Do I want or need an ADHD identity?

The recent Channel 4 programme ‘The great ADHD myth?’ has highlighted how the ADHD community feels under attack (see previous post). This community has been validated, for example, by the Neurodevelopmental Psychiatry Special Interest Group (NDPSIG) of the Royal College of Psychiatrists. I’m not wanting to undermine the benefits people value from being identified as ADHD, but I do worry they are being misled, including by NDPSIG.

But is the role of psychiatry to identify people to provide an explanation for years of frustration, even failure, in their life? Originally, modern psychiatry identified people with mental illness within the poor law system and provided asylum care for them (see eg. previous post). With the closure of the asylums, psychiatry has broadened its remit. Not many people wanted to be admitted to an asylum; in fact, originally they had to be compulsorily detained. Now people complain about being on a waiting list for a neurodivergent diagnosis, because they at least wonder if they have the diagnosis, and in a sense at least, maybe hope they have to explain their personal difficulties. As I said, not many people would have wanted a diagnosis of mental illness to be committed to an asylum, whereas many value a diagnosis of ADHD and other neurodiversity diagnoses.

This situation highlights how much psychiatry has changed since the closure of the asylums. As a young person, I may have agonised about my difficulty in communication and relating to people, and seen myself as having schizoid personality disorder. These days I guess I may fit within the autistic spectrum. Does it matter that our understanding of such personal difficulties may have changed? At least it shows how arbitrary such distinctions may be. Despite my personal difficulties, I’ve survived into retirement as a psychiatrist!

I still think that psychiatry’s priority should be psychotic mental illness. Such people are likely not even to see themselves as being ill. But from other people’s point of view, they may be out of touch with reality (see eg. previous post). They are deserving of an affective, caring kind of relationship with others (see eg. another previous post). I’m not saying neurodivergent people shouldn’t be treated in a similar way, although many are merely wanting their difference to be recognised, rather than wishing to be identified as ill.  

My primary concern, and this concern straddles what I am calling the change in psychiatry since the closure of the asylums, is that people understand functional mental illness and neurodiversity as a disorder of the brain. Of course the brain is implicated. It mediates our thoughts, feelings and behaviour, but people are not machines and are more than their brains. There’s always been a philosophical problem in relating mind to brain. But that difficulty should not mean that we reduce people to their brains, however much such oversimplistic apparent solutions may be attractive. The data on which NDPSIG makes its claims is at least open to interpretation. It makes bold statements about the biological and genetic basis of ADHD which mislead people (see eg. last post).