ADHD: The Non-Biomedical Disorder with Too Much Hype
A piece written for my Health, Biomedicine, Culture, and Society course.
Our society loves numbers; hearing statistics and having our subjective ruminations about the world be validated with empirical and objective data is like music to our ears. There is nothing wrong with this phenomena; research exists because people want to know that there is a certain degree of scientific and academic backing behind the claims that people make, or else why believe them? For this reason, medicine is one of the most empirically sound and legitimized fields in our society.
With each year, thousands of clinical trials are performed to assess the efficacy of new drugs and equipment. With each year, society’s standards for the rigor of medical education and research rise. So then why, with each year, does our society become more medicalized, with the threshold for labeling disorders decreasing exponentially? Moreover, why are certain conditions, like ADHD, barely founded on scientific and biomedical data and yet some of the most pervasive and indiscriminate sources of illness in our society?
ADHD, although not as cogent of a biomedical entity like cancer or AIDS, has generated serious discussion on the increasing medicalization of illness. The actors involved in the construction of ADHD as a medicalized condition have made ADHD one of the most diagnosed and treated illnesses, even while is remains more of a social ill than a biomedical one.
As Brown discusses, the social construction of any illness begins with a social discovery. At its core, most of our diagnosed disorders and conditions originate from the experience of the illness and peoples’ determination that they cannot live normally if the given condition is not treated. Consequently, the condition works its way up the healthcare hierarchy, with medical professionals at its apex deciding how best to treat these ailments.
Research into this condition ultimately produces a generally accepted diagnosis which becomes a form of social control. As such, the diagnosis not only “locates the parameters of normality” but it “demarcates the professional and institutional boundaries of social control and the treatment system,” authorizing medical professionals to label and sell conditions based on this designation (Brown 88). Simply by giving a name to something, a degree of legitimization is created.
According to Brown’s stages of illness construction, once laypeople and professionals accept a condition, the illness experience must be defined. Both of these actors, patients and medical professionals, are intertwined. The scientific understanding of the illness is shaped by health providers while the experience and treatment efficacy is determined by the patient. This creates a dynamic interaction between the patient and the provider, leading to a negotiated diagnosis and treatment (Brown 97).
However, there is another omnipresent and monolithic actor that plays a major role in both the construction and the medicalization of illness: biotechnological companies.Stage 1 of Brown’s construction of illness contends that acceptance of an illness precedes the clinically and scientifically proven treatment (stage 3).
Most illnesses are accepted due to unassailable biological and scientific data proving that without the treatments proposed, there is no escaping the condition. Curiously enough, ADHD does not follow such logic. It is due to the commercialization by biotech corporations that ADHD has reached epidemic proportions from social factors rather than biomedical ones.
Doctors are still gatekeepers for treatment, but they have become subordinate to commercial interests that intervene at earlier stages of illness construction. Biotechnology has only recently become the biggest actor in the construction of ADHD.
While the expansion of medical jurisdiction may have played a part in its ascension through the healthcare ranks, pharmaceutical companies and mass media became what it is today because of our consumer culture. Even when Ritalin was used to treat hyperactivity, it was only when the “buyer driven system” took over the “golden age of doctoring” that ADHD became a medicalized entity (Conrad 4).
Direct to consumer advertising began mixing patient and expert voices to try and provide the ethos of professional viability to the diagnoses, with the pathos that ADHD could happen to anyone, child or adult (Conrad 6).
Moreover, sources of information that seemed neutral were delivering messages directly from pharmaceutical industries; doctors were and are paid by drug companies and subsequently publish research and deliver presentations encouraging physicians to make diagnoses more often while discrediting growing concerns about overdiagnosis and medicalization (Schwarz 2).
Corporations try to find the most viable market, with industries employing marketing techniques used for children’s ADHD because the adult market has become highly profitable (Schwarz 2). Even the rhetoric used, with terms like “profitable” and “marketing,” shows that medicine and healthcare has become a business conglomerate.
Furthermore, commercial and corporate stake-holders play a large part in how an illness and treatment is framed. Drug companies, while often having desires different from medical professionals, will tailor their advertisements to emphasize certain social qualities that are deviant and have a connotation of being unhealthy, such as hyperactivity or not being able to focus. This portrays the mask of a humanitarian trend of trying to control deviant behavior, even if such behavior is actually normal.
Given the global reach of mass media, the expansion of western biomedicine, and the existence of multinational drug companies, one can see why such social frames have created an epidemic of ADHD sufferers (Conrad 11).
What is most fascinating about the social construction and etiology of ADHD is that many of its arguments and assertions of being a disorder are not supported by science. In the efforts of creating an “adult ADHD” market, studies have shown that “perhaps half of A.D.H.D. children are not impaired as adults, and that little is known about the risks or efficacy of long-term medication use” (Schwarz 5).
Moreover, there are many proponents that claim ADHD is not a real disorder nor has its prevalence risen; people argue that ADHD is simply a matter of overdiagnosis and overuse of stimulants (Singh 958). ADHD has only weak genetic associations and while the neurobiological evidence seems to have taken large strides, structural and functional neuroimaging data is inconclusive due to small sample sizes and inconsistent equipment (Singh 960).
As such, the “state of scientific understanding is not sufficient to overcome overdiagnosis and overuse of drugs” and people cannot help but revert to nonbiological factors to explain their condition (Singh 962). Perhaps it is our western culture that is creating ADHD with “institutional and professional structures… shaping the knowledge base which produces our assumptions about the prevalence, incidence, treatment, and meaning of disease” (Brown 82).
The influence of these biotech companies has infiltrated medical establishments, all the way down to the patient itself. Hospitals and health care institutions are now competing for patients as consumers and patients themselves have become information-hungry consumers (Conrad 8).
With the case of adult ADHD, patients are fueled by the marketing strategies employed by mass media such as ads showing that ADHD persists through childhood into adulthood and more specifically, pathos-ridden books and screening tests online that purposefully over-exaggerate the symptoms and encourage people to seek treatment (Schwarz 4).
Thus, one cannot solely blame the media and biomedical corporations. The consumer willingly goes in for evaluations and treatment and in turn, helps to medicalize their illness by enthusiastically labeling it and seeking treatment. As one doctor eloquently explains, “You have to have a susceptible host for the epidemic to take hold. There’s something they know about us that they utilize and exploit” (Schwarz 4).
All of this labeling, both from patients and from biotech companies, has created a social construction of ADHD and other disorders where nonbiological factors such as beliefs, economic relationships, and societal institutions define our illness. Why else would the rise of ADHD diagnoses and prescriptions for stimulants coincide with a successful two-decade campaign by pharmaceutical companies to publicize the syndrome and promote the pills to doctors, educators, and parents, even when the biological basis of the disorder was unclear (Schwarz 2)?
Diseases that used to hold such epidemic proportions such as AIDS were associated with certain modes of disease transmission and unassailable somatic foundations, at the very least (Aronowitz 80). Instead, we see ADHD operating on a mode of social transmission, with fear being induced through advertising and a perverse obsession with perfection.The normal has become pathological.
As a society we care too much about being perfectly healthy and as such, are being persuaded by social factors more than empirical and biomedical ones. Children, and more recently adults, have an ADHD epidemic on their hands, and one begins to ask, how were they able to live normally before?
Some posit that the social construction and medicalization of disease is “a concoction to justify the giving out of medication at unprecedented and unjustifiable levels” (Schwarz 2). Big Pharma marketing has “stretched the image of classic A.D.H.D. to include relatively normal behavior like carelessness and impatience, and has often overstated the pills’ benefits” (Schwarz 2).
And the situation will only worsen; given patients’ desire for legitimation, the lowering of deviation criteria from the norm, and the detection and construction of new conditions by means of new and more nuanced medical tools, our definition of perfect will continue rising, and our definition of what it means to be an imperfect and unique human will be obliterated.
Aronowitz, R.A. 1991. Lyme Disease: The Social Construction of a New Disease and Its
Social Consequences. The Milbank Quarterly. 69:79-112.
Brown, P. 1995. Naming and Framing: The Social Construction of Diagnosis and Illness.
Journal of Health and Social Behavior. 33: 267-81.
Conrad, P. 2005. The Shifting Engines of Medicalization. Journal of Health and Social
Behavior. 46: 3-14.
Schwarz, A. 2013. The Selling of Attention Deficit Disorder. The New York Times.
Singh, I. 2008. Beyond Polemics: Science and Ethics of ADHD. Nature Reviews