Want to understand the reason and the meanings of the narratives that led us here and maybe how to head them off at the pass? That's on the media specialty. I'm Brooke Gladstone, host of WNYC's On the Media. Listen wherever you get your podcasts. So to set this scene, let me share some videos that have been popping up on my social feed lately. Rarely specific signs of ADHD. Your bladder is trash. You can learn a new skill in record time. It would take me two weeks to pick my clothes up off the floor. You can remember really weird minute details from the past. I can't remember why I've walked into a room. These are all from the hashtag ADHD. And these kinds of videos from how to self-diagnose to how to manage a diagnosis are all over social feeds. And one study found that over a third of the claims about ADHD on social media weren't related at all to ADHD or even other diagnoses but were instead just quote, reflecting normal human experience. All these online voices start to make it seem like anything could be a sign of a diagnosis. Now I'm not trying to say ADHD looks one way or that it can't affect many parts of people's lives. Trust me, it affects many parts of mine. But this all has me wondering. What happens when a diagnosis goes viral? And when people say, oh, that sounds like me, how do you separate personal identity from a diagnosable condition? Kelly Maria Corducki is a culture journalist. And Manvir Singh is a professor of anthropology at UC Davis. Kelly Manvir, welcome to It's Been a Minute. Thank you. Yeah, thank you so much for having us. Hello, hello. I'm Brittany Loos and you're listening to It's Been a Minute from NPR, a show about what's going on in culture and why it doesn't happen by accident. So Kelly Manvir, a lot to get into but I want to first focus on adults. Adult ADHD diagnoses have soared in recent years. Count me in that number. Kelly, your reporting showed that there was over a 100% increase. What's going on here? Why the increase? You know, I think it's a variety of factors. One is simply awareness, increased awareness of ADHD characteristic symptoms during the pandemic in particular. Telemud was huge in the surge of prescription rates for ADHD medication, psychostimulant medications. These Telemud providers came in just at the exact moment that many people were noticing that they couldn't focus on their stuff when they were stuck at home and freaking out. That correlation has also fueled the speculation over a potential rise in misdiagnoses. Yeah. I think one thing that I would add is that the rise that we see in adults, my understanding is one that you've also had a huge expansion of diagnosis in children. And I think across the spectrum is like a strong indication that there is kind of filling out the reservoir or people who have long lacked a diagnosis. So there's better diagnosis of women, better diagnosis of people of color. But at the same time, I think there are all of these interesting indications that in some directions that there is also like a potential pathologization of normal behavior or normal variation. And so one example that you find in children is that young children are much more likely to be diagnosed with ADHD than older children in a class. That's a general trend that you find where younger kids are not only seen to have ADHD more, but are medicated more often. I definitely hear what you're saying about the possibility for kind of, this is an elegant term, almost like a market correction for people who maybe previously should have been diagnosed and were not. Like you said, women, people of color, check, check. That definitely I think was a little bit apart of probably what happened with me. Like I had teacher reach out to my mom about me having inattentive actually, not hyperactive, but like inattentive ADHD symptoms when I was like in kindergarten. We didn't come back around to that for about another 28 years, but it's all good. What benefits do people see from getting a diagnosis? Well, I think that the first and most important thing is it provides a sense of understanding for people who maybe have attributed their symptoms to a personal failing. Low moral character. Yeah, low moral character. We really do tend to moralize these ADHD traits in particular as signs of laziness, as signs of arrogance, like you're too arrogant to try. That's a big one. And people internalize that. So in a way, getting told like actually this is a neurodevelopmental disorder that's a real thing in your brain, I think is very reassuring. It also can potentially provide people with an infrastructure to learn to better deal with their symptoms and it provides access or opens up access to care and medication potentially. I think a really important one is community. There are support groups through things like Reddit, through social media that I think can create a sense of belonging, can create an identity that turns what might be a neurodevelopmental difference into an opportunity for connection. And I think that can be big for a lot of people. Yeah, I mean, I've seen some of that play out for sure online, but also, I mean, ADHD content more broadly is super popular online. I think that's a really important one. And I think that's a really important one. And I think that's a really important one. And I think that's a really important one. And I think that's a really important one. And I think that's a really important one. And I think that's a really important one. And I think that's a really important one. And I think that's a really important one. And I think that's a really important one. And I think that's a really important one. And I think that's a really important one. And I think that's a really important one. And I think that's a really important one. Algorithmic content incentive and affirmation of experience. Why do we need to separate those two things? Well, I really think of ADHD as kind of two separate things. There's the experience of ADHD. There is the neurodevelopmental reality of ADHD. And then the social media commodified version of the label is imprecise. And I do think that it's important to separate those two because they're not exactly the same, right? One is sort of a talking point. And the other is a science thing. Yeah. Like a lot of creators are making videos discussing their symptoms. And some of them are backed by science and others are not. There's a bigger list that clinicians use. But some of the recognized symptoms of ADHD include task avoidance, easy distraction, forgetfulness, and fidgeting. But I also saw a bunch of tiktoks about how people with ADHD have a hard time doing fridge management. Like that's its own symptom. You know what food is in your fridge, how long it's been in there, making sure your nice produce isn't going bad. And the takeout leftovers are moldering in the back. And I'll say, that's not a problem for me. And I also know a lot of people who don't have ADHD who struggle with fridge management for whatever reason. And one study found that over a third of the claims about ADHD on social media weren't related at all to ADHD. Or even other diagnoses, but were instead just, quote, reflecting normal human experience. This study to me suggests perhaps people are over pathologizing aspects of their own lives. But what I really don't understand is what do they get out of this? Like why do people want diagnosis? And what does it add to their identity? If I just look at my table right now, on my computers I have one, two, three, four, five open windows. I have my phone next to me. I have like several books. I have checks. I have like so much going on here. I don't consider myself to have ADHD, but I think it's very hard for me not to be inattentive and distracted. I think like inattentiveness and some degree of distractiveness, maybe less so hyperactivity, are just like common elements of the human experience at the moment. And so there is also, I think, something very familiar in that kind of content. You can kind of resonate with just the difficulties that everyone has in everyday life. Now, I would say though that that is, I think, distinct from the question of what are the benefits that come from naming oneself? I mean, I think it can reduce these feelings of guilt or self-blame, but I think that also creates narratives about ourselves, creates stories about ourselves. People write about the self-fulfilling prophecy that comes from diagnostic labeling. You know, I've seen a couple of writers describe what's going on as quote unquote diagnosis culture. And going off of what you just said about diagnosis becoming a self-fulfilling prophecy, I think some people might use it as a full explanation for what's going on in their lives at, you know, the expense of thinking about how their personal history might factor in, or even thinking about some social or systemic reasons why people might find it hard to cope with their lives. What do you think about that? I mean, I think that has long been a critique of psychiatry more generally. To what extent does society create particular conditions that make it harder to function, or that, you know, induce depression or anxiety or inattentiveness, and then those become pathologized and medicated? Yet, to what extent does psychiatry more generally like a way of medicalizing the things that society subjects us to? Yeah, that's a very rich question. It is an individual who has ADHD and who like just really has really spent, you know, I've spent my whole life trying to make it work. It's really wonderful for people to be able to explain and narrativize their experience through a formalized lens and through an official channel. And so I think really the biggest challenge maybe for people who are receiving diagnoses is to kind of be able to locate their own agency and their own path within the frame of this diagnosis. You know, to understand that the diagnostic criteria are not predictors of their everyday experience and to recognize that they have agency and also accountability for their own decisions and actions. Coming up, is the diagnostic system itself the problem? How do you design a diagnostic system that like draws lines around people according to a checklist that is useful for them but does not end up harming other people, pathologizing other people, providing medication to other people that might get them addicted? Stick around. This message comes from WISE, the app for international people using money around the globe. You can send, spend and receive an up to 40 currencies with only a few simple taps. Be smart, get WISE. Download the WISE app today or visit WISE.com. T's and C's apply. You know, some researchers say that even with this increase in diagnoses, ADHD is still under diagnosed specifically for people of color and women. And I think that that can be true, but you know, there are also business incentives that go along with these cultural incentives to see ADHD in everyone. You know, like there is one telehealth company accused of and another whose executives have been criminally charged with distributing Adderall and other ADHD. Drugs to patients who didn't need them in order to allegedly boost bottom lines and keep patient retention. Also, there's mentioning that a lot of these drugs are addictive. How do we balance getting people with ADHD to help they need with not allowing situations like this to arise? Well, the first step and maybe the most obvious one is just more widely available therapeutic care for a greater share of the population. And also, I would say that broadly speaking, there's a real overreliance on pharmaceutical tools at the expense of behavioral tools, organizational tools, kind of a more like therapeutic toolkit. Yeah, I mean, it's interesting that you pose that question because I think that is the question of psychiatric labeling. How do you design a diagnostic system that like draws lines around people according to a checklist that is useful for them but does not end up harming other people, pathologizing other people, providing medication to other people that might get them addicted? And I mean, it was Steve Hyman, the former director of the National Institute of Mental Health. He said something like the current DSM, this diagnostic system that we have for labeling psychiatric disorders is an absolute mess. It's because of issues like this. Right. For people who don't know, the DSM is the Diagnostic and Statistical Manual for Mental Disorders, which is the book that doctors use to diagnose people for all kinds of mental health issues and disorders. But speaking to the issues with it, even after getting diagnosed myself, I noticed so many discrepancies between how that process happened for me and how that process happened for other people I know who got diagnosed with ADHD. Like, I had to jump through way more hoops. That's kind of when I had an inkling that maybe the diagnostic tools that we have are not perfect. Yeah. I would say that. So I think there are two issues that we can point to. One is the one that you're talking about where there isn't consistency in how each individual is evaluated. But the broader one is like, is it the best system to have a, forgive me, but glorified checklist that practitioners use? And I would say that many people argue that it's not the best system that we are actually fundamentally are using the wrong system to catch people. So what would a better model look like? So one model is called Hytop and it says we should throw out a system where you have diagnoses that you're labeled by and instead we should think about everything as a system of dimensions or spectra. For example, everyone is on a spectrum between not socially anxious and really socially anxious. And there's some point along the spectrum where clinicians might say someone needs therapy to help for it, right? And there are all kinds of traits people have that exist on these lines and some of them are related. And looking at all these dimensions more holistically can help us sort out what's going on with a person and what interventions might help them, rather than a label that might not fully explain people's symptoms. That seems to make a lot of sense. The idea of a more nuanced diagnostic framework, it makes a lot more sense. Well, I should say some clinicians think that this Hytop model is also flawed and would point out that there isn't any empirical evidence that shows it would work better than the DSM. But regardless, what are the consequences of so much personal and cultural investment in diagnoses or in any particular diagnostic system? Yeah, I think that's a really good question. One thing that I have thought about and written about has been that once you have people who are labeled by a system, that creates an investment in the system staying around. I've written about the difficulty of Asperger's when they were moving from one edition of the DSM to the other, they got rid of Asperger's, they made it a part of autism spectrum disorder. And that created a lot of backlash because by naming people as having Asperger's, you created an identity, you created a community, you created a kind of person, essentially. And that in turn made it harder to revise the system. When you have such a close link between psychiatric diagnosis and identity, you actually make it harder to reform psychiatric diagnosis to make it better capture human variation. Thank you both so much for this conversation. I really appreciate it. Learn from you. Thank you so much for having me. Yeah, thank you so much. That was culture journalist Kelly Maria Cordecchi and Munveer Singh, assistant professor of anthropology at UC Davis. And I'm going to put on my influencer hat for a minute and ask you to please subscribe to this show on Spotify, Apple or wherever you're listening. Click follow so you know the latest in culture while it's still hot. This episode of It's Been a Minute was produced by Liam McBain. This episode was edited by Nina Pahtug. Our supervising producer is Barton Girdwood. Our VP of programming is Yolanda Sanguini. All right, that's all for this episode of It's Been a Minute from NPR. I'm Brittany Loos. Talk soon.
