ADHD: Are we pathologising difference?

“Don’t take my devils away, because my angels may flee too”

Rainer Maria Wilke

Six months ago, my GP hypothesised that my everlasting post-viral fatigue might be due to burnout from undiagnosed ADHD. Six months, minus ten-minutes ago, I laughed myself out of his office, waving a pre-assessment form that I considered throwing in the bin. Six days ago, following a full assessment, I was given an ADHD diagnosis.

Predominantly hyperactive type, for those of you wondering.

As with so many people, when my assessor drew her conclusions, to my surprise, I felt relief. Maybe it was an explanation for the overwhelm, for the bonkers 7 careers I’ve always spun, the challenges with close relationships, the selective superpower super-focus, and for how clean my fridge is when I have something important to do. But there was something else niggling at me, and it’s left me with a conflicted response: why did I need a medical diagnosis to give myself permission to be compassionate to my brain?

Yoga is all about compassion. Psychotherapy relies on it. Even music and writing (that’s 4 out of my 7 jobs) have empathy and understanding of humanness at their heart. Yet so many of us still need this “permission” , and when it comes with the label of a disorder, it comes with implications. Are we simply pathologising difference?

I’m not a typical ADHDer. But then, it turns out, there’s no such thing. I did well at school. In fact, I was devastated if I got less than about 98% on any test I took (yes, I know, hello perfectionism, hyper-focus and rejection sensitivity dysphoria that I didn’t know was part of this whole shebang), but at home I was in emotional meltdown, tearing up my diaries and scrawling on my walls.

I also realised I’ve organised my life to work for my brain: I do multiple things that switch between the physical, creative, cerebral and admin. I laughed when the assessor asked whether I could sit still in one place for long periods, until she pointed out I have designed my week not to have to do that.

It never occurred to me, so long as I was a good student and “achieving” in work that there might be something to pay attention to. That any distress outside of ticking those expected boxes (I point you largely in the direction of my relationships, or rather, the rarity of them them), or my “impressive emotional range” (I recommend this reframe) might be telling me something.

I started to think about this, and a second question popped up: why is it that this set of differences and behaviours are considered a “disorder” when others aren’t? For many people with ADHD, their differences mean they don’t hit the “expected” life beats, whether that’s a relationship, 9-5 sitting at a desk, or sitting still and silent at school, is that why we frown at them?

I want to pause here to acknowledge the spectrum and myriad presentations of ADHD) (side note: the Diagnostic and Statistical Manual of Mental Disorders (DSM) does a terrible job of encompassing it all), and that there are many with such severe, debilitating presentations that medication is essential, and full-time support is required.

But for those of us outside that bracket, should we really be labelled with a “disorder”?

This is, I think a worrying trend. In my psychotherapy practice, one of my clients informed me she had received a diagnosis of clinical depression because she hadn’t recovered from the grief of losing her mother after 12 sessions of CBT. Another received a diagnosis of an adjustment disorder because she wasn’t over the loss of her career and identity as a dancer after a catastrophic knee injury. This strikes me as misguided at best, and deeply damaging at worst.

I mention it because this medicalisation of normal life responses to events feels like part of the same thing. Both have the power to change our conception of ourselves, what we believe we can and can’t do. Diagnosis can bring great relief, but great limitation too.

So, what’s the conclusion of all this? I think people who think differently should be celebrated rather than slapped with the label of disordered. I think education systems need to change to move beyond wrote-learning and celebrate creative thinking, embodiment, wisdom, social values. I think most people can benefit from some sort of psychotherapeutic relationship in their life to unpack their ways of being and looking at the world and themselves. And I think people who struggle with differences so great that they cannot function need full support and the as much medical attention and research as possible, and the correct, researched, titrated medication, if appropriate.

How do I feel about my diagnosis? I’ll come back to that when I’ve reorganised the bedroom cupboard.