I'll step in for rozal, because this is a big ask (and much more effort than picking out a few research papers, that no one here will surely read).

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The main issues with ADHD (and the current crop of mental health disorders) are postulates that researchers, practitioners, and regulatory bodies (RPR) all take for granted, without rigorous inquiry:

1. There is a "normal" state that some majority of people are in

2. There is an "abnormal" state that some minority of people are in -- with various subcategories/subsets of "abnormal"

3. That the "abnormal" set of people requires intervention to help move them into the "normal" set

4. That the set of people currently proposing and executing interventions (RPR) are the right people

5. That the current set of methods and tools used by (4/RPR) to move the "abnormal" to the "normal" is the right set

6. That (5) achieves the right goals

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For #1, this has never been formally agreed upon. There are various interpretations of what a "normal" life is, depending on one's own: value system, culture, upbringing, current environment, professional training, etc. Likewise, this "normal" may take on other labels, depending on who you ask: e.g. "fulfilled," "actualized," "happy," "content," "productive," "well-lived," "spiritually-rich," "good enough," "tolerable," "economically stable," etc. In lieu of any centralized and concrete definition, RPR has unconsciously gravitated to not defining what's "right," but what is "wrong."

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For #2, there is again no concrete and unifying criteria for what satisfies "abnormal," but a constantly changing set of qualifiers based on: statistical frequency (a), executive function (b), adherence to an ideal set of traits (c), adherence to social norms (d).

In (a), the basic idea is that statistically prevalent traits are the "norm" and those less prevalent are the "abnorm"; i.e. the mean set of traits is treated as an ideal. Generally, this method makes no subjective judgement on the nature or "rightness" of the traits, just that they are the most prevalent. Readers can generalize from their own lives, times when groups of people exhibiting similar traits were not what one would consider "normal," by personal definition.

In (b), executive function* concerns one's ability to self-regulate, deal with stress and adversity (i.e. adapt), and participate in one's society, i.e. sustain one's life as a human being involved within a group of other human beings. Once again, no subjective judgement is made on the nature or "rightness" of the environment or group one find's oneself in -- only that the individual is able to meet the demands of his or her environment. Readers can generalize from their own lives, times when environments are sufficiently harmful to themselves that adaptation to, rather than escape from, such environments would've been considered in their minds "abnormal."

* as reductively, but generously, rewritten by me, paraphrasing the gist of Rosenhan & Seligman, while ignoring the obvious subjectivity around "rationality," "moral/social standards," and "appearances/how one appears to others"

In (c), we start to get the first concrete, yet not-yet-popularly-accepted, definition of a "normal"; paraphrased from Jahoda (a la Wikipedia):

- Efficient self perception

- Realistic self esteem and acceptance,

- Voluntary control of behavior

- True perception of the world

- Sustaining relationships and giving affection

- Self-direction and productivity

Plainly, many of these are highly subjective, and dependent on the environment one find's one in. I will not be digging into these, because I too have my own biases, values, and so on that would color these differently. However, these will be relevant to (4).

In (d), this is self-explanatory: does the individual adhere sufficiently to his environment's social norms? Once more, no subjective judgement is made whether or not the norms are "right," only that they are the prevailing ones.

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For #3, the unspoken justification of providing treatments to the "abnormal" is that it brings benefits to the "normal." Reductively, one only carries out tasks that benefit oneself. These could be financial, social, spiritual, or otherwise, incentives that move one to act for some imagined benefit.

One could make a case for allowing the local community to assist the "abnormal" to "normalcy," because resources are limited, and each member relies on the others to survive and thrive. This can be seen in tight-knit farming communities, where no single individual can realistically survive alone; and the addition of this individual into a beneficial member of the group allows the group access to more resources, ergo increasing its chances of prosperity.

On a more national level, one could make the same case for assistance that is outside of the community, but within the overarching "group" that encompasses all the other groups. For example, institutionalized mental health treatments will allow the populace of a country to contribute to the country's goals, same as they would to their local community.

Now, once again no subjective judgement is made on whether the goals of the local community or the goals of the nation are "right" -- or any philosophical quandary raised about the necessity of adhering to these goals. Readers can decide for themselves what extra-personal goals are useful to their ends.

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For #4, there has never been any widely popular questioning of who should be "right" ones to assist in the "renormalization." Simply, there was a power vacuum, and people (RPR) filled it in to achieve their own ends.

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For #5, yes there have been a plethora of studies and experiments, and so on, to test efficacy of treatments towards various fuzzy ends (e.g. a reduction or increase in certain subjective traits, experiences, and criteria, or that of more objective economical figures). However, there has been no popular questioning of whether or not the tools (medication and the current flavor of physcological therapies) are the best ones to be used.

In the U.S., the institutionalized mental health systems have a near-monopoly on such services. Partly due to their academic roots, all knowledge must be built on what has already been "discovered" and deemed "right." Anything not aligning to the past, will not be given due consideration as legitimate -- thereby artificially restricting the global maximum set of available tools, to a local maximum set of "popular" tools (regardless of their actual substance).

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For #6, we look again at #5, and ask whether the "fuzzy ends" are the right ends to be sought after. No popular discussion has been made here.

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In fairness, "right" can only ever be a personal definition, based upon one's own: values, biases, culture, upbringing, etc. -- and others can either agree, and spur on the legitimacy of a certain definition of "right," or disagree and lower its power.

The main question to be formulated with all this background information is: "are the current treatments for mental abnormalities the best for the individual, or the best for the whole?"

With consideration to all the ideas I've laid out in this post, I believe that the current treatments for mental health abnormalities greatly benefit the larger "whole" rather than the "individual." Medications come with a plethora of side-effects, and potential long-term issues. Likewise, the long-term efficacy, sustainability, and outcomes of behavioral and psychological treatment via therapies are under question by me. Entire livelihoods and industries are built upon the treatment inherently (i.e. institutional mental health services), but also its after-treatment effects (i.e. "you can function at a job, and help grow the economy").

My belief on "right" is to bring about a life to the individual where their mental health abnormalities do not require constant reliance on external forces to allow the individual to live the life that best fulfills his or her own needs. Otherwise, the incentives are grossly weighted towards the external force's ends, rather than said individual's.

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N.B. Whether or not ADHD is legitimate is a subjective discussion -- and one that I believe misses the point. I think it can be further reduced down to: "there are people with a different set of traits that institutional players have decided to umbrella under 'ADHD', with all the various treatments involved. Is this the right way to go about things?"

user:	datathrow0007
created:	May 13, 2023
karma:	26