We’re Missing Something Big in the Way We Talk About ADHD

Photo: Chris Gallagher/Getty Images/Science Source

After I finished Alan Schwarz’s ADHD Nation: Children, Doctors, Big Pharma and the Making of an American Epidemic, I kept thinking about another story — one that doesn’t appear in Schwarz’s book but that, in my opinion at least, gets at the heart of his subject matter: On a cold February morning in 1966, the journalist Hunter S. Thompson found himself facing down the most important deadline of his life. He needed to turn in a draft of his first book about the Hell’s Angels motorcycle gang or risk forfeiting his $1,500 advance — what amounted to a year’s worth of income.

Thompson knew what he needed to say. He’d already outlined the book’s structure and had long since finished his reporting. The problem now was the same one he always faced: sitting down to write. So during the last week of February, in a fit of panic over the looming deadline, he lighted on a tactic that might sound familiar: stimulants. Specifically, he began taking Dexedrine, an amphetamine mixed with salt and consumed in gelatin capsules. It had been prescribed to him by a friend, and he’d found that it helped him stay focused on necessary but boring tasks, without taking away the natural spontaneity that was his writing strength.

A stimulant like Dexedrine — similar to Adderall — has a way of mimicking sobriety. Reality becomes less blurry and more immediate, and as a result, the distance between you and what you want to accomplish feels smaller, which goes a long way to offsetting whatever motivation issues you might be facing. In this sense, staying on task — in his case, remaining seated in front of a typewriter for long stretches of time — can feel surprisingly natural, especially for someone who struggles with a task like that in the first place.

For the next four days, Thompson didn’t sleep. And after nearly a hundred hours of uninterrupted composition, he met his deadline with only moments to spare. Hell’s Angels: A Strange and Terrible Saga would go on to sell 500,000 copies in its first printing, launching Thompson’s literary career.

But in this instance and many others, Thompson’s use of Dexedrine went far beyond what today’s medical professionals have in mind when they prescribe stimulants to treat ADHD. Thompson did actually struggle with the harmful effects of hyperactivity, impulsivity, and distraction in his professional and personal life. There’s no question he benefited from the stimulants he was prescribed. There’s also no question that he blatantly abused them.

Though this particular story took place in 1966, it’s a startling example of the bargain millions of people enter into today with drugs like Adderall: Whenever something is gained, something is also lost. And more than half a century later, Americans continue to replay the same sort of trade-off Hunter S. Thompson once made — and they’re doing it on a wider scale than ever before.

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That’s the issue that Schwarz, a New York Times reporter, sets out to address — implicitly, at leas — in ADHD Nation. I say implicitly because, from the very beginning, Schwarz’s most pressing concern is to prove the extent of overdiagnosis and overmedication in America, rather than getting to the root causes.

His book, he writes in the introduction, is the story of how we “have allowed what could be a legitimate medical condition to become diluted beyond recognition, and beneficial medication to become a serious drug problem.”

Despite my criticisms — which I’ll get to in a bit — I think it’s important to come right out and say that ADHD Nation is a necessary book. Schwarz has done a fine job on a maddening topic, and everyone who’s interested in hyperactivity, attention spans, stimulants, and the current state of American health care should grab a copy. Schwarz goes to great lengths to explain that ADHD is a real disorder affecting the portion of the population for whom overactivity, inattention, and impulsivity cause extensive and significant harm (about 5 percent, give or take); that the diagnostic process is completely broken; that children and especially adults are receiving medication they shouldn’t; and that the doctors, organizations, and pharmaceutical companies who’ve all played a role in this systemic failure have at the same time made an enormous amount of money off it — and will fight tooth and nail to prevent significant changes.

The book begins with a historical overview of ADHD, going on to describe some of the people whose lives have been touched by the disorder in varying ways: There’s an attempt to dramatize the story of a young girl who was misdiagnosed with the disorder at age 7, as well as that of a teenage boy who faked symptoms to get medication. The most compelling of these profiles follows the long, fascinating career of C. Keith Conners, a child psychologist whose work, in the 1960s, would go on to play an outsize role in how we’ve come to conceptualize ADHD.

But perhaps the best way to understand ADHD Nation is through the context of a book that has nothing to do with attention and hyperactivity: Game of Shadows, by Mark Fainaru-Wada and Lance Williams — an exposé about steroid use and the baseball player Barry Bonds. At his best, Schwarz is channeling Fainaru-Wada and Williams’s careful reportage and moral urgency. But the problem with exposés is that they run the risk of reducing action and motivation to simple dichotomies: villain/hero; underdog/favorite, etc. And that’s my strongest criticism, in the end, of Alan Schwarz’s work on ADHD: he refuses to include or even consider examples from the real world that won’t fit neatly into the argument he’s created. In his view, there are people who have ADHD and are helped by medication. And then there are many more who, either through misdiagnosis or subterfuge, use stimulants in the way that baseball players use steroids: to gain an advantage. And if you don’t fall into these categories, then you don’t make it into his book.

This is why, in retrospect, Hunter S. Thompson’s experience writing Hell’s Angels feels so striking to me: It refuses easy categorization. We can file Thompson in both silos.

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Despite the similarities between Schwartz’s book and Fainaru-Wada and Williams’s, writing about stimulants and ADHD is an entirely different endeavor than writing about steroids and baseball. After all, the odds are slim that a great writer will also have a chance to play starting shortstop for the New York Yankees (and with few exceptions, vice versa). But there’s more overlap with ADHD — journalists of Schwarz’s caliber can be extremely hyperactive/inattentive and still excel in their field. There’s a whole generation of them coming up now, along with many others who, even if they don’t have ADHD, know from personal experience what it’s like to take Adderall and try to write.

Perhaps that’s why Schwarz’s book fell short in the way that it did: He hasn’t lived the phenomenon he’s writing about. Schwarz, through no fault of his own — and due to the simple reality that he’s over 35 years of age — will inherently fail to represent the perspective and experience of the very people he’s describing. But there are others who could succeed.

This isn’t to say that he shouldn’t have written his book. Or that he’s done a poor job. I’m simply trying to draw our attention to the direction we might be heading next — that moment when our discussion on ADHD will finally expand to include fresh perspectives. Specifically the voices of people who, on account of their personal and professional experience, hold the power to articulate the many things we don’t already know. I think it’s important to keep in mind that, even when we can point to larger forces at work in the widespread nature of ADHD diagnoses, the drama of the disorder will always play out on the personal level, in ways that broad sociology studies don’t necessarily articulate. ADHD manifests on a case-by-case basis. Stimulants work differently on everyone.

It’s time to hear from people with some skin in the game. What’s it like to work as a rookie reporter or go through college or enroll in a graduate program, today, in an era where you can acquire a drug like Adderall so easily — and without the moral opprobrium that was once attached to previous versions of amphetamine? How have the lives of your friends and family members who were diagnosed with ADHD at a young age played out? What happens when you reach the limits of your own ambition — and how do stimulants, in baffling ways, change the parameters of this equation altogether? When it comes to psychotropic drugs, where do the boundaries of personal agency end and begin? The goal is to speak honestly, and carefully, and without hesitation on the subject of stimulants and ADHD.

We’re Missing Something Big in the Way We Talk About ADHD