Advice From the Trenches

Advice from the trenches: ADHD or brainwashed

Dear C and Dr. B;

My wife Maeve asked me today, “Do I have ADHD?” 

I am a doctor and we should never diagnose friends and family, but I considered the question. Yeah – she had traits. But then, I have some of the characteristics of Asperger’s, and nearly every medical student meets the criteria for schizophrenia when in training. Everyone has traits of something – but that doesn’t mean that everyone has a psychiatric disorder.  

By definition, in order to have a real diagnosis there has to be functional impairment, and this is a subjective land mine in itself. I don’t want to send my wife for testing – she completed a masters degree and has been running a nonprofit organization for 16 years without medications. But every time I send a patient for testing, they come back with a diagnosis of ADHD and a prescription for stimulants. My wife doesn’t sleep for 2 days after 1 cup of coffee. I fear she will end up in the hospital as a consequence of testing.  

The problem is that Maeve is convinced from watching ads on TV and the internet that she has ADHD and now she wants to try medications.  

I can’t convince her she is just a normal overworked, over-stimulated, overly hard on herself, aging American.  What else can I do?                                               

– Exasperated Edgar

Dr. B says:

Every symptom in the diagnostic book (DSM5) is on a spectrum. At one end of the spectrum, all symptoms are normal human experiences. At the other end, the symptoms are functionally impairing and impart some imbalance.  

Not every emotion or symptom needs professional treatment. In fact, many of our “symptoms” are necessary for the survival of the individual or of the species group. For example, anxiety’s function is to warn the individual of some danger; it also serves to alert the group. Complete removal of anxiety makes a person incapable of adapting to change and can cause stagnation.  Many people suffer anxiety because they live or work in an inhospitable environment and their bodies are telling them to leave. Failing to leave can result in panic attacks over time. 

Although your wife has traits of ADHD, she probably doesn’t meet the criteria for an actual disorder. But I agree with you – someone will diagnose her and try to treat her. 

Diagnosing in order to push medications is the backbone of American medicine. Doctors seldom take the time to understand the specific situation. However, I would not recommend starting medications in this case. I suggest going on vacation away from work and stress. Then, after a few days, have her reassess. If she has a real disorder, it goes with her. If her symptoms are situation-based, they will stay behind. 

C says:

Just how susceptible is your wife to suggestion? I have a bridge in Brooklyn I’d like to sell her.

Message to Maeve: if it ain’t broke, don’t fix it. 

Come on, Edgar! This is a no-brainer. Your wife never felt like she needed medication until she saw an ad for it – and that’s your answer right there. She doesn’t need it. But the pharmaceutical companies can’t keep up their profits if they don’t recruit more patients, so they invest heavily in advertising to make everyone think they need medications they don’t really need.

In the US, our health system seems to believe in better living through chemistry. We have medications for stuff like Restless Leg Syndrome that no one even heard of until the ads came out. But every pill we pop puts a strain on the organs that filter those drugs, and every medication we take has side effects, and the more pills we take, the more interactions there are, the greater the strain on our systems and the greater the chances that our treatments will hurt us or even kill us – or, in some cases, induce life-destroying addictions.

No, Edgar. No, Maeve. Just learn when to say no.

– Cathren Housley 

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