Welcome to From Insults to Respect.
Recently, I came upon an article in The New York Times by Ellen Barry titled, “Autism, A.D.H.D., Anxiety: Can a Diagnosis Make You Better?” She begins by telling us about a woman in her early 50s who, upon getting a diagnosis of attention deficit hyperactivity disorder, “described it as a profound relief, releasing her from years of self-blame — about missed deadlines and lost receipts, but also things that were deeper and more complicated, like her sensitivity to injustice.” Other people Ms. Barry met who were given a “diagnosis” of autism spectrum disorder also experienced it as relief. Simply putting a name to it seemed to help.
Negative Effects Emerging
However, Ms. Barry notes that evidence is emerging that over the long term, diagnosing these conditions doesn’t help. “Yes,” she says, “there is a positive effect of lowered self-blame. But there is a negative effect as well–a greater pessimism about recovery.”
Defending her position, Ms. Barry describes a study that looked into this negative effect. The study identified no significant differences in the demographic characteristics or socio-emotional wellbeing of 9-year-olds with hyperactivity/inattention who had and who had not received a diagnosis of ADHD. However, by age 13, those who had a diagnosis at age 9 showed more emotional and peer relationship problems, worse prosocial behaviour, and poorer self-concept.
Other research found that those who were treated with A.D.H.D. medication, in the long run, did no better academically while suffering a variety of negative effects from the prescribed drugs such as becoming addicted to the drug, along with head and stomach aches,
Last year, a study found that even a medium strength daily dose of Adderall, the most commonly prescribed drug to treat A.D.H.D., more than tripled a patient’s likelihood of developing psychosis or mania. A high dose increased the risk by a factor of five. And yet, another study found that the height suppression found in earlier studies, which were thought to be temporary, found that nine years after treatment, the height gap remained. The subjects’ A.D.H.D. symptoms, meanwhile, were no better than those who had stopped taking the medication or who had never started.
Benefits To Realizing The Characteristics That Lead To An A.D.H.D. Diagnosis Are Often Not Permanent
Recent researchers have been discovering that A.D.H.D. behavior characteristics can be highly responsive to the environment. 
When the surroundings of a person with an A.D.H.D. diagnosis better matches the person’s interests and talents or home life improves, the behavior pattern that led to the “diagnosis” often improves as well.
We need people with different interests and talents to fill the various roles society values. Someone who enjoys painting houses might find sitting all day in front of a computer screen very boring, while others enjoy a job that has them engaging for hours on a computer. Fortunately, we have a need for both types, and conceptualizing one or the other as having a pathological condition does not appear to be helpful in the long run. Much better is to provide narratives that demonstrate people who find they are inattentive in certain settings, such as the typical school classroom, may very well do much better in some other environments better suited to them. More and more, research is demonstrating this is true.
In 2016, Arielle Lasky and other members of her research team published a paper that describes their discussions with subjects who had been given a diagnosis of A.D.H.D. as children, but were now in their mid-20s. Subject after subject spontaneously brought up the importance of finding their “niche,” or the right “fit,” in school or in the workplace. As adults, they had more freedom than they did as children to control the parameters of their lives — whether to go to college, what to study, what kind of career to pursue. Many of them had sensibly chosen contexts that were a better match for their personalities than what they experienced in school, and as a result, they reported that their A.D.H.D. symptoms had disappeared. In fact, some of them were questioning whether they had ever had a disorder at all — or if they had just been in the wrong environment as children.
The work environments where the subjects were thriving varied. For some, the appeal of their new jobs was that they were busy and cognitively demanding, requiring constant multitasking. For others, the right context was physical, hands-on labor. For all of them, what made a difference was having work that to them felt “intrinsically interesting.”
One subject, who was studying film in college, said that his ability to thrive in his chosen field made him question the years he spent being treated for A.D.H.D. “Originally, when I was first diagnosed with it, it was explained to me as attention deficit, just a lack of attention,” he said. “An ability not to have an attention span for very long. But I can have an attention span for extremely long for the things that I care about.”
A hairstylist told the researchers that her inability to concentrate in school vanished when she began studying hair. “If you sit up there and give me a lecture on a haircut, I will remember everything you said, word for word,” she said. “Stuff that I’m into, I am so immersed in it. But in school, it was awful.”
A young man who was training to be an auto technician said that in his new career, his A.D.H.D. was no longer an issue. “It’s just that I had to figure out what I wanted to do,” he explained. “I want to work with cars. I don’t get bored doing that. If people with A.D.H.D. are directed into areas where their strengths and interests lie, I’m pretty sure that they can naturally just go about dealing with it, instead of having to give people medications.”
Instead of characterizing A.D.H.D. as a medical disorder, which tends to lead people to believe they are defective, perhaps suggesting to them that they may have an “Attention Priority Difference” might be better. For some children, a different school, or a different kind of school, might produce the same profound shift that we are finding in recent research studies.
In a 2021 review paper, researchers found 14 studies in which receiving an A.D.H.D. diagnosis seemed to create a sense of “empowerment” by “supporting a sense of legitimacy accompanied by understanding and sympathy as well as decreased guilt, blame and anger.” In 22 other studies this team found, “a biomedical view of difficulties was shown to be associated with disempowerment. By providing an excuse for problems, a decrease in responsibility by all involved can occur, often followed by inaction and stagnation.” An additional 14 studies found that the diagnosis increased feelings of stigmatization. “The diagnosis can create an identity that enhances prejudice and judgment, which are associated with even greater feelings of isolation, exclusion and shame.”
Conclusion
Admittedly, the A.D.H.D.medical model provides parents and students a simple explanation for their children’s problems that can bring about relief and reduce blame, at least in the short term. However, the Attention Priority Difference model can do this as well and more accurately reflects the latest scientific understanding that a student’s environmental context can dramatically alter the concerning behavior. Rather than our society spending millions of dollars on drugs that people have become convinced is a quick fix to these problems, the Attention Priority Difference idea can offer for many a valuable alternative. It can motivate schools to provide more varied classroom activities that are designed to better match the various interests and talents of their students who are bored with the traditional approach that has students sitting at their desks doing seat work for unbearably long hours. And it can give these children a vision of their future in which things might actually improve — not because their brains are chemically refashioned in a way that makes them better able to fit into the world, but because they find a way to make the world fit better with whom they are.
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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 intelligence. To begin at the very first post you can click HERE
Welcome to From Insults to Respect.
A mock funeral mourning those lost to psychiatry or who have had their spirits broken and struggle to survive is to be held as protesters deliver a public message to psychiatrists at the annual meeting of the American Psychiatric Association on Sunday, May 6, 2018. “First, Do No Harm” is the message that protesters hope will go viral and get people to think twice before getting involved with psychiatry.
I became interested in the conflict about the use of psychiatric drugs very early in my career as a psychologist. I began to discuss the issues with psychiatrists as well as those who objected to this form of treatment. A broad outline of what I heard follows:
In contrast, critics of psychiatric drugs have made the following counter claims: The use of psychiatric drugs has unleashed the worst medically induced disaster in history. They have caused millions of people to become addicted to them, suffering debilitating, life threatening side effects. Rather than promoting mental health, these drugs are being used to promote social control and conformity. Reduction in hospitalization, moreover, occurred not because of the use of these drugs, but because of a deinstitutionalization policy that became known as “dumping.” Problems now being handled with psychiatric drugs can be more effectively, safely, and humanely handled with a variety of social support systems, counseling, mindfulness, healthy diet, and physical exercise techniques.
As I heard these conflicting claims, I initially thought that psychiatrists had principles of science on their side. With my graduate training in research methods and statistics, I thought that by doing a thorough job finding out the scientific research that backs up the psychiatric drug supporters I could explain in an easy to understand language why psychiatric drugs are necessary. With such an explanation, perhaps the conflict would be resolved.
I began with researching Ritalin because I was working in Rochester, NY’s school system. This was from 1974 to 1979. It was a time when drugs were just beginning to be prescribed more and more to treat students who had teachers dissatisfied with their activity level or ability to pay attention. I had witnessed a time when schools managed to deal with such problems without the use of this drug and life went on reasonably well. With the rise in its use, some thought it was a wonderful advancement, while others were expressing great discomfort at this new trend.
Not all of the findings were supportive. At the time I initially did my research, there was only one study that looked at the long-term results of Ritalin use. It compared children placed on methylphenidate, the generic version of Ritalin, with those who received no treatment. The children in the two groups were matched with respect to age, IQ, socioeconomic class and sex. After 3 to 5 years, no statistically significant differences were found between the two groups on the following outcome measures: emotion maladjustment, delinquency, Wechsler Intelligence Scale for Children, Bender gestalt visual-motor test, and academic performance.
Perhaps most troubling of all was the recognition that the safety of long term use of Ritalin had not been established despite many students being treated for years.
In the end, I discovered that although the approval process of the FDA had in its documents the available scientific evidence in making its decision to approve Ritalin, the reviewers’ decision nevertheless relied more on their personal values. It seemed to me, and it still does, that different people looking over the same scientific evidence could, depending on their values, come to completely different conclusions about whether or not the drug should be approved.
For example, Marcia Angell, M.D., is a former editor in chief of The New England Journal of Medicine, and now is a member of Harvard’s Medical School. In her insightful book, The Truth About the Drug Companies: How They Deceive Us and What to Do About It, she writes, “Is there some way companies can rig clinical trials to make their drugs look better than they are? Unfortunately, the answer is yes. Trials can be rigged in a dozen ways, and it happens all the time” (p. 95).
Civil rights activists worked for generations to make some progress in achieving their goals. Among the most successful of these advocates was Martin Luther King, Jr. When advocating for civil rights, he avoided throwing insults at those who resisted the changes he was after. Instead, he focussed on painting his dream in beautiful, hopeful phrases and demonstrating in nonviolent, but impossible to ignore, peaceful resistance.
Currently, in many countries a wide variety of children are being classified as having ADHD and placed on a regimen of consuming psychiatric drugs. Supporters of this trend often cast a disrespectful eye toward their critics while arguing that scientific research supports their position. Meanwhile, equally scientific minded individuals who have looked at the same research come up with a completely different set of conclusions. So, about once a year I take a look at the most current research to see if I can throw some light on this topic.
Factors looked at were academic achievement and social functioning. Although the medicated ADHD students didn’t do any better or worse on these measures then the unmedicated ADHD students, they did endure many uncomfortable side effects while they were on the ADHD drugs, such as sleep problems, headaches, stomach aches, and feelings of depression each evening when the drug wore off. Thousands of dollars per child were consumed on purchasing the medications that achieved some modest short term gains but had no lasting positive effects.
“In this study, the authors pooled together MRI brain-scan data for the 3,242 participants in the study (which had been collected and archived at the 23 sites), and then calculated, for each cohort, mean intracranial volumes and mean volumes of specific brain regions. They reported the differences for each of these comparisons and the “effect size” of the differences. This is the critical aspect of the results to consider and understand: effect sizes reveal the true strength of the findings and how much overlap there is between the individual brain volumes in both groups, and thus establish the likelihood that an individual in the ADHD group has a smaller brain volume than an individual in the control group.
The biggest effect size that was found was .19. This was for differences in the mean volume of a region known as the accumbens for ADHD labelled children under 15 years of age. An effect size of 3, which is the largest effect size one can obtain using this type of statistic, would have suggested that pretty much all of the children in the study that were labelled as having ADHD had a distinctly smaller volume in that region than controls. An effect size of 2 would have suggested a distinctly weaker relationship and that some of the children in the ADHD group did not have smaller volumes than the control group, some in the ADHD group had larger volumes than the control group, and some of the control group had smaller than average volumes in that region and yet showed no signs of ADHD. An effect size of 1 would have indicated even a weaker relationship. The effect size of .19 is less than a fifth the size of 1, that is, about a small an effect size as you can imagine. (To learn more about what an effect size is, access this article by Robert Coe: 
Particularly troubling is the suggestion by the study’s authors that their findings will help to reduce stigma. How in the world does telling people that ADHD people have smaller brains help to reduce stigma for that group of people? Moreover, even if we found enough evidence to conclude that there are some differences in the brains of people being labelled ADHD, this would still not lead us to conclude they have a brain disorder. A difference is not automatically a disorder. Having people with different brains can be a wonderful thing. For example, it can mean that some people will prefer to work sitting all day, while others prefer to do work requiring lots of activity. We need both types of people, and other types as well, to enrich our lives.
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 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.
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.
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.
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.
From time to time, I like to enrich some ideas that I introduced in earlier posts with some relevant thoughts that Bob Dylan has shared on his 
Are the drugs used to treat ADHD as safe and effective as the pharmaceutical industry claim? Are many of the students now classified as having ADHD really more aptly construed as having an “attention priority difference?” Are many of those who are classified really just the youngest students in their class? Are there safer ways than drugs to deal with the challenges that are associated with the behavior patterns that lead to an ADHD classification? These are some of the questions that I addressed in my earlier posts. Let’s see what Bob has to say about this.
What a day for a daydream
“Back when I was going to school you would see kids daydreaming and sometimes not paying attention, running around or acting impulsively. I always thought that was being a kid. Nowadays, everybody’s got Attention Deficit/Hyperactivity disorder–ADHD. They say it’s hyperactivity, impulsivity, and all sorts of other things. I’m sure there are kids with real problems. But quite often people just didn’t want to pay attention. I see parents not wanting to spend time with their kids, and for them, not paying attention or being bored or acting impulsively is the kid’s problem. I don’t think so. Spend time with your kids. You might find that they don’t have ADHD, they have other needs, a need to see their parents. I’ll tell ya something, I didn’t pay a lot of attention, and I was known to daydream in class and things turned out pretty good for me. I’ll be the first to agree with you that sometime medication is necessary. But maybe we are too often in a hurry to treat things chemically and not look at what the real problem is. Sometimes there is not even a problem there, at least one that couldn’t be solved with a little bit of patience, attention, care, and love.
Mr. Kramer is a professional photographer, who got a sweet deal when he was hired to follow Bob around for a little over a year to take pictures of him at home, going around different places, and before and during performances. Here’s a little of what he observed.
“he would grab at moments that were available, often writing in a small black looseleaf notebook, in which he probably wrote new material or kept ideas. He would interrupt something in order to glimpse a TV screen to see another performer. I’ve seen him use ten minutes working out melodies on a backstage piano while someone was out locating the key to his dressing room.” (p. 36)
“No matter how scatter-brained the type of a man’s successive fields of consciousness may be, if he really cares for a subject, he will return to it incessantly from his incessant wanderings, and first and last do more with it, and get more results from it, than another person whose attention may be more continuous during a given interval, but whose passion for the subject is of a more languid and less permanent sort.
In typical American classrooms, a subject is brought up by teachers at a given time and for a specific period of time. Those in the class who have the ability to switch their attention to what the teacher brings up at a given time and then stay focussed throughout the scheduled time, are often more highly valued by teachers then those students who are less skilled at this. Teachers often refer to the Special Education Department those children who are not following along in lockstep with their schedule and they urge parents to take these children to doctors to get prescriptions for drugs. Like Bob, I’m not comfortable with this.
“
Trying to get the kids off your hands by sticking them in front of a TV or computer game terminal may be a pretty enticing thing to do. If that doesn’t work, it is oh, so easy to just give them some pills.
When I say, “take the responsibility” I don’t mean to imply that parents should blame themselves. Blame suggests that parents should seek to punish themselves whenever their approach at discipline doesn’t work well. Punishing themselves in such situations only makes a challenging situation worse.
What I mean by taking responsibility is that we recognize within ourselves that we are dissatisfied with where things are at. We observe in a nonjudgmental manner how this goes along with some physical sensations in our body–perhaps a tightening in our chest, and tension around the forehead. Perhaps we might observe ourselves making some nasty comments about ourselves because of old habits. Although we observe these nasty comments, we don’t accept them as correct, just habitual statements learned oh, so many years ago. But as we observe all of this, from time to time we consider the attitude that these sensations that we are experiencing have the potential of spurring us to make some improvement in our own actions.
In my earlier blog posts, I also reviewed research studies that indicate that almost immediately after taking these types of drugs, many children will complete more academic work and get more of the items correct. Parents also tend to report behavioral improvements. But these effects begin to wane. According to the best available evidence, by a little over a year, any perceived improvement, when objectively measured, had completely disappeared. The available studies indicate no lasting benefits for those who use them in terms of academic achievement, social outcomes, and high school graduation rates. In the end, thousands of dollars have been spent and the drug treated children, having suffered the various side-effects and been subjected to serious risks are no better off than children who had similar behavior challenges but did not take any of the ADHD drugs.
“Researchers in Taiwan looked at data from 378,881 children ages 4 to 17 and found that students born in August, the cut-off month for school entry in that country, were more likely to be given diagnoses of A.D.H.D. than students born in September. The children born in September would have missed the previous year’s cut-off date for school entry, and thus had nearly a full extra year to mature before entering school.”
On March 13, 2016, 
In my opinion, I did not have a medical illness. Out on the streets of Brooklyn, I was as healthy as a horse as I got into handball, basketball, and stickball games for hours and hours during my free time. Nevertheless, I am certain that if my parents had taken me to a doctor in this modern world of ours, I very likely would have been given an ADHD label and placed on one of the ADHD drugs.
The idea that certain actions that violate societal norms are mental illnesses like any other illnesses is attractive to many people because they believe it helps to reduce this guilt and shame. To understand this a little better, let’s take a look at a quick parable:
Rachel, the mother of five-year old Jonathan, recently went through a very sad divorce. Now, at Jonathan’s parent-teacher conference, his Kindergarten teacher expresses some serious concerns. “Your son is very hyperactive and he has a great deal of difficulty paying attention. Have you considered taking him to a doctor? He may have ADHD.”
“There is no need to blame yourself,” the doctor explains. “ADHD isn’t caused by bad mothering. It is an illness very much like diabetes. Just like insulin is a drug that treats diabetes, the drug I’m prescribing for your son’s ADHD will treat his medical condition.”
But when she tells her father what the doctor has said, he grumbles and says that the doctor is full of crap. “Jonathan is angry and upset because of the divorce and not having his father with him any more. Anyone can see that!”
“You did your best, Rachel. I think it makes sense that you take some responsibility for what has happened, but blaming yourself isn’t being fair, nor is it helpful. When people blame themselves a lot of the time they think they deserve some type of punishment. In my opinion, a better way to take responsibility for what went wrong is to accept the strong emotional experiences that go along with taking responsibility, accept that you played at least a part in what went wrong, and then set yourself on becoming determined to take steps to improve. The genuine sad, heartfelt feelings that come with taking responsibility leads us to do a search for making improvements.”
In the above parable, a doctor tries to reduce the shame and guilt that a mother is feeling about her son’s behavior by framing the behavior as an illness. Although this initially appears to help, she runs into some people who refuse to go along with this anti-shame/mental illness notion. Let’s explore this notion a little more thoroughly with the help of some of the writings of psychologist and philosopher, William James.
In an 
To suggest personal will and effort to one “all sicklied o’er” with the sense of weakness, of helpless failure, and of fear, is to suggest the most horrible of things to him. What he craves is to be consoled in his very impotence, to feel the Powers of the Universe recognize and secure him, all passive and failing as he is.
From my discussions with people in Alcoholic Anonymous, it seems to me that many of its members found themselves in a state similar to what James describes in his letter. The program seems to provide them a way to stop blaming themselves by using the “I have a real sickness” idea. It also offers a sense that they could put themselves in the hands of a higher power, while, at the same time, they receive a great deal of support from peers who have managed to recover.
It is in no other way that we overcome balkiness in a horse: we divert his attention, do something to his nose or ear, lead him around in a circle, and thus get him over a place where flogging would only have made him more invincible.
By apperceiving the case as neural pathology, what does James hope to gain? He does not explicitly say. The technique that he describes of dropping the subject, diverting the mind, then springing it on the pupil later, is stated plainly enough so that many individuals can employ it without first apperceiving the case as neural pathology. I have done so, myself, on numerous occasions.
And yet, parents who undeniably care about their children, regularly expose their children to the side effects of these drugs, as well as potential long term risks. Why? Because they are convinced that the helpfulness of the drugs outweigh those negatives.
As I entered into my twenties, I began to notice that in the morning before I got my first cup, I was irritable and struggling with sleepiness. With the first sips, ahhhh, relief.
By the time I was forty, the headaches became so bad that I went to a physician who prescribed some pills. I don’t like taking pills, but the headaches were so bad that I thought maybe I should give them a try.
