Here's a song I wrote for some of my symptom-obsessed fellow psychiatrists who are - what's the word? - oh, yes - incompetent:
Take some of these and you’ll feel better
Forget about those hippies who claimed, “speed kills”
You’ve got ADHD and just a touch of bipolar
Things are always better when you’re taking pills
Your family life’s a mess but that we won’t mention
What’s crucial is your trouble paying attention
You say bad memories make you a sad girl
If your ma drank too much, that’s ‘cause you were a bad girl
[chorus:]
So what if your husband’s out chasing booty?
So what if your brother’s coming on to your kids?
If you find that you’re feeling moody
Your brain’s miswired, that’s all that is!
Those things you remember, they’re all distorted
Your stepfather couldn’t have fondled you
If he had he would have been reported
Others must have been there, not just you two
[repeat chorus]
[repeat first verse]
[repeat chorus]
(Anyone who wants the chords, please feel free to contact me).
Here's my idea. Let's just stop calling ADHD a "disorder," thereby giving it credence it doesn't deserve (at least not yet).
ReplyDeleteI'm serious. We can still prescribe ADHD meds to people if they say they help-- along with the proper safeguards, of course-- in the name of "cosmetic pharmacology." Heck, dermatologists, plastic surgeons, and bariatric specialists do procedures for more dubious "conditions" all the time.
In the meantime, we should continue to do genetic, neuroimaging, psychological investigations to determine the root cause of inattention & hyperactivity-- and, perhaps, to determine whether a sub-population of our "ADHD" people actually have a biologically based disorder, and if so, how best to treat them. We might find that there are several causes of "ADHD," each deserving of its own unique form of treatment-- a great improvement over the current situation.
Would this radical move increase the rate of false negatives (i.e., people who actually have a disorder but which we're no longer diagnosing as such)? Yes. But, in my opinion, that would sure beat the glut of false positive "ADHDs" running around.
SteveBMD, I am not surprised to see you are a physician in Northern California, which has the highest rate of ignorance about ADHD.
Delete(Perhaps because they prefer to prescribe pot for patients with ADHD; maybe it makes them feel better about their own predilections.)
The ignorance about ADHD that you reveal in your comment is staggering. You should lose your license.
anon,
DeleteFirst of all, I do not prescribe pot for ADHD-- or anything else, for that matter. In fact, I do prescribe stimulants.
The point I was making was that what we call "ADHD" might in fact be multiple disorders. I'm not advocating that we should take all patients with the diagnosis of "ADHD" and discharge them. In fact, I made it very clear that they deserve treatment and that many, if not most, benefit from treatment.
But in order to provide optimal, personalized care, it behooves us to determine the biological/psychological/sociocultural origins of what we call "ADHD", and for such a heterogeneous condition there are bound to be multiple origins-- hence, possibly several "subtypes" of ADHD: some who benefit most from stimulants, some from alpha-agonists, some from omega-3 fatty acids, some from more aggressive educational interventions. To me, it seems that that would be a vast improvement over what we have now. and we might be able to serve more patients more effectively and more safely.
Regarding your last point, if my desire for a deeper understanding of the conditions I treat-- to improve outcomes for my patients-- is a reason for me to lose my license, then you might as well call the Medical Board today, because I refuse to practice medicine any other way.
You sure have a funny way of making your point then: by saying things like this:
Delete"We can still prescribe ADHD meds to people if they say they help -- along with the proper safeguards, of course-- in the name of "cosmetic pharmacology.""
Who wants a psychiatrist playing these kinds of games with their brain?
You act like ADHD has not been well-researched (it is) or that it is talked about only in terms of stimulants (not the case and hasn't ever been by true experts). That is strictly an "outsider's" assumption and one more common to anti-psychiatry wingnuts than actual psychiatrists.
You write: "to determine whether a sub-population of our "ADHD" people actually have a biologically based disorder, and if so, how best to treat them."
That research has been done. I suggest that you read it.
Why would you assume you have "adapted enough" if your colleagues often tell you have Adult ADD.
DeleteHas it not occurred to you that they are telling you have problems, that perhaps you don't pay attention to important issues, that you drop the ball at critical points, that perhaps they are alarmed at the details you miss in patient care?
The sad truth of ADHD is that its symptoms can conspire to worsen objectivity and insight. You might be surprised at what people see about you that you cannot see yourself.
As for the rest.... if you really are a treating physician, it would behoove you to upgrade your information about ADHD. It might just make a critical importance to a patient's life.
Gina, I think this response was meant for doctorz, below.
DeleteAnyway, I don't want to open a can of worms, but I can't quite tell from your responses what I should be doing with people (adults or children) who come to my office with ADHD symptoms. What tests should I do? What other psychiatric diagnoses should I rule out? What social issues should I address? What medication(s) should I prescribe?
If, as you assume, I'm not up to date on the research (which is entirely possible, as there are only so many hours in the day), I would truly appreciate your input.
What the "science" behind ADHD really shows about how it is "biologically based." (In much the same way as ANY multi-determined group of traits): http://www.nytimes.com/2012/01/29/opinion/sunday/childrens-add-drugs-dont-work-long-term.html?_r=2&ref=opinion&pagewanted=all.
DeleteThank you for calling attention to the excellent book pictured above, "The Idiot's Guide to Adult ADHD."
ReplyDeletePerhaps you should read it. It's for idiots.
Oh wait, idiots aren't usually so mean-spirited. Maybe there should be a Sociopath's Guide to Adult ADHD.
"Anonymous" is a perfect moniker for you...no face or identity, other than to insult others in your leisure time, or perhaps this is your avocation as an SSI recipient. I suppose I'd remain anonymous too if I had nothing better to do. Go park it somewhere else.
Deletedoctorz, Anonymous is Gina Pera. Her website is http://adhdrollercoaster.org/
DeleteGood heaven, after perusing that website, I'd prefer she remain anonymous. Take away the "Adult ADD" label, and one is left with a vacuum that apparently can only be filled with projective vitriole.
DeleteThank you for referring readers to my website.
Delete"Anonymous" referred me to your blog. And I find he/she makes excellent points.
How juvenile the response from two psychiatrists.
David,
ReplyDeleteI've been a hyperactive "kid" all my life...the 4th of 5 kids from a Catholic family growing up in the 60s. Nobody knew what "minimal brain dysfunction" was then in my hometown, but my mom realized in my infancy that I was going to be hell on wheels. Like alot of kids who have been branded with what we now call ADHD, combined type, I was in to everything, accident prone, immature, etc. Spent my most of my first year in kindergarten tied to my chair, and when I learned how to untie myself, was transferred to a barrel. I remember, at that point, hearing what my teacher was saying, though not being able to see her, thus setting the stage for becoming an auditory learner. In 4th grade, I had a teacher who must have seen my potential and took the extra time with her creativity to help me catch up on my reading, which at the time was on a 2nd grade level. I took off at that point, and eventually graduated from medical school, never having the benefit of a stimulant trial, though they were certainly available. Now, as a 52 year old, I'm reminded often by colleagues that I have "Adult ADD", but apparently have adapted enough to be tolerated by my family, friends, and patients. The point of all of this is that I'm of the terrier breed by nature. Just like dogs, we have particular innate characteristics, and what distinguishes normal from abnormal in the end analysis, is rooted in our upbringing. Had I not come from a structured and nurturing environment, given my genetic temperament, I might have been an erratic, unemployed, drug-addicted adult. The same holds true for the quirky and pesky behaviors of a Jack Russell, who will become unmanageable, if his owners aren't appreciative of his distinctive nature and raise him accordingly.
It's the old bell-shaped curve of normality. Every trait has one. It's amazing how much the right social environment can make that issue way less important (at least to a point. My favorite parenting columnist John Rosemond said, "Everyone is in the bottom percentile in something. In my case it's in pole vaulting").
DeleteNow how could I have guessed that John Rosemond would be your favorite parenting columnist.
DeleteThe same way I could have guessed that he would not be yours.
DeleteGina Pera has written a book about ADHD and is militantly hostile against anyone who dares question this pseudoscience label. Psychiatry itself admits it does not have one shred of evidence to prove that any of its labels have any brain related causes nor are there any real medical tests like x-rays, blood tests or MRI's to prove the diagnosis.
ReplyDeleteHowever, Dr. Fred Baughman, highly qualified Neurologist, who knows the difference between disease and nondisease as a doctor who discovered one, states that the ADHD diagnosis with its related Ritalin like drugs is 100% fraud like all psychiatric diagnoses with their related toxic drug treatments. Dr. Baughman has written a book called ADHD FRAUD and has several articles on the web about the history of psychiatry and neurology. He points out that when psychiatry and neurology were split up, neurology handled real brain diseases like alzheimer's while psychiatry dealt with nonbrain diseases involving the mind, problems of living, social distress, trauma, etc. Recently, I have noticed that more emphasis is being placed on one's social environment since total biological reductionism is proving quite bankrupt in healing these problems in a majority of cases per Robert Whitaker's excellent book, ANATOMY OF AN EPIDEMIC that also includes the huge damage done by the ADHD diagnosis and its related drug treatments. Though it has been claimed that Whitaker has been refuted by psychiatrists, Whitaker exposes that these critques deliberately misrepresent the actual studies he quotes to push the biological agenda in his MAD IN AMERICA web site/blog.
Anon -
DeleteWhile we may agree about ADHD and some other psychiatric diagnoses, to say that your statement about ALL of biological psychiatry being a pseudoscience is ridiculous would be an incredible understatement.
I've already critiqued Whitaker's ideas extensively in previous blog posts and replies to comments.
I can't decide if this song would be classic blues country or teenaged emo rock… Still, I completely agree the sentiment.
ReplyDeleteIt's a sorta cross between the two :)
DeleteAs an adult with ADHD, diagnosed both as a child and as an adult, the trivialization I'm seeing is so disheartening.
ReplyDeleteThe research is there, it is sound but we still have P-Docs acting like it's something trivial. Stigma might have a GHOST of a chance of ending if mental health professionals would stop promoting it.
Yeah crack jokes comparing being unable to pole vault with someone who has ADHD. Sheesh.. shame on you!
Wow. Are you ALL doctors? It's hard to believe, given the juvenile and ignorant comments. Oh, and, yes, I'm anonymous because I do not wish to go through all the profile nonsense. Buh bye. :)
ReplyDeleteMaybe you could say which comments are ignorant.
ReplyDeleteWonderful David, but I want a YouTube of you singing it.
ReplyDelete