draft
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
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
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
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
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
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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