Welcome to From Insults to Respect. This week we are going to see if there is a more respectful way to view people said to have ADHD than the unjustified names in common use.
Anita Thapar’s opinion may lead some to conclude that she has to be correct. She is, after all, a recognized authority on this subject.
However, before making my own judgments, I insist on a reasoned argument even from authorities. If they won’t give me one, or if I find their argument unconvincing, I’m pretty skeptical about what they have to say.
So, what is the reasoned argument backing up Professor Thapar’s “genetic disease” label? She relies on the single study that is cited in the Science Daily article. Let’s take a look at it.
The study looked at the chromosomes of 366 individuals identified as having ADHD, and 1047 individuals who were from a sample of the general population, most of whom were assumed to not have ADHD.
Chromosomes are a threadlike structure of nucleic acids and protein found in the nucleus of most living cells, carrying genetic information in the form of genes.
The authors found that 57 individuals in the ADHD group had a difference in their chromosomes known as “copy number variants” (CNVs). Said another way, 15 percent of the identified ADHD individuals had this difference. Only 7 percent of the individuals in the sample of the general population had this difference.
Although this finding is, statistically, a significant difference, it is not of practical value in identifying the energetic individuals who tend to get classified as having ADHD. This is because if we were to rely on identifying individuals as having the pattern of behavior that leads to an ADHD classification by seeing if they have this CNVs difference, the vast majority would be incorrectly labelled. In the ADHD sample of 366 individuals, over 300 of them would be wrongly viewed as not having the behavior pattern that typically gets labeled as ADHD.
In the words of Dr. Kate Langley, one of the other authors of the study, “Screening children for the CNVs that we have identified will not help diagnose their condition.”
So, based on the fact that in this study 15 percent of the ADHD labelled individuals were found to have this chromosome difference, is it correct or fair to declare that all ADHD labelled individuals have a genetic disease? I don’t think so because 85 percent of them were not identified as having any difference with their genetic profile.
What about the 15 percent that had this difference? Can we say that at least they have a genetic disease? Here too, I don’t think so.
Just because some people have a difference in their genetic makeup that might be involved in a specific behavior pattern does not mean these people have a disease. I know that some say, it is only if the behavior pattern can be linked in some way to some risky behavior would we properly label those with such a pattern, diseased. But the risky descriptor is highly problematic for the following reason:
Let’s say we can find a reliable gene difference in some people who enlist in the military. We then find that joining the military places these people at greater risk of harm, and even death. Would the finding of this type of connection require us to say that this means all who join the military have a genetic disease? I think that would be wrong and unfair.
How about people who have become addicted to cigarette smoking? At one point, most Americans were smoking. Smoking is a behavior pattern that has some risk. Did all smokers have a genetic disease? How about people who comfortably sit in class for hours, get well paying jobs that have them sitting in front of a computer all day, and when they come home, choose to sit in front of a TV? Somewhere there is something in their body make-up that is predictive of this type of sedentary life, so the theory goes. We know such a pattern is a risk factor for a number of health problems. Do these people all have a disease, or would it be clearer, and more scientific, to say their behavior pattern is a “risk factor” for some negative outcome? I believe the latter is more scientific.
How about being a male? Being a male is clearly due to some genetic difference when compared with the other sex. Males are clearly at a greater risk of violence, and they are more prone to dying from a number of diseases at an earlier age than women. Therefore, does it make sense that all males have a genetic disease? Not in my opinion.
Now, in a free society, a person is free to define a disease as broadly as they wish. If they want to declare that any behavior pattern they don’t like is a disease, no one is going to arrest them, certainly not me. That said, I do think there is value in making a distinction between a scientific definition, and one that is just thrown around in any willy nilly manner.
In science, there is a field of pathology. Here we discover that there is a cluster of body conditions that, taken together, define the field of diseases. These include tumors, microbe infections, tissue tears, bone fractures, and blockages to organs such as the heart. If some genetic difference is correlated to one of these pathological conditions, we say that the genetic difference is a risk factor for the particular disease.
The field of pathology, as it is now scientifically defined, is so broad that no single scientist or physician can be fully expert in all aspects of the conditions properly classified as diseases. That’s why we have heart specialists, cancer specialists, etc. To imagine that pathologists and physicians can become, not only experts in the scientific collection of conditions referred to as diseases, and also every other concern a person might have, is not remotely reasonable.
With regards to the individuals who are now being classified as having ADHD, the vast majority have no identified scientific pathology. Moreover, often we find that once they get out of a setting in which they are forced to sit in school for hours and hours, they find a career and life style that many value.
Some labelled individuals do get into trouble, but there are many questions concerning the reason for the correlations related to this. Can it be that being placed in a setting throughout their childhood and adolescence where they are viewed as failures, lead to alienation, and less job opportunities? Can this be part of the reason for the correlations?
In my view, the motivation behind physicians classifying the behavior pattern now referred to as ADHD has nothing to do with science, but rather, to make money. The pharmaceutical companies make billions of dollars by promoting the disease concept of ADHD, and many physicians have found their medical practice has enormously benefited as well.
Well, that’s my critique of the above study and the labels that I view as disrespectful for many a healthy person. I invite anyone to explain disagreements or agreements with my reasoning.
Some people will enjoy reading this blog by beginning with the first post and then moving forward to the next more recent one; then to the next one; and so on. This permits readers to catch up on some ideas that were presented earlier and to move through all of the ideas in a systematic fashion to develop their emotional and social intelligence. To begin at the very first post you can click HERE.