ADHD is 'not a real disease'

Mr.Samsa · **#161** by **Mr.Samsa** » May 05, 2014 2:08 am

Can we go back to blaming it all on the aliens? At least that was more plausible than the wibble we have to put up with now.

Regina · **#162** by **Regina** » May 05, 2014 4:42 pm

consistency wrote:
Regina wrote:
Templeton wrote:
Regina wrote:

Ah, I get it now. Six-year-olds are your typical viewers of porn, whereas adult males go out and sniff the roses.
What age are you?

Why the disrespectful asinine behavior? This is so typical of Ratskeptians. The questions and opinions are given in earnest and then you act like that.
Regina, you might learn something if you think a little bigger. Maybe the example could have been better, but the intent was worthy, and well thought out.

The intent was technology, and while porn might not be what the kiddies are watching they certainly are exposed to television, and the internet at six years old and younger. They most certainly spend more time engaged in those sedentary activities than children their age did 20 years ago. Relevant? Only a small mind wouldn't be able to see what the intent was, and it's relevance.

I'm the cheerful type, you know. And no, I don't see "it's" relevance because it was the opposite of well thought out.
But let's talk about your idea.
Would you say that girls watch significantly less TV than boys? And that they are more physically active?

Girls are naturally social because of society and therefore more likely to have friends in person, while boys have been brainwashed by society into believing that we have no emotions, we should not cry, we should be strong, etc.. therefore we have been repressed and the majority of us have slipped into using external stimulants excessively to compensate for our repressed feelings.

Its A LOT more complicated than I lay it out.

Girls are naturally social because of society

Hm, so girls are conditioned by society, but in a more natural way than boys? Or do they possess some kind of "social gene" which boys lack?
Breathlessly awaiting the research.

Templeton · **#163** by **Templeton** » May 05, 2014 5:18 pm

Regina wrote:
Hm, so girls are conditioned by society, but in a more natural way than boys? Or do they possess some kind of "social gene" which boys lack?
Breathlessly awaiting the research.

And you think that society doesn't condition children based on their gender? Hmmm :think:

I can't barely wait for the research on that, and while you're at it, would you care to reference the "social gene" you're talking about? That ought to be interesting. :excited:

You see Reg, anybody can act like an ass - It just happens to be far too common around here.

Regina · **#164** by **Regina** » May 05, 2014 6:25 pm

Templeton wrote:
Regina wrote:
Hm, so girls are conditioned by society, but in a more natural way than boys? Or do they possess some kind of "social gene" which boys lack?
Breathlessly awaiting the research.

And you think that society doesn't condition children based on their gender? Hmmm I can't barely wait for the research on that, and while you're at it, would you care to reference the "social gene" you're talking about? That ought to be interesting.

You see Reg, anybody can act like an ass - It just happens to be far too common around here.

You see, I go strictly by what consistency says.

Girls are naturally social because of society

Girls are somehow more natural than boys, who repress their emotions which is unnatural. Because of society. So gender determines either natural or unnatural conditioning. Or maybe there's no conditioning at all for girls, because they are naturally social. It's hard to tell, hence I introduced the "social gene". I can make up shit like the next guy.
Not that anyone has explained what "natural" is supposed to mean in this, or indeed any other context.

If you don't like asses, you know where the programmer left the hole in the wall, as we say over here.

Shrunk · **#165** by **Shrunk** » May 05, 2014 7:02 pm

It's a long thread, and I'm not sure where the best place for me to butt in would be, so this seems as good a spot as any:

Cito di Pense wrote:
Mr.Samsa wrote:Diagnosis and treatment of mental disorder has nothing to do with social conformity and social efficiency.

You and I disagree fundamentally on this point. I don't insist that it has everything to do with social conformity and efficiency, but that they are considerations in the diagnosis and treatment, considerations that apparently some self-styled 'experts' find they can ignore.

IMHO, you're both getting close to the correct answer, but not quite getting there. I agree that "social conformity and efficiency" play a role in determining the diagnosis of ADHD, but I don't think this is any different from the case with any other disease or disorder.

Certain variations in the architecture of the coronary arteries and myocardium lead to a situation in which a person is unable to walk more than a block without getting chest pain and turning blue. Other variations allow a person to run a marathon in just a little over 2 hours. At some point between the two we draw a fuzzy line that separates "sickness" from health, and start precribing interventions of various degrees of invasiveness for those on the wrong side of the line. But the position of that line is not going to be determined just by science, but also by social expectations and values. Few people are going to begrudge the first guy medications (though there will be some people who cast moral aspersions on those who suggest them to him, and insist he should rely just on living a good, clean life, eating his veggies and exercising). If the second guy takes medications to achieve his remarkably efficient cardiovascular functioning, though, he'll be called a cheater. I don't really see that it is purely science that is guiding that distinction.

We make similar value judgments over pretty well everything we call a "disease" or "disorder", but we are able arrive at consensus views with so little rancour in most cases that we don't realize this is what we are doing. We get a lot touchier when it starts to involve particular manifestations of neurological functioning, however. It seems to me this is mostly the case with those functions that were once (and which, to some, still are) attributed to the "soul".

Clive Durdle · **#166** by **Clive Durdle** » May 06, 2014 6:05 am

Personally, I blame chairs.

Regina · **#167** by **Regina** » May 06, 2014 6:27 am

Clive Durdle wrote:Personally, I blame chairs.

Strange you should say that. Anyone who's ever had the misfortune of having to sit on a typical school chair knows that it's torture. In my part of the world, at least.

Beatsong · **#168** by **Beatsong** » May 07, 2014 4:48 pm

Shrunk wrote:It's a long thread, and I'm not sure where the best place for me to butt in would be, so this seems as good a spot as any:

Cito di Pense wrote:
Mr.Samsa wrote:Diagnosis and treatment of mental disorder has nothing to do with social conformity and social efficiency.

You and I disagree fundamentally on this point. I don't insist that it has everything to do with social conformity and efficiency, but that they are considerations in the diagnosis and treatment, considerations that apparently some self-styled 'experts' find they can ignore.

IMHO, you're both getting close to the correct answer, but not quite getting there. I agree that "social conformity and efficiency" play a role in determining the diagnosis of ADHD, but I don't think this is any different from the case with any other disease or disorder.

Certain variations in the architecture of the coronary arteries and myocardium lead to a situation in which a person is unable to walk more than a block without getting chest pain and turning blue. Other variations allow a person to run a marathon in just a little over 2 hours. At some point between the two we draw a fuzzy line that separates "sickness" from health, and start precribing interventions of various degrees of invasiveness for those on the wrong side of the line. But the position of that line is not going to be determined just by science, but also by social expectations and values. Few people are going to begrudge the first guy medications (though there will be some people who cast moral aspersions on those who suggest them to him, and insist he should rely just on living a good, clean life, eating his veggies and exercising). If the second guy takes medications to achieve his remarkably efficient cardiovascular functioning, though, he'll be called a cheater. I don't really see that it is purely science that is guiding that distinction.

We make similar value judgments over pretty well everything we call a "disease" or "disorder", but we are able arrive at consensus views with so little rancour in most cases that we don't realize this is what we are doing. We get a lot touchier when it starts to involve particular manifestations of neurological functioning, however. It seems to me this is mostly the case with those functions that were once (and which, to some, still are) attributed to the "soul".

I agree with that, generally. Surely, however, one could make a clear distinction between such diseases and those that cause death. If we accept it as a pretty near-universal assumption of the human condition that people want to go on living and medicine should aim to help them do so, then diseases and disorders serious enough to cause death are surely going to be judged as bad by definition in any society, and not subject to the claim of social relativism you make here.

One could say that something like sever schizophrenia is near this mark. If for example a person is so deluded they genuinely think they can fly, then it's likely that delusion is going to cause death or at least very severe injury eventually if left unchecked, regardless of the social circumstances. But it's difficult to think of any behavioural disorders like ADHD that can be directly linked to inevitability of death in the way that sever cancers or heart attacks can.

It's easy to see that Cito has a valid point, and that Mr Samsa's claim that "diagnosis and treatment of mental disorder has nothing to do with social conformity and social efficiency" is wrong, by looking at the changing conceptions of mental disorder over time. Not long ago, if you were homosexual you had a mental disorder - and it was in fact defined as a disorder due to causing distress and impairment in the same way as ADHD is now. If you grow up in a society where homosexuality is considered vile and sinful and you're expected to get married to someone of the opposite sex and have children and enjoy it, then being afflicted by homsexuality IS distressing and impairing.

Nowadays of course, in western societies at least it is not defined by the medical profession as a disorder. So what's changed? Society's values, that's all. A disorder is something that causes people distress or impairment of functioning in relation to their environment. There is no other meaning of distress or impairment, since nobody lives separately from an environment. And since society and its values are a huge part of that environment, when they change the definition of what's a disorder will necessarily change too.

Cito di Pense · **#169** by **Cito di Pense** » May 07, 2014 6:52 pm

Beatsong wrote:It's easy to see that Cito has a valid point, and that Mr Samsa's claim that "diagnosis and treatment of mental disorder has nothing to do with social conformity and social efficiency" is wrong, by looking at the changing conceptions of mental disorder over time. Not long ago, if you were homosexual you had a mental disorder - and it was in fact defined as a disorder due to causing distress and impairment in the same way as ADHD is now. If you grow up in a society where homosexuality is considered vile and sinful and you're expected to get married to someone of the opposite sex and have children and enjoy it, then being afflicted by homsexuality IS distressing and impairing.

Nowadays of course, in western societies at least it is not defined by the medical profession as a disorder. So what's changed? Society's values, that's all. A disorder is something that causes people distress or impairment of functioning in relation to their environment. There is no other meaning of distress or impairment, since nobody lives separately from an environment. And since society and its values are a huge part of that environment, when they change the definition of what's a disorder will necessarily change too.

It's easy to see why I don't want to quibble with this, but rather, to amplify it according to my lights, and also not to disagree with what Shrunk said, either. I don't know how to view 'deviance' in any other way than in relation to a norm, and I indicate both in purely statistical terms when something can be measured that gives us robust statistics. Which mostly means knowing something about your confounding variables, and so forth.

You see the morass that the profession of 'abnormal psychology' has gotten itself into over the decades, mainly in having to play catch-up with norms of all sorts of distributions they didn't think to try to identify last year.

What I can't abide are self-styled experts who blow into the room sporting brightly-coloured images of brain-scans held aloft with statistics gathered by social psychologists and purporting to tell me what, precisely, the problem really-o, truly-o IS.

What's the aim? Well, yes, society has to defend itself, whether it's from the social and financial costs of unnecessary coronaries, or disruptive kids in classrooms where an undisrupted curriculum developed by educational psychologists is just as deadly dull as being in a crowd that's too noisy to get any thinking done.

Mr.Samsa · **#170** by **Mr.Samsa** » May 07, 2014 10:23 pm

Beatsong wrote:I agree with that, generally. Surely, however, one could make a clear distinction between such diseases and those that cause death. If we accept it as a pretty near-universal assumption of the human condition that people want to go on living and medicine should aim to help them do so, then diseases and disorders serious enough to cause death are surely going to be judged as bad by definition in any society, and not subject to the claim of social relativism you make here.

One could say that something like sever schizophrenia is near this mark. If for example a person is so deluded they genuinely think they can fly, then it's likely that delusion is going to cause death or at least very severe injury eventually if left unchecked, regardless of the social circumstances. But it's difficult to think of any behavioural disorders like ADHD that can be directly linked to inevitability of death in the way that sever cancers or heart attacks can.

But this assumes that diseases have a likelihood of death or serious injury, and that the difficulties in functioning with mental disorders aren't "serious enough", and that determining a point of diagnosis in medical diseases is pretty cut and dry (when in reality it's a fairly arbitrary social judgement based on what a group of doctors think a "normal" level is).

Beatsong wrote:It's easy to see that Cito has a valid point, and that Mr Samsa's claim that "diagnosis and treatment of mental disorder has nothing to do with social conformity and social efficiency" is wrong, by looking at the changing conceptions of mental disorder over time.

My point has been taken out of context since being re-quoted long after the original discussion took place but my point was simply that Cito's claim that people are diagnosed with ADHD based on not "fitting in" or conforming to social standards is blatantly ludicrous. This is because diagnostic practices explicitly exclude people from diagnosis who are simply 'quirky' or 'not normal'.

This makes sense when you look at what things the DSM treats as a disorder and what is has excluded - there's no "cat lady disorder" despite the lady with a million cats clearly being not normal, or the guy who is sexually attracted to kids but doesn't do anything about it and is happy enough with disturbing thoughts, or murderers, thieves, and other criminals. Not conforming to society's standards is not a diagnostic criterion for any mental disorder that I can think of, at the very least not ADHD.

Beatsong wrote:Not long ago, if you were homosexual you had a mental disorder - and it was in fact defined as a disorder due to causing distress and impairment in the same way as ADHD is now. If you grow up in a society where homosexuality is considered vile and sinful and you're expected to get married to someone of the opposite sex and have children and enjoy it, then being afflicted by homsexuality IS distressing and impairing.

I'm not sure how the use of homosexuality supports your point there though. It was changed on the basis of evidence, not social standards. And ADHD is nothing like homosexuality as a disorder because the evidence clearly shows that the disturbances they experience are inherently due to the ADHD.

Beatsong wrote:Nowadays of course, in western societies at least it is not defined by the medical profession as a disorder. So what's changed? Society's values, that's all. A disorder is something that causes people distress or impairment of functioning in relation to their environment. There is no other meaning of distress or impairment, since nobody lives separately from an environment. And since society and its values are a huge part of that environment, when they change the definition of what's a disorder will necessarily change too.

Except, as mentioned above, the change in the DSM for homosexuality was due to changing evidence. Originally (due to the poor sampling methods of the mental health professionals at the time) it appeared to be clear that if you were gay then you necessarily had a whole host of mental issues, as every gay person that a psychiatrist knew happened to also be depressed, suicidal, anxious, etc.

Of course, the problem was simply that the only gay people they saw (or that they knew about) were the ones coming in asking for help with their mental issues. It took the work of people like Kinsey and Hooker to show that when you go out into the general public and assess the mental state of gay people as a whole, you see no significant correlation or inherent condition. This is why the decision to remove homosexuality from the DSM was made before the petition to have it removed could be finished or even presented to the DSM board.

Cito di Pense wrote:It's easy to see why I don't want to quibble with this, but rather, to amplify it according to my lights, and also not to disagree with what Shrunk said, either. I don't know how to view 'deviance' in any other way than in relation to a norm, and I indicate both in purely statistical terms when something can be measured that gives us robust statistics. Which mostly means knowing something about your confounding variables, and so forth.

You see the morass that the profession of 'abnormal psychology' has gotten itself into over the decades, mainly in having to play catch-up with norms of all sorts of distributions they didn't think to try to identify last year.

What I can't abide are self-styled experts who blow into the room sporting brightly-coloured images of brain-scans held aloft with statistics gathered by social psychologists and purporting to tell me what, precisely, the problem really-o, truly-o IS.

What's the aim? Well, yes, society has to defend itself, whether it's from the social and financial costs of unnecessary coronaries, or disruptive kids in classrooms where an undisrupted curriculum developed by educational psychologists is just as deadly dull as being in a crowd that's too noisy to get any thinking done.

Cito di Pense · **#171** by **Cito di Pense** » May 08, 2014 10:16 am

This isn't just snark, Mr.Samsa. You could always debate the point, instead of personalising.

stijndeloose · **#172** by **stijndeloose** » May 08, 2014 10:16 am

"Personalizing"? :scratch:

Cito di Pense · **#173** by **Cito di Pense** » May 08, 2014 10:30 am

stijndeloose wrote:"Personalizing"?

I disagree. It would be ad hom to assert that someone took a particular position w.r.t. ADHD because of having self-diagnosed as such or accepted a diagnosis from someone else. Anyone who lets someone else diagnose them with ADHD is already on the back foot. Unless it makes a great excuse, a leg up in an otherwise free-for-all competition. All you have to do is game the system into treating ADHD as an affliction. I empathise. I really do. ADHD really precludes a career in physics, but other departments leave their doors wide open to people who want to research their own peculiarities in the guise of researching human diversity.

Fallible · **#174** by **Fallible** » May 08, 2014 10:35 am

stijndeloose · **#175** by **stijndeloose** » May 08, 2014 10:38 am

Cito di Pense wrote:
stijndeloose wrote:"Personalizing"?

I disagree. It would be ad hom to assert that someone took a particular position w.r.t. ADHD because of having self-diagnosed as such or accepted a diagnosis from someone else. Anyone who lets someone else diagnose them with ADHD is already on the back foot. Unless it makes a great excuse, a leg up in an otherwise free-for-all competition. All you have to do is game the system into treating ADHD as an affliction. I empathise. I really do. ADHD really precludes a career in physics, but other departments leave their doors wide open to people who want to research their own peculiarities in the guise of researching human diversity.

That doesn't explain where you think Mr.Samsa was personalizing the discussion, though.

Cito di Pense · **#176** by **Cito di Pense** » May 08, 2014 10:43 am

stijndeloose wrote:
Cito di Pense wrote:
stijndeloose wrote:"Personalizing"?

I disagree. It would be ad hom to assert that someone took a particular position w.r.t. ADHD because of having self-diagnosed as such or accepted a diagnosis from someone else. Anyone who lets someone else diagnose them with ADHD is already on the back foot. Unless it makes a great excuse, a leg up in an otherwise free-for-all competition. All you have to do is game the system into treating ADHD as an affliction. I empathise. I really do. ADHD really precludes a career in physics, but other departments leave their doors wide open to people who want to research their own peculiarities in the guise of researching human diversity.

That doesn't explain where you think Mr.Samsa was personalizing the discussion, though.

What's not clear is why you are playing dumb about acknowledging Mr.Samsa's "aliens" trope: Anything that doesn't recognise the authority of brain scans is a conspiracy theory. M'kay?

stijndeloose · **#177** by **stijndeloose** » May 08, 2014 10:53 am

I still don't see any personalization, though. :dunno:

The_Metatron · **#178** by **The_Metatron** » May 08, 2014 12:07 pm

Samsa amuses me very much with that trope about "the poor sampling methods of the mental health professionals at the time", in an attempt to handwave away the uncomfortable truth about homosexuality being classed as a disorder until recently. Something changed, and it wasn't the homosexuals.

Are we to believe that the study of statistics is a recent development? That there has been a revolution in sampling methods in our lifetime? That scientists were previously unable to control for other variables?

There are other scientific fields that didn't seem to suffer this problem. Ampere, Coulomb, Faraday, Maxwell, Hertz, and many others in my field of science were able to figure shit out that still holds perfectly true today. Clearly, the ability to apply the scientific method and analyze data has existed for a far longer time than the age of DSM IV, or whatever manual it was in which its authors decided that homosexuality wasn't really a disorder. There is no possibility of a committee changing Maxwell's field equations, regardless of what society does or does not hold to be true.

So, why the incompetence in this field?

Here's some fun stuff about how DSM IV compares to DSM IV regarding ADHD:

Attention-Deficit/Hyperactivity Disorder

The diagnostic criteria for attention-deficit/hyperactivity disorder (ADHD) in DSM-5 are similar to those in DSM-IV. The same 18 symptoms are used as in DSM-IV, and continue to be divided into two symptom domains (inattention and hyperactivity/impulsivity), of which at least six symptoms in one domain are required for diagnosis. However, several changes have been made in DSM-5: 1) examples have been added to the criterion items to facilitate application across the life span; 2) the cross-situational requirement has been strengthened to “several” symptoms in each setting; 3) the onset criterion has been changed from “symptoms that caused impairment were present before age 7 years” to “several inattentive or hyperactive-impulsive symptoms were present prior to age 12”; 4) subtypes have been replaced with presentation specifiers that map directly to the prior subtypes; 5) a comorbid diagnosis with autism spectrum disorder is now allowed; and 6) a symptom threshold change has been made for adults, to reflect their substantial evidence of clinically significant ADHD impairment, with the cutoff for ADHD of five symptoms, instead of six required for younger persons, both for inattention and for hyperactivity and impulsivity. Finally, ADHD was placed in the neurodevelopmental disorders chapter to reflect brain developmental correlates with ADHD and the DSM-5 decision to eliminate the DSM-IV chapter that includes all diagnoses usually first made in infancy, childhood, or adolescence.

Try that kind of shit in engineering and see how far you get. Try sending a probe to another planet by burning the thrusters "several" times. This isn't science, I don't care how it's presented. You do not get to use vague, undefined terms to make a diagnosis of anything and call it science based. Oh, you can call it a hunch, a wild-assed guess, or a feeling, you can even call it a consensus. Science, my ass.

"An ampere is several electrons flowing past a point in a little bit of time."

See what you can build with that.

Cito di Pense · **#179** by **Cito di Pense** » May 08, 2014 12:17 pm

The_Metatron wrote:See what you can build with that.

Asta666 · **#180** by **Asta666** » May 09, 2014 5:55 am

The_Metatron wrote:"An ampere is several electrons flowing past a point in a little bit of time."

See what you can build with that.

Oh come on, this has never been about building anything. Nor it has been about arguments, at least from Cito's perspective, if he was presented operationally defined variables in mathematical terms from an observed experiment he'd say it's just physics envy or empty jargon. It's all about showing how his random babbling can allegedly be seen as having the same value as the results of an empirical study and therefore nothing in the field can be taken seriously, it's all just a battle of mere opinions.
I ask you the same thing I asked CDP when we reached this point in a previous and almost identical discussion:

¿why in God's name should we compare the success of behavioral technology with physical ones, when they have different goals? You can bring all the laser beams and mathematical equations about what is going on inside the sun or a black hole, but that won't help a person suffering from the most simple form or phobia, or make a dog respond to your commands. It would be like comparing basketball points with football goals, that would only start making (some) sense if we were able to previously develop some formal system of equivalence, like between meters and inches.

I don't think that makes it more useful anyway. You can't just say how precise someone else is at doing something completely different and pretend that it is meaningful for the subject in question. It's just called a syndrome, and it's not a direct product of basic scientific research, but a clinical tool that aims to take into account the data gathered from field trials and basic research in related areas, it's not presented as the psychiatric equivalent of a probe or an ampere. I sincerely hope that you and/or CDP can make contributions that'll make these tools more precise and scientific and quit talking from the random stranger POV, like how worried CDP seems to be about the possible waste of the taxpayer's money.

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