ADHD: Understanding distress and the need for nuanced respect

Posted on Jun 27 2023 by Natalie Aboustate

Robin Lewis

Robin is a student on the MSc in Mad Studies at Queen Margaret University, Edinburgh and volunteers for CAPS Experiences of Psychosis collective advocacy group. Robin is particularly interested in how we can thread our own personal stories and perspectives into wider narratives that can be used to celebrate diversity as a means to challenge discriminatory and dehumanising ways of relating to and treating each other.

The UK has seen a 400% increase in the number of adults seeking treatment for ADHD since 2020 (1), raising questions of whether increasing awareness for the condition has forced people to reframe their behaviours and struggles into the realm of what is an ill-defined disorder (2) or whether there is something more at play. After all, with the vast majority of adults now carrying dopamine machines in their pockets there is an argument that this is instead a reaction to the current context we find ourselves in than any nascent understanding of our biological wiring (3). This presents us with the conundrum of how we can respect the rights of those who might benefit from medical interventions whilst not resorting to a bio-reductionist account of human behaviour, which through ‘othering’ individuals encourages discrimination (4), in ways which may breach fundamental human rights (5). In order to move towards a more rights-based understanding we must therefore look beyond segregated and oppositional thinking structures, instead seeking to realise an ecological perspective that makes space for differences of experience and opinion to incorporate a genuinely holistic understanding of the web that manifests between the biological and the social.

Western science, and particularly its structuring of modern medicine, however, makes this ambition difficult, with the ideological construction of a method that prioritises “observable” phenomena by a “detached” subject preferred, in the process undermining the notion that the subject is being influenced by their relationship to the object under enquiry. Take for instance Dr. Hallowell (6), a leader in the field of ADHD, who talks about his successes in treating patients who have struggled with the impairment. Whilst his work should be admired for breaking down stigma surrounding the condition and celebrating the human stories under the diagnosis, his work is conspicuous by the absence of an acknowledgement that ADHD may be caused by anything other than the biological, particularly genetic, nature of his patients. This convenient idea is used to alleviate blaming parents and to champion the potential of the chemical cures so central to his profession, but is it an idea that stands the test of reality or are we being fed a fallacy?

Dr. Gabor Maté, the renowned physician, takes a more nuanced perspective (7). He dismisses the idea that ADHD can be detached from the context it sits within, a context constructed through the histories of those who struggle with it. This perspective allows for a more humane viewpoint from which to begin to understand the lived complexity that constitutes our lives. We are after all not robots, with which some tinkering may optimise our performance, but perceptive manifestations of our values and sociocultural experiences. Therefore it is not only through medicine that we can find what gives value to our lives but through a thorough examination of potential stumbling blocks impeding us and the construction of a narrative surrounding what constitutes our own good life. This is a view that promotes the position that it is not science but art and the stories we tell ourselves and each other that really matter. On the other hand there is a danger that such a reification of subjectivity slides into humanity’s exceptionalism, disrespecting our basis as natural subjects (8).

To counter such subjectivity Maté brings a wealth of scientific enquiry into his work, situating this within his own experiences or standpoint (9); that is, he makes clear his own struggles with ADHD both personally and as a father of three children who have been diagnosed with the condition. As such we are provided with an insight of the personal significance of the work to Maté, consequently broaching a compassionate narrative between author and reader which can be more enlivening to consider, creating the perception of a rounded, even visceral knowledge surrounding the complexity of the subject matter. This therefore encourages a non-reductionist account that allows for a respect of how ADHD may be exacerbated but not caused by a genetic predisposition, but also that it is a maladaptive response to our environment that requires healing in personalised ways, of which medication is only one option.

Whilst this piece has focused on ADHD, the principles can be considered as relevant to other manifestations of “disorder” and difficult experience. That is because distress in its multitude of manifestations is an adaptive response to an individual’s relationship with themselves and wider networks (10). Taking this lesson forwards can champion a more compassionate view of the struggles we face and encourage more genuinely holistic support for psychosocial ailments that look to thoroughly account for the ways in which we each create meaning for ourselves, something that has yet to be found in the hierarchy that places medical “cures” as the gold standard for mediating distress.

References

Suggested citation:

Lewis, R (2023). "ADHD: Understanding distress and the need for nuanced respect". CEMH Human Rights & Mental Health Blog. 27 Jun 2023. Available at: https://www.adelaide.edu.au/robinson-research-institute/critical-and-ethical-mental-health/news/list/2023/05/13/adhd-understanding-distress-and-the-need-for-nuanced-respect/ [date accessed].

Tagged in Human rights and mental health