Saving "Disorder"

Isn't all medicine just a bunch of fancy made-up words?

Note: I am not a doctor (I didn’t even finish High School) and none of this should be taken seriously let alone be considered medical advice, or in any way accurate, rational, logical, grammatically correct, or even comprehensible, and should probably be ignored by all of humanity. Anyone taking this too seriously might want to get checked out for Autism ahem I mean ENT J/P.

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I’m not usually interesting or popular enough to be written about, but on occasion it happens. This time, it was due to a post I made about being accepted into a “secret society of neurodivergents” at my new workplace:

(If you can’t see the light-hearted, tongue-in-cheek nature of this post, you should perhaps consider therapy)

I got into an interesting discussion in the comments, challenged on whether ADHD is just a personality profile, and what exactly makes it pathological. I think we had a good discussion about it.

Turns out, however, the same individual went to the trouble of interpreting this as me being self-diagnosed, and decided to turn me into the poster boy for everything that is wrong with the kids these days and all their social-media-driven self-labelling rainbow-67-skibidi-toilet nonsense.

The AI-generated image does bear a very slight resemblance to me, I guess

Apparently I’m not who I think I am?

Take this fellow, Nicholas Kircher, who posted about being added to a ‘secret’ AuDHD group. Now, those not up with the lingo, this Frankenstein word is a fusion of Autism and ADHD, two of the most conflated and error-prone ‘diagnoses’ of the last 15 years.

The authors take issue with the whole neuro-divergence thing, and seek to un-diagnose me. They paint me as having succumbed to some tiktok fad, joined a bandwagon, been “influenced” into self-diagnosis.

Nicholas and the rest of the Neurodivergent bandwagon

Which, lets be honest, is pretty funny considering my history (and I don’t even use tiktok.)

The whole thing is horrifically over-cooked, and although probably not meant to be mean-spirited, it definitely smells like self-righteous silliness. This might be a valuable teaching opportunity. Then again, it might not. Time will tell.

So I am posting today to send the whole thing even more over-the-top than is necessary, or responsible, or even legal. For one time only. After this, I’m not spending any more time on the subject, as we all have better things to do.

First, some history about me and my situation, because nobody asked (and perhaps if anyone had asked, the original article could have been significantly improved, and maybe a lot shorter):

I was diagnosed with ADHD and Autism Spectrum in the year 1999 - the same year The Matrix came out - when “Social Media” didn’t even exist yet, and MySpace was still a good 4 years away. Back then, my diagnoses were known as ADD-Inattentive and Aspergers Syndrome.

Why was I diagnosed?

I was nearing the end of primary school. I’d already repeated one grade, and was failing another. I’d had no success in making any in-school friends or proper connections with others, and I fidgeted incessantly at all times. Some developmental goals I was reaching, but many I was hopelessly behind in.

I was not absorbing anything being taught, I was constantly getting lost in time and in space, and for nearly every activity in class, I would somehow draw a blank when instructions were given, having no idea what was happening or what we were doing. I almost never remembered to do homework, or quite frankly anything else unless it was squarely within my “special interest” bubble, and when I did remember or was reminded, I could rarely get it started, and even then I didn’t last more than 5 minutes before I’d crash and burn, hard.

I didn’t even complete the IQ test I was given by a psychologist, and never got a score. (I like to joke that I got a zero)

I came home every day to my mum - who was suffering in the throes of a chronic illness - sobbing intensely, because I could not understand why I could not do what all the other kids were doing with apparent ease.

Every unqualified person and their dog seemed to have an opinion on why this was. The greatest hits:

• he’s lazy,

• he’s faking (for attention, apparently)

• he has a bad/lazy mother,

• he needs to take more responsibility for himself,

• he’s not being punished enough (bring out the lash),

• he just needs to apply himself,

• he just needs to pay more attention (duh),

• he’s a designer moron

Wait, a “designer moron?” Yes, friends, that was the term used for me by some of my extended family after I received my formal diagnosis. They, too, thought all this fancy label stuff was just to hide the simple fact that I was an idiot.

Growing up with a single mum, she worked hard to find a way to help me. She was the only person in my life for a long time that gave a shit, and she refused to give up on me. I saw several different specialists as we searched for some explanation that actually made sense. Most of the opinions we got in those early days were nonsense - like mum being told she needs to take “parenting classes” - while some of them were outright scams. However, two interesting leads came along.

The first: perhaps I was having “absent seizures”, a kind of epilepsy that causes a blanking of conscious awareness, without the typical shaking/motor movement symptoms commonly associated with epileptic seizures. Thankfully that one can be pretty definitively tested, and it came back negative.

The second: maybe I have some combination of attention deficit, and/or Asperger’s. This one was - and still is - far from having a definitive test, and very few specialists in Australia at that time were well equipped to diagnose either of them. We got a lucky break however, and managed to get in to see perhaps the leading specialist in these two psychiatric conditions in the country.

My mum remembers the moment he came to a conclusion about my case:

“Mrs Kircher, I see a lot of kids brought in who are suspected of having one of these conditions, and the fact is, most don’t have it. In the case of your son, there is absolutely no doubt in my mind that this diagnosis fits.”

Since that day, it has been re-evaluated at least 4 separate times by independent specialists for various reasons, each time being re-confirmed.

So let’s just get one thing absolutely clear before we do anything else:

I am not one of your guinnea pigs for hypotheses about self-diagnosis.

And back to the beginning, when we mix personality types of both individual and cultural, where the US is an amalgamation of dozens of cultures, what is neurotypical? Ironically, for Nicholas and the rest of the Neurodivergent bandwagon… They are.

Currently, 20% of the US population and a whopping 53% of Gen Z self-identify as neurodivergent.

53% self-identify. Read that again: self-identify. One person’s self-identity is not the same as my psychiatric diagnosis.

I’m not self-diagnosed, I’m not Gen Z, and I’m not American.

Could have spent 5 seconds to find all that out, but instead of “doing the hard things,” why not just make assumptions and roll with them?

And that is also a very typical human behavior because doing hard things is… hard.

I bet.

What’s more, I’ve lived my whole life with people casting all kinds of aspersions about whether I’m “really” this or that or the other thing, or whether I’m just bereft of moral fibre and/or character, based on some 5-second observation they’ve made of me.

This is not the first time - not by a long shot - and won’t be the last.

As the New Zealand pathologist Dr Temple-Camp said: “That’s the thing about opinions and arseholes, isn’t it, gentlemen; everyone’s got one.”

So I asked Nicholas how he defined typical, but in answering my question, he skirted with vague statements about holding a standard job, maintaining social connections, and navigating daily life without significant distress. Which I’d like to find a single human who does this with frictionless ease.

I didn’t realise I was expected to provide some sort of DSM-version of the definition of a word that arose originally as a joke.

The term “neurotypical” was actually coined in the late 1990s by the autistic community, specifically by the autism rights group Autism Network International (ANI). It was created as a satirical counterpart to the idea that people with Autism were “neuro-defective.”

They wanted a neutral word to describe non-autistic people (whom they playfully referred to as having “Neurotypical Syndrome”) to shift the framing away from autism being a “disease” and neurotypicals being the “healthy default.”

The author’s actual question was this:

What, specifically, is Neurotypical because neither Level 1 Autism, nor ADHD are divergent, given the quantities they exist and they can be easily explained by Personality proclivities, not pathologies.

The reason I ask is people keep trying to tell me I’m both Autistic (I’m not, I’m analytical, disagreeable, and not nuerotic) and ADHD (I’m not, I’m Intuitive, fast thinking, and middling contientiousness.) What I’m saying I’m an ENT J/P… which is one of sixteen personality categories, totally neurotypical…

Here’s the actual part of my much longer response to their overall comment that partially dealt with the author’s specific question, framed within the context of how neurological conditions and personality constructs relate and differ:

So if you’re able to hold a standard job, maintain social connections, and navigate daily life without significant distress or the need for specific accommodations, you may still exhibit traits common to people with Autism or ADHD without being impacted by the symptoms which make it pathological. A diagnosis is only necessary when the underlying neurological factors create barriers to typical functioning.

I wasn’t even trying to explicitly define anything, merely explain how one might differentiate between a trait or variation and a functional disorder.

ADHD, Autism Spectrum Disorder, OCD, are psychiatric conditions defined in medical literature. The reason why the medical and psychiatric fields don’t explicitly define “neurotypical” or “neurodivergent” is because they’re overly-broad generalisations that don’t take into account the particular neuropathology involved. “Neurotypical” being a state of “the absence of a neuropathology” is obviously unsatisfactory as a medical term.

It’s like the word “healthy” - what is “healthy?” Is it just the absence of disease? How can you even be sure they truly are absent of disease?

Having dispensed with the assumption that I am a product of some modern social-contagion, this article can essentially be broken down into 2 arguments:

1. People self-diagnosing (”collecting”) psychiatric conditions are really just seeking belonging and validation

2. But also, ADHD and Autism Spectrum Disorder aren’t reeeeeally real anyway, it’s just an excuse to be an entitled self-absorbed little brat

The first argument is, in fact, an important topic of debate and discussion, and has been for many years now. The highly successful campaigns for awareness of these conditions could very well have resulted in over-saturation, with terms like “OCD”, “Autistic” and “Dopamine” being used as verbs in day-to-day language and completely outside their proper medico-psychiatric context (e.g “I’m so OCD about keeping the house tidy”, or “I need more dopamine, I’m really low today”).

However, stepping back to the world of 1999, most people simply defaulted to moral judgements: “he’s just lazy.” They weren’t adequately aware of other possible neurological explanations. They might have heard the term “ADD”, but until they had an adequate comprehension of what it meant in terms of the impact on behaviour, perception etc, they would quickly dismiss it as “some made-up medical jargon.”

The authors argue that we are wrongfully pathologising healthy human behaviour; that framing my traits as ADHD or Autism is simply medicalising the “perceiving” side of a normal personality matrix. I am just disorganised and analytically minded, they argue, and trapping myself in clinical language strips me of my agency to just “do hard things” and mature.

This might be true for some people who are self-diagnosing after watching a few youtube shorts about being “neurospicy.” Hell, sometimes even formal medical diagnoses are wrong. That happens in all fields of medicine, not just psychiatry. Sometimes, medication is given to the “worried well” in order to make them go away. That’s a legit thing we can be concerned about as a society.

It has absolutely nothing to do with me and my situation, nor that of many others who have spent their lives in constant and often fruitless struggle against disorders of this kind.

Then, there’s the sheer irony of trying to use a scientifically meaningless corporate sorting-hat like Myers-Briggs to debunk heavily researched neuro-developmental disorders; it’s quite something to behold.

The fundamental clinical description of ADHD was established in 1902 in a series of famous lectures by the father of British paediatrics, Sir George Still.

The first pen-and-pencil version of the MBTI (Myers-Briggs Type Indicator) was established 42 years later by two amateur mystery writers with zero clinical, psychological or medical training.

It’s like using Astrology to debunk General Relativity.

Let’s see what a tiny portion of the research says:

In 2017, the journal Lancet Psychiatry published the largest-ever global MRI study of ADHD brain structure, evaluating scans from over 3,200 individuals. The researchers concluded decisively that “Attention-deficit hyperactivity disorder (ADHD) is associated with the delayed development of five brain regions and should be considered a brain disorder.”¹

The data reveals robust, quantifiable reductions in the volume of the amygdala, accumbens, and hippocampus in individuals with ADHD compared to controls. These regions form the core of the brain’s reward, emotion-regulation, associative learning and impulse control circuitry. A reduction in their volume is a strong indicator of an innate, physiological deficit in how dopamine is transported and utilised.

Claiming this is just a behavioural choice or a natural inclination toward untidiness is equivalent to claiming clinical myopia - short-sightedness - is simply a preference for looking at objects closely.

Then, there’s the environmental argument, one which I’m fairly sympathetic towards, but it’s also a sociological trope: the idea that our educational systems and modern work environments “were designed for factory workers to perform a specific function,” and therefore, my brain is simply reacting normally to an abnormal environment. Put an ADHD brain in a hunter-gatherer society, the logic goes, and it is perfectly adapted.

I think there is some truth to this, but it’s far from clean-cut.

Dr. Russell Barkley, one of the world’s pre-eminent clinical authorities on the subject, characterises ADHD as a profound impairment of executive function, which is seated squarely in the under-stimulated prefrontal cortex². Executive function is what allows a human being to pause, evaluate the consequences of an action, recall past mistakes, and carefully decide what should happen next. It also plays a major role in inhibiting immediate emotion-driven responses.

Executive dysfunction does not just make sitting at a desk for eight hours difficult. A person lacking behavioural inhibition can frequently act on impulse, chronically misplace essential tools, forget crucial steps in multistep processes, and struggle to regulate their emotions and temper.

Even in a theoretical nomadic tribe free from the tyranny of the eight-hour workday, an inability to accurately track time or evaluate risk can be a significant disadvantage. Despite the fact that there do exist some benefits to particular traits which ADHD brings about in other environments, that doesn’t nullify all other deficits. Sometimes, it can even magnify them.

Without a doubt, environment can play a role in improving overall outcomes or degrading them; yet it does not necessarily follow that the environment makes the disorder.

This brings us to the most dangerous aspect of redefining these conditions as healthy variations.

The critics state that adopting these labels leads to a closed feedback loop where “entropy rules” and “that means no growth.” If you just chose to lean into the hard tasks and matured, they argue, you wouldn’t need accommodations or medication.

The epidemiological data tells a much darker story, as your typical personality quirks aren’t likely to carry a body count.

In 2019, Barkley and his colleagues published a ground-breaking longitudinal study evaluating the life expectancy of children with ADHD tracked into adulthood. The data was pretty stark.

Barkley noted that childhood ADHD “may more drastically shorten a patient’s life expectancy than any other single health threat including high cholesterol, obesity, and alcohol or tobacco use,” determining that the associated risk factors may decrease longevity by up to 13 years³.

Notoriously elevated rates of substance abuse, severe traffic accidents, impulsive violence, and significantly higher rates of suicide mean ADHD all too often translates to an early grave.

The critics argue that clinical diagnoses and pharmaceutical interventions strip a person of their agency. In reality, the exact opposite usually occurs. The entire point of a diagnosis is understanding and treatment. The whole point is to find ways to thrive in spite of challenges which we are unable to overcome by other “common-sense” means.

That’s why we have the freakin labels!

When a person with a broken leg gets around using a crutch, we don’t accuse them of denying their personal accountability or demanding special treatment. We understand that the crutch provides the mechanical support required for them to actually participate in society.

We don’t wax philosophical about how a broken leg is really just a broken environment, how such people could just roll down a slope and they’d get around fine, so they just need to live on a hill-side and how hill-based societies had benefits for people with broken legs, yaadaa yaadaa.

“Isn’t it just a healthy variation in leg bone structure?”

It’s true that medication is often given to the “worried well”, yet that has no bearing on whether ADHD, or Autism Spectrum Disorder, or any other conditions are real or not.

What’s more, stimulant medication and clinical accommodations do not create an excuse for laziness. By medically counteracting the excessive reuptake of dopamine in the ADHD brain, we make it possible to actually exercise better discipline, build effective habits, and take genuine accountability for one’s life.

The diagnosis and treatment make this possible when all other options have failed.

We do need to have a serious conversation about the sociological impact of internet self-diagnosis. The proliferation of influencers turning serious clinical disorders into quirky aesthetic identities is doing immense damage to public understanding.

However, the solution to that entirely valid problem is not to swing the pendulum back into the dark ages and pretend that structural neuro-developmental disorders are just an amalgamation of normal personality traits, which essentially translates into “it’s just a will-power issue.”

One can argue about whether one person or other could be reasonably diagnosed. We can argue about whether Autism is a spectrum disorder. The fact is, everything in the DSM, and pretty much everything else in science, is simply an approximation, and is up for discussion and refinement.

We use language - “fancy labels” - for categorising and finding treatments for challenges which take shape in the extremely complex biology and neurophysiology of human bodies. It’s an attempt to take something mind-bogglingly complex and bring it down to a level of human comprehension.

If you want to talk about normal, language is normal.

Words, like “ADHD” and “Autism”, are just language, and using language to communicate with others is normal.

The disorder itself is not.

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If you recognise yourself in my self-description, or are facing similar challenges, and need medical advice: you should speak to a qualified medical professional. I am not one, and most people on the internet are wrong, including me.

Don’t just self-diagnose: trust the professionals.

Footnotes:

1. Hoogman, M., et al. “Subcortical brain volume differences in participants with attention deficit hyperactivity disorder in children and adults: a cross-sectional mega-analysis.” The Lancet Psychiatry, vol. 4, no. 4, 2017, pp. 310-319.

2. Barkley, R. A. “Behavioral Inhibition, Sustained Attention, and Executive Functions: Constructing a Unifying Theory of ADHD.” Psychological Bulletin, vol. 121, no. 1, 1997, pp. 65-94.

3. Barkley, R. A., & Fischer, M. “ADHD Adversely Impacts Health, Mortality Risk, and Estimated Life Expectancy by Adulthood.” Journal of Attention Disorders, vol. 28, no. 4, 2020.