9’s more than 13,000 diagnostic codes. Do you really believe there are even 13,000 different lab tests a doctor can perform on you? (The answer is, of course not… there are just a few dozen, and even those won’t come close to diagnosing 13,000 or 67,000 different conditions.)

Only someone who’s never seen a differential diagnosis decision tree in medicine could make the claim that medicine is somehow cleaner and simpler than the diagnostic process for mental disorders.

But Mental Disorders aren’t Really “Real”

The heart of Rosemond’s claim is similar to one made by Thomas Szasz in 1961, in his legendary tome, “The Myth of Mental Illness.” In that book, Szasz asserts that mental illness is simply a myth, created by (perhaps well-meaning) researchers and clinicians in an ill-fated attempt to help medicalize everyday human struggles and problems. Put simply, there’s no disease as one typically finds in medicine at the root of a mental disorder’s symptoms.

And that much is true. While mental disorders don’t take the same form as medical diseases, neuroscience research over the past 20 years pretty clearly shows there are significant changes going on in a person’s brain (and perhaps gut as well) in people who have a mental disorder. Genetics are also a factor, but not the only ones. I believe you can’t look at this vast body of neuroscience and genetic research and simply dismiss it all because a single gene or a single neurotransmitter hasn’t been implicated as the singular cause of a disorder. As we have learned, our bodies and brains are far more complex than we had even imagined just ten years ago.

Reality is Simply What We All Say It Is

Virtually everything we believe is “real” is simply a construct of human imagination and arbitrary labels we’ve all agreed to. The color blue is simply what we call a particular hue and shade that our eyes discern in a very specific spectrum of lighting; other animals on this planet likely perceive blue as something completely different. In a different spectrum of lighting, blue doesn’t look very blue at all.

A piece of paper with some symbols and writing on it has no intrinsic value outside of the cost of the paper and ink. Yet we say a certain type of paper, with certain types of writing on it, are of actual monetary value in order to make it easier to exchange goods and services. But paper money isn’t any more “real” than the color blue.

Once you agree that virtually everything in our world is a construct we’ve consciously decided upon,2 it’s far easier to understand why we have also created mental disorders and diagnoses that fit within categories that seem to make sense — at least at this point in time.

ADHD is Real, And So Are All Mental Disorders

Mental disorders are just as real as anything else in our world. To claim otherwise seems to me to be trying to split hairs that nobody but a few academics and philosophers would really care about. You can treat a mental disorder just as easily as you can treat any disease.

And, at the end of the day, that’s what’s important — throwing off these stigma-driven views and seeking out treatment for a mental health concern. Serious mental disorders generally do not resolve themselves with just the passage of time (or, if they do, it usually takes a very long time).

 

Read the original op-ed from John Rosemond: ‘My views on ADHD are controversial, yes, but factual’

Footnotes:

  1. For instance, how does an eye doctor diagnose near-sightedness? Is it through a medical scan of your eye, or your behavioral responses to external stimuli (e.g., reading from an eye chart)? []
  2. After all, isn’t that what school is? Learning about all the things we as humans have all agreed upon as our objective reality? []