If you ever get diagnosed as having ADHD though, then every doctor will forever pretend that they know for a 100% fact that your ADHD is caused by mutated dopamine receptors, while having done no testing of course; why would they when you have already been diagnosed
That is pretty silly, and a misunderstanding of the research. All of the mutations in dopamine transport associated with ADHD are pretty weakly associated, and still very common in the non-ADHD population.
You are actually making the case that ADHD doesn't exist or is pretty meaningless.
There is no scientific basis for it, it was a bunch of criteria that were arbitrarily chosen to create a term called "ADHD" so that they can prescribe meds.
You just have to ask the question as to why we can't give meds to everyone when 25% of college students report using them. Why can't we give meds to someone addicted to social media as a fix?
Everything is premised on it being a neurodevelopmental brain defect from birth...so that meds can be effective. But there is no basis for this.
You might as well just give anyone who doesn't get good marks at school or doesn't perform at work meds. In fact people want to do this.
Most medical conditions are diagnosed entirely on symptoms, and then those symptoms are treated. Especially in psychiatry, where we understand so little about the brain- all conditions in the DSM are symptom based, not mechanistic.
We cannot have a scientific understanding of the underlying mechanisms behind a disease, when our biological understanding is way too primitive to allow that.
Medicine has been helping people effectively for thousands of years, long before science even existed, by treating symptoms. It is "scientific" in the sense that the symptoms for a specific disease are clearly defined, and the safety and effectiveness of a treatment is determined experimentally, for the group of people fitting those symptoms.
The concept of a neurodevelopmental disorder is also symptom based- there is a measured progression of certain abilities in the "average" person, and there is a measurable delay in those abilities with a neurodevelopmental disorder. Again, that is a symptom, and has nothing to do with understanding the mechanism.
Using a lack of mechanistic understanding to say a condition doesn't exist, or is meaningless is nonsense. It's a clearly defined set of symptoms that can make normal life extremely difficult for the people affected, and can be effectively treated. It has known causes- both environmental, and genetic, as well as known physical phenotypic traits that can be measured experimentally. All hints towards eventually increasing our understanding of the underlying biology.
I would argue we actually understand virtually nothing about essentially all medical conditions, even the most deadly and most treatable ones. By your same logic, you could say diabetes "does not exist" because we don't understand exactly why people stop producing or become resistant to insulin. Yet people without treatment die, and people with treatment can thrive, which is sufficient reason for having a disease category despite lack of mechanistic understanding.
It would be great if we understood the human body a lot better, but that will take a long time, and a lot more research. We shouldn't stop making peoples lives better in the short term.
As a researcher in the biomedical field for a long time, I have come to see mechanisms come and go for diseases over the years, yet the diseases themselves remain constant. Most of our historically popular mechanisms like "depression is low serotonin" turned out to be either misunderstandings, or gross oversimplifications. Yet that doesn't change the fact that certain treatments work for certain clusters of symptoms we define as a disease.
I think "scientism" in medicine has been very harmful, and is mostly a delusion, and often a type of fraud aimed at creating an illusion of credibility. Pretending that things have a deep mechanistic explanation or understanding when they do not, and then dismissing safe and effective treatments when the mechanism isn't understood, or dismissing traditional medicine from other cultures and time periods because it's "not scientific."
Indeed, defining medical conditions always involves a cultural context, and is therefore "arbitrary" in a sense. I could imagine, for example, that having an ADHD brain could actually be a huge benefit to a hunter gatherer, but harmful to a modern office worker. Many other cultures and time periods have concepts of disease conditions that are basically incomprehensible to us, because they represent human differences which are now mainstream and culturally acceptable, so, despite representing a real difference, they do not cause a problem for people affected in the context of our modern society, and are therefore not a disease to us.
> We shouldn't stop making peoples lives better in the short term.
> I think "scientism" in medicine has been very harmful
That's what they said when they were drilling holes in people's skulls and doing lobotomies.
Now we are giving children meth and yelling down anyone who wants to discuss long-term side-effects.
The obvious reality is ADHD is a means to sell meds and psych appointments. You cannot escape homeostasis and you just end up with people dependent on a drug for the entire life where the effectiveness has completely waned and they are worse than when they started.
It's unbelievable that ADHD diagnoses are increasing at the same time almost everyone is completely addicted to social media. If you start prescribing stimulants for ADHD when all they needed was to get off social media...you are going to fuck up an entire generation.
The neurodevelopment dopamine theory is the reason why ADHD people get these smart drugs and no one else does. It makes them safe from addiction. But its entirely unproven.
I agree that we should study the more extended time effects of this medication. I started in 8th grade and stopped 2 years after college because I was worried about building a dependency. When I stopped taking my meds, my symptoms were way worse, so I almost had to take meds. Since I've stopped, I've been able to manage my symptoms well.
Meds are a great starting place to give you momentum, but we should slowly transition away from them as we develop better habits.
I get why you have this perspective because I shared it a few months ago, before my kid was diagnosed, and then I did a deep dive into the research, and more or less did a 180.
You are dead wrong, and have some serious misconceptions, which can't really be explained in a short reply here, but I will outline the main things I think you are missing, if you are open to looking into it.
-There are a lot of non-stimulant treatments and medications that work for ADHD. The reason stimulants are the most widely used is because they have high effectiveness, and low side effect risk. There is tons of research, discussion, and concern on long term side effects and there are risks, but they are less than the extra risks of untreated ADHD.
-Tolerance does not negate the effectiveness of stimulants, it does keep working long term for most people.
-Addiction and dependence on stimulants has mostly to do with the rate at which the effects come up. Doses and protocols used for ADHD don't cause addiction in ADHD people or the general population, because the levels don't come up enough to cause any euphoria.
-Social media and smartphone/internet addiction, etc. do harm executive function in everyone, and make ADHD worse but the effect is tiny compared to the baseline impairment in a person with ADHD.
-The "neurodevelopment dopamine theory" you're talking about is not a mainstream concept among neurologists and neuroscientists anymore. Current research and ideas on executive function and ADHD have moved a long long way from that. If you're seeing a psychiatrist that thinks like this, find someone that has read some literature in their field in the last few decades.
-Your response to my comment about scientism shows you don't know what I mean by scientism. I'm not critical of using science to advance medicine, but in doing the same old thing and pretending it's science, with nonsense explanations. The "neurodevelopment dopamine theory" is scientism.
