Sunday, February 26, 2017
Facebook Discussion About Whether ADD/ADHD is a Fraud
This is a transcript of a Facebook conversation I had with Robit Hairman about ADD/ADHD in response to an article he posted about how ADD/ADHD is a fraud. My response was treated with contempt by Robit, so I let loose with a full dose in response. I have retained some of the FB formatting to try and keep some of the flavor of my response. I believe that ADHD denial is another form of science denial on the part of Americans. At the same time I have no doubt that the disorder may be over-diagnosed.
But it is not a fraud.
Michael Wahrman So every five years or so, some asshole comes out with an article about how ADHD is not real. But it is real. And the medication works. But the medication is nearly impossible to get because of stupid laws put in place by the Nixon administration. You may not like that, but that is just too bad. Oh by the way, thousands of doctors think that ADHD is real. I suppose you deny Climate Change is manmade as well?
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Michael Wahrman Since I have been publicly humiliated for daring to discuss some experiences with ADHD and medication here on this forum, let me go further and share with you a little bit of what I think I have learned after living with this disease all my life and studying it for 20 + years after being diagnosed. I should mention that I am not a Dr. of Medicine, although I hope to be a Dr. of Philosophy in a few years if that matters. First, the track record of psychiatry in diagnosing this and other "mental" disorders (that is, for the most part I am referring to physical disorders that affect cognition) is not great. They have to rely on a lot of patient-reported states of mind in many cases, and there is no definitive blood test for depression or ADHD. Second, various classes of psychiatrists do not talk to each other, or maybe do not respect each other, and in the case of adult ADHD this affected people getting diagnosed and treated for decades. Third, there are excellent tests in child psychiatry for ADHD and if you have a child you suspect may have ADD/ADHD, I hope that these tests are used before a diagnosis is made. I have only been through these tests once, and they were hilarious and very convincing. Ask for more details if you like. Fourth, it was only my first doctor, the highly recommended Dr. Koch of Greenwich Ct who ever used these tests, none of the others have. It is not a coincidence that the others are adult ADD/ADHD doctors but Dr. Koch treats both types of patients. Fifth, I can tell you from personal experience that not all ADHD doctors are drug mad who prescribe at the first sign of anything wrong, on the contrary, the doctors I have used are anti-stimulant and prescribe them as a last resort. As someone who has tried all on-label medications for this disease and most of the off-label ones, I can tell you that for those with my class of the disorder, it is only the stimulants that reliably and significantly work. (The others may indeed be sufficient for those with a minor case of this disease). Sixth, which leads us to the next problem .... (end of part 1)
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Michael Wahrman (beginning of part 2), Sixth, there is no objective way to judge in advance which medication is sufficient or effective or in what dose for the patient, at least not to my knowledge. If you are like me, you will find the hit and miss approach used by doctors to be both annoying and time consuming. In fact, I only found the best medication for my particular version of this problem more or less by accident (in the same way I was diagnosed by a friend not a doctor, originally). Seventh, once you do find the appropriate medication, if you are lucky enough to do so, good luck in getting the Dr to prescribe what you need in a reliable and cost effective manner. I repeat, Drs do not like to prescribe stimulants as it puts them at risk of losing their license. And why on earth would they want to lose their license merely because it helps the patient? Eighth, I have no doubt that this as well as many other "psychiatric" diseases are or may be overdiagnosed, and powerful medications prescribed. Sadly it is up to the parent to figure out if this medication is appropriate or not, as the patient, if a child, may not be able to. Now in the case of adult ADD/ADHD, this is quite straightforward believe it or else. Particularly in the case of ADHD but also with ADD to a lesser extent, the effects of medication in the appropriate dose are not subtle, not in the least. And in the case of the adult, it is extremely likely that the patient has self-medicated all their life to try and get relief in the absence of diagnosis and treatment. (end of part 2)
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Michael Wahrman (beginning of part 3) Ninth, I can tell you, and Robits contemptuous response to my comment above demonstrates, that many people, perhaps most people, do not take this disease seriously. They either do not believe it exists, or that it is serious, or that the medication is required, or some other version of contempt. The fact that millions of Americans will tell them differently has no effect on their preconceptions. But let me tell you, for people like me, and I can not tell you how many there are, the disease is non trivial and the medication is non optional. If you do not believe that, then you are not going to care about the rest of this testimony. It will be dismissed by you with some off hand gesture or ("aww"). And so, tenth, you would not believe how difficult it is to get this medication legally. And we are only talking about legal medication here, not illegal self-medication. I could go on for pages about the hurdles you have to go through and not be exhaustive and you would probably not believe me anyway (most people dont). So if I have any credibility here, let me say that anyone with a serious version of this disease will spend an unknown amount of time per month getting the medication and in many, many cases not get sufficient or reliable medication for years on end. But you probably dont care because you do not believe that this is a real and serious disease, now do you? (end of part 3)
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Michael Wahrman (part 4) Tenth, do I believe that this disease is probably overdiagnosed? Yes, I do. Psychiatry is a screwy business, subject to fads and other influences (including a very corrupt Pharma business) and the free market (what a stupid concept to apply to medicine). To all parents, I would tell you to insist on the tests I went through when I first formally diagnosed. Believe me, they are not subtle. And if your child is only ambiguously diagnosed, then dont worry about it. Its not severe. If it is a clear diagnosis, then trying a low dose of stimulant (or if you prefer the more ambiguous non-stimulants) is not going to kill anyone, and if it works or sortof works, then it will be obvious within hours. This is less true for ADD than ADHD, in the former case, one must rely more on personal testimony of the patient, but even then there are informal tests one can apply. In the latter case, the symptoms of ADHD respond very well to low dose stimulants and one can see results within hours (or even minutes in some cases). Eleventh, the good news is that the primary stimulants prescribed for ADD/ADHD are trivial to get off of. They are no where near as addictive as say, coffee or cocaine. There is the problem that people can get dependent on them for psychological reasons as these are human performance drugs, which is why Dextroamphetamine has been used by our armed forces in WW2 and afterwards. (The Germans used methamphatamine btw, a drug I have no experience with). Twelth, I do not write about my personal experiences because it does me any good. It has been used against me whenever I have, or I have been subjected to abuse or contempt. I do it to help my friends and others who may have this disease and do not know what is going on and may not realize that there is a solution. Therefore you should say thank you for the time I have taken to give you the benefit of my experience and research. You are very welcome.
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