Guest Post: Does ADHD Exist?

The following guest post comes courtesy of Dr. Marilyn Wedge, author of Pills Are Not for Preschoolers, A Drug Free Approach for Troubled Kids, which I recently reviewed here as part of TLC virtual book tours.Marilyn Wedge, Ph.D.In July, 2012, I attended a talk by the distinguished Chilean biologist, philosopher, and constructivist thinker, Humberto Maturana, at a conference at which we were both speaking. Maturana is best known for his theory of autopoiesis. Simply put, autopoiesis (which literally means self-creation) is the view that the world we inhabit is a world that we ourselves create. Humberto MaturanaAccording to Maturana, all reality, including the reality that scientific theories claim to illuminate, is ultimately self-referential, and must therefore take into account the scientists who are doing the illuminating.  All theoretical constructs implicitly contain a reference to the person who is doing the theorizing. And, according to Maturana, it is more honest to be aware of the self-reflexivity of our theories than not to be. He is, in a sense, a modern incarnation of the ancient sophist Protagoras, who famously said: “man is the measure of all things.”      Of course, many people have accused Maturana of solipsism [a theory holding that the self can know nothing but its own modifications and that the self is the only existent thing], but I think this criticism misses the point. The importance of what Maturana is trying to convey can be best grasped if we understand his philosophy as a countermeasure to dogmatism. Maturana’s view is humbling--just as he himself comes across as more humble than one would expect considering his fame and importance as a biologist and philosopher. His ideas lead us to question pronouncements of reality that do not take into account the agenda or motives of the people who are doing the pronouncing.     As a therapist, I found Maturana’s radical constructivist point of view very much in keeping with the way I view my work. When a child or young person enters my office, often he bears one or more diagnostic labels. A parent will tell me, “My son’s teacher thinks he has ADHD or ODD” or “my daughter’s pediatrician says she has ADHD.” When you think about it, ADHD is a human construction—in particular, a construction by a panel of psychiatrists who authored a diagnostic manual called the DSM-IV. And many of these panelists—56% of them to be exact—accepted money from pharmaceutical companies during the time they were creating the diagnoses in the manual. Here’s an important example of how the reflexive nature of theoretical constructions has to be taken into account to fully understand their nature.       So the answer to the question “Does ADHD exist” really depends on the agenda of the observer. Personally, I find it more helpful to uncover the underlying social causes of a child’s fidgetiness or distractedness and make targeted changes in the child’s social environment to remove the stressors. Does the child hear his parents fighting or arguing all the time? Is the child being abused? Does the child have a teacher who is not able to give him the extra attention he needs because she must deal with an overcrowded classroom? I don’t need to construct a diagnosis of ADHD to help a child. In fact, constructing a diagnosis of ADHD is not helpful at all, because the only way to treat it is by stimulant medications, which may, in the long term, be harmful to the child’s brain development or predispose him to become a drug addict as a young adult. Furthermore, constructing the diagnosis tends to obscure the underlying cause of the child’s distress. The diagnosis doesn’t help me to figure out what I need to do to get kids over their problems. Constructing a diagnosis is, however, very helpful to pharmaceutical companies who want to see drugs, and also to DSMpanelists who depend on drug companies to fund their research and provide them with elaborate vacations.      From this we can see the power of Maturana’s constructivist theory as an antidote to dogmatic pronouncements of reality—in particular, those of the psycho-pharmaceutical complex.  Using Maturana’s constructivist point of view, ADHD does not exist as an objective reality, and it is up to the individual therapist whether she chooses to construct a child’s problem as ADHD or not. Marilyn Wedge, Ph.D.  9/6/2012

 
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