“Treating” ADHD

Here a couple of quick thoughts about treating ADHD.

my former doctor who is amazing, and just retired, said something once that has always stuck with me. He said, in medicine we don’t only treat the worst cases. I think that’s a pretty profound statement when applied to psychiatry and pharmacology. It’s a little more obvious when we’re talking about physical ailments. But one of the biggest problems we have in this country is not viewing mental health as real health.

You break your arm, you go to the doctor. Both my sons have had a cast once in their life. My youngest just got a cast off because he had two small hairline fractures in his finger. It was painful. But the ER doctor didn’t even put a cast on it originally. But after a week with a splint, the orthopedist decided he needed a cast for 3 weeks. So, clearly not the worst break anyone’s ever seen. But it still needed to be treated.

my oldest fell off the playground equipment when he was two and a half. He broke his right arm just above the elbow. As it turns out, it was a partially displaced fracture and he spent the night in the hospital, had surgery the next day where he had pins inserted, and had to wear a cast for 4 weeks and then get the pins removed. A much more serious injury than the one my youngest just had but the treatment was not too different. Obviously, the more severe break needed somewhat more intervention but they were both treated.

the problem with psychiatric disorders is that there’s no x-ray. There’s no blood test. There’s no mri. And for the most part, all psychiatric illnesses, except perhaps the most severe, have some element of something we all experience as part of them. Adhd. Everyone has trouble paying attention sometimes. Depression. Everybody feels down and sad sometimes, especially when the situation dictates. Everybody feels anxious sometimes. Sometimes we might get obsessive about something. The difference is the severity, the length of suffering, and biological underpinnings.

I think it’s great how autism is by definition referred to as a spectrum. But that’s pretty easy to see. The difference between someone who’s nonverbal and may need to be institutionalized, and a high functioning person with what we used to call Asperger’s it’s pretty Stark. I think we can all look at that and say there is a spectrum of this disorder. But there is very much a spectrum of ADHD. There is very much a spectrum of anxiety and of depression. There are even different degrees of very serious psychiatric disorders like bipolar or schizophrenia. I think we struggle as a culture because it’s not always easy to tell where that spectrum of pathology begins and normal struggles end. As a society, we tend to err on the side of saying, it’s not a real thing, unless we can see it or it’s really really bad. But there are millions of people who suffer in the margins between a normal amount of whatever it is and the worst case scenario.

I’m certainly not espousing overdiagnosing and over-treating anything. But I think we need to try to get it right. Depression for example. Yes, everyone’s had a bad day or even a bad week. But if you’ve been feeling depressed for 3 weeks or more, that’s a good indication that you should seek treatment. And I just use depression as an example.

to bring it back to adhd, there is a huge spectrum of people with adhd. We don’t all present the same. And we don’t all have our functioning diminished by our add in the same way or to the same degree. But that doesn’t mean we shouldn’t treat everyone who meets the diagnostic criteria for ADHD. I have more ADHD than you can shake a stick at. There’s no way I would have been successful at anything without treatment getting diagnosed truly saved my life. But there are plenty of people who struggle with life and get by because they haven’t been diagnosed or treated. And though I honor their struggle, I don’t believe there is any honor in the struggle. There is no glory in working harder than you have to because of the hand you were dealt in terms of brain chemistry.

if you’ve got it, treat it. You don’t have to be the poster child for ADHD like I am to get diagnosed and get treated and live a better life.

Standard disclaimer: I promised myself when I started this blog that I would post regularly, hopefully weekly. In order to achieve this goal, I have to fight against my own perfectionists. That means I edit very little if at all. I’m focusing on content not on detail. So please forgive any mypellings grammatical / punctuation mishaps, and anything Strange like weird capitalizations due to my using voice recognition.