We should also ask the question: why do people need penicillin, anesthetics, and disinfectant so much today, when past generations did fine without them?
The intellectual exploration is understanding that we have a better understanding of medicine, and ADHD is just like other conditions we can now treat.
but sure, lets ignore over a century of research and progress because someone wants to ask "what if" and treat all that as an emotional response.
Meh, medical research in terms of psychology (disorders) is largely based on how well a person functions in modern society, which is sick. Since the OP asked the question in terms of sociology/evolution, it makes sense that the medical literature would not say much about it.
For antibiotics, it is at least partly due to the psychology of numbers. If you live in a village of 1000 and 1 person dies every year, then it's doing pretty well. But on a planet of 8 billion, 8 million people dying without penicillin sounds like a tragedy...
Individual people who need penicillin are doing better today, but as a whole past generations did as well as today, at least in the fact that they survived and produced us. In other words, we are doing BETTER when it comes to average individual comfort but the same in terms of surviving.
It depends on how you measure "well". In terms of evolution and survivorship of genes, we did perfectly well. In terms of average well-being, of course we are better today.
That is a good question, and I'm not sure why your question is rarely asked. The answer for ADHD is that modern society is forcing almost everyone to study endlessly, which is rather ridiculous from an evolutionary point of view. The amount and style of school we have in also rather unnatural for some people, too.
The reason why this system exists is because it is the most effective system, most effective in the sense that it as outcompeted other systems where the pressure for survival was how useful in furthering our industrial age.
In small tribes, people with "ADHD" would likely have easily found a place and no one would really find it unusual if some children weren't good at studying abstract concepts for 6 hours a day...because most wouldn't need to do that.
The fact that ADHD is classified as a disorder is because children with ADHD are simply less effective at serving our highly industralized system, which incidentally is not making us happier, but only more efficient at giving people differential advantages through economic growth, which in turn is making us sicker.
People with ADHD might have a harder time concentrating and sitting still, but it is our society which has the real disease.
The reason the question is rarely asked is because past generations did not do perfectly fine without the medications used today.
One sympton of children with ADHD are they have a tendency to be far more impulsive and make far more risky decisions, with some correspondingly awful consequences. That was happening before the disorder was discovered, only at the time no-one knew why the behaviour was occurring.
It's evolutionary psychology. It doesn't need evidence.
(I honestly think that "a group with members who both seek novelty and avoid it is more likely to prosper than one that doesn't have a mix" is probably true. It's just impossible to prove).
Williams, Jonathan, and Eric Taylor. "The evolution of hyperactivity, impulsivity and cognitive diversity." Journal of the Royal Society Interface 3.8 (2006): 399-413.
The first use of medication to treat ADHD was in 1937. Before that, children with ADHD had severe problems interacting with their families that were very difficult to treat.
I have no doubts that ADHD existed before, but there's no way the sudden influx of people with it was just 'always there but hidden'. Pretty much all my friends have diagnosed ADHD. Something is going on. In large part, likely the internet destroying our attention spans.
I only have had these problems since I was about 22, before that I concentrated great.
Anecdotally, I continue to see friend groups form where near all of them are neurodivergent without knowing it. Because their brains work differently, when they find someone else whose brain works in a similar way it’s less effort to spend time with them.
It shouldn’t be a surprise then when one of them gets diagnosed, the rest eventually look into it and get diagnosed too.
It helps that in the last 3-5 years talking publicly about ADHD has become less stigmatised (one of the reasons I continue to do so). I first suspected having it over a decade before looking more into it. I wouldn’t have hesitated if social conversation then is like it is now.
The internet doesn’t cause ADHD, neurodivergence is likely more prevalent than expected. We (neurodivergent’s) have all been masking and developing strategies to survive the modern world. Then covid happened, and the normal support structures fell away, coping mechanisms failed.
All of a sudden things went from hard to basically impossible, it’s no wonder some of us decided to ask whether or not the experience was normal or if there might be something else at play.
Diagnostically ADHD symptoms need to be present when you were younger (IIRC 10-12), so if they just started at 22 it might be something else. Or it might be you left home, made a major life change, and your previous coping strategies no longer work.
> Diagnostically ADHD symptoms need to be present when you were younger (IIRC 10-12), so if they just started at 22 it might be something else. Or it might be you left home, made a major life change, and your previous coping strategies no longer work.
Exactly. Looking back at my own life the symptoms were there since the very beginning; they just weren't causing me as much trouble as they can do now, so I didn't even know they were "symptoms" at all. ADHD doesn't mean "I can't concentrate", it means "I can't choose what I concentrate on", and for the most of school time it turned out that I was interested enough in most of the things I had to learn to not cause me real troubles until later in my life.
I also had no comparison and didn't know that other people don't suffer so much when trying to learn something that doesn't spark their interest. They're not excited about it, but they just do it. I had to fight with my own brain that actively resisted and thought it was what everyone else had to do as well and that they were just better at it than I am.
I ended up doing things like composing music to poems I had to learn and recording them as songs just because it was pretty much the only way not to suffer tremendously while trying to learn them. Back then it just seemed like one of my "quirks" - it wasn't a problem because I successfully managed to tackle it, but now it's obvious that most people didn't even have to tackle it in the first place.
ADHD and autism are quite correlated and neurodiverse people tend to form bubbles of friends even without realizing that they're neurodiverse, and I assume that was also true even before these were being formally diagnosed.
What was interesting to me about that paper is that Sir Alexander Crichton noted that people who were born with it generally grew out of it. The authors note that this belief was generally held into the 1990s, followed with a note that recent studies show 50% growing out of it.
I do wonder if the nature of our modern lives- less physical activity, fewer working hours, with more 'mind' or white-collar jobs- has made us as a society less resilient to attention disorders like ADD or ADHD.
It's possible that, given the lack of extensive recorded research into it at the time, we don't know that these kids who were observed as having grown out of it were properly accounted for. A poor sample could easily make 50% seem like "most" after all.
Even so, it is worth wondering if non-pharmacological therapeutic treatment might be worth emphasizing more heavily. I don't know what it's like for kids in college now, but I recall meds like Adderall prescriptions being surprisingly common, and that it was being abused was something of an open secret.
1. ADHD always existed, is a problem that needs solving for someone to participate in society, and everyone went untreated. Diagnosis has improved.
2. ADHD has increased because of environmental changes such as pollution, food, chemicals, screens, how we raise children, or some other factor.
3. ADHD is a description of a group of people who have different preferences and corporate interests have identified it as a profitable problem and have become dependent on it to hit their revenue targets, so they tell themselves and customers that their kids will not be successful in life without their drugs.
4. Schools and society operate differently now and so opportunities that fit well for people who thrive in more physically active settings have been diminished (more time indoors, less free roaming outside, less physical jobs, etc).
5. A combination of several items above when brought together caused real or perceived increase in ADHD.
I also posted this reference below but I doubt it will be seen so:
Williams, Jonathan, and Eric Taylor. "The evolution of hyperactivity, impulsivity and cognitive diversity." Journal of the Royal Society Interface 3.8 (2006): 399-413.
because my (born 1991) parents' (born early 1960s) generation, at least (probably other generations too) was raised to unquestioningly believe in the infinite miracles of the pharmaceutical industry such that any time there was any sort of "problem" with any of their children, they reached out to someone with a degree in something that would permit them to write a prescription for something, anything. they put me on all kinds of various antidepressants and amphetamines, trying to figure out the big mystery behind why the computer dork kid finds high school boring and feels sad all the time because he doesn't fit in because he's a computer dork. they put me on all kinds of shit that messed with my head in various ways—thank God I didn't kill myself—and I'm still on Adderall to this day. at some point I'll wean myself off of it but in the meantime I'm dependent on it and withdrawal is hell. I'm going to raise my children differently. we'll still get antibiotics when they catch a cold or whatever, but this "oh there's a magic pill that can solve your specific problem for you, we just need to try a dozen different ones, throwing shit at the wall until you either kill yourself or feel better" mindset is incomprehensibly insane to me.
"throwing shit at a wall" is kind of unavoidable because everybody responds differently and using educated guesses and iterating is a sensible approach.
Virtually every medication has risks/issues, so responsible use requires understanding those risks and be prepared to change course as conditions warrent it.
That said, medication should be one facet of many (behavioral modification, diet, exercise, meditation, etc). We're also all ultimately responsible for our own health so passively consuming pills without taking ownership is not license to blame your parents, "the system" or anything else.
Amphetamine addiction is not that different from opiate addiction: someone told you it was good for you and then you got addicted and now it's hard to live without your favorite drug.
I'd suggest just getting rid of the 'I have a sickness' excuse and just admit you like to get high. Then you might be able to come to grips with the negative consequences of being high all the time. Hmm?
> Channel One was controversial[12] largely because of the commercial content of the show. Critics claimed that it was a problem in classrooms because it forced children to watch ads and wasted class time and tax dollars.[13] Supporters argued that the ads were necessary to help keep the program running and lease TVs, VCRs, and satellite dishes to schools, as well as commercial-free educational video through Channel One Connection. In 2006, the American Academy of Pediatrics reported that research indicated that children who watched Channel One remembered the commercials more than they remembered the news.[14]
> Another criticism, noted by Media Education Foundation's documentary Captive Audience, was that very little time was dedicated to actual news and that the majority of the programming was corporate marketing and PR tie-ins to promote products and services, arguing that it further corrupted the school setting with consumerism. [15]
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it was an ABC news network show (also, in hindsight, a kind of "farm league" for later news network talent, lol) for middle and high school kids, and it was roughly 33% advertisements. I guess maybe it's not a thing anymore?
but, man... every other commercial on the damn thing—at least when I was in middle and high school—was for various prescription acne treatments. kind of messed up when you think about it, explicitly targeting prescription medications in advertisements that legally underage youths are mandated to watch by their local governments school systems due to them making deals with news networks, all funded by advertising, both pharmaceutical and otherwise.
pretty dystopian and fucked up when you think about it, in hindsight.
Yes, this is how 'upstanding members of society' get their opiates and amphetamines. It's also why drug testing isn't part of the job application process for Party members (see Orwell).
With full knowledge of what could happen (because effects are often not uniform), and with the right care and support I would think it can be done ethically.
Look at the trials of using LSD/mushrooms/MDMA to help people work through serious trauma. Done well it looks to be positively life changing, done poorly and it seems to be horrifying.
Fine, so print warnings on the bottle and make me sign a disclaimer. Isn’t it more harmful to create a black market with no quality controls? Isn’t it more harmful to ruin countless lives with felony convictions?
Not analogous at all. At this point, I would say what are the ethics on preventing someone from doing what they want to themselves if it does not hurt someone else.
If it means that people who genuinely need it for their daily routines to operate as human beings face difficulties with getting their prescriptions, then nope, 100% shame and to hell with your bullshit startup.
There are studies out there which show that ADHD medications can negatively impact the cognitive functioning of neurotypical individuals.[1]
Anecdotally, as someone with ADHD as diagnosed by a psychiatrist who specializes in the area, taking Vyvanse makes me feel calm. I have seen people taking ADHD meds for exams/assignments become completely wired as a result of taking the drugs. YMMV and all that.
Yes, with strict regulation from medical boards that doctors are actually operating in their patients' best interest. We don't need more Texas-style "Doctor Death"s.
We need to ensure there are not incentives to over-medicate or over-prescribe, but ultimately the patient should be the final arbiter of their health care regimen.
I was started on atomoxetine in February after 48 years of getting by, and it's been absolutely life changing - I'm finishing projects and clearing stuff off my desk that would in the past have been 90% complete with me having to be interrupted to clean up.
There's a shortage of atomoxetine, my pharmacist has ordered extra so I should be ok, and I have a stash of lower dosage capsules just in case.
The worry is that the side effects between 40mg and 60mg were awful, and I don't really want to go through that again.
I did have ED for a while when I first started, that and the disconnected / painful orgasms. After 6 months though it's all back to normal and working better than it was tbh.
I tried atomoxetine for awhile. I was on a fairly low dosage, somewhere between 10 and 25mg. It was a very weird experience tbh. I felt very muted, like someone took my personality and affect and replaced it with a greyed out version of me. It was so noticeable that my girlfriend noticed and asked if there was something wrong. Anyways, it sucks that getting ADHD drugs is hard these days. I've considered going back to them as stress at work ramps up, but I'm worried even if I do I won't be able to get any. Oh well.
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