ADHD as social contagion or actual mental health crisis: a response to Philippa Perry interview, The Times, 10 Oct 23
10 Oct 23, The Times, article image
In a recent Times article, Philippa Perry claimed that ADHD is “fashionable”, a trend driven by social contagion. This has not gone down well with the ADHD community, the parents of children who are struggling, unsupported, at school, or the enormous number of people on the waiting list for an ADHD diagnosis.
If fashionable is taken to mean popular, and social contagion is taken positively, then what Perry is seeing is a trend towards recognising, understanding and connecting with ADHD. This can be seen as a Good Thing - that there is far more awareness of ADHD’s negative aspects, of the enormity of the impact it has on every facet of people’s lives, and the constant struggle people have to keep their mental health on an even keel, as a result of being ADHD.
But I suspect Perry’s intentions were not positive when she used the words “social contagion” to describe the increase in identification with ADHD. Clearly she dismisses those wishing to understand and make sense of their struggles through the lens of an ADHD diagnosis.
“Talking about myself? Amazing! Don’t have to pretend to be interested in anyone else? Amazing.”
Personally I’m not inclined to pay any attention to a therapist who pretends to be interested in others, but the fact that she publicly judges people who are trying to find a reason for their dismay and pain as merely making “an excuse not to take self-responsibility” is a good reason to both pay attention and draw attention to what she is saying.
Hypocrisy
Interestingly, Perry notes that she was deemed to be less than intellectually gifted: “I was always believed to be thick…” and that she could fight against this description because she had been given a label of dyslexic.
“…I’m not thick, I’m dyslexic”
Perry is disparaging about those looking for labels to provide explanations, and for a defence against judgement, while at the same time using the label “dyslexic” to counter assumptions about her intelligence. When challenged over her apparent duality of thinking, she responds:
“Yes, but wouldn’t it be great if I could just be understood as someone who gets the letters muddled up in their words and be accepted as that rather than having to have a label?”
I can’t help but wonder if, without a diagnosis of dyslexia, Perry would have internalised that message that she was less than bright? Because that is what’s happening with the millions of people who have ADHD, some of whom are lucky enough to have made it through years of waiting, to an eventual diagnosis. If they are really lucky, they might receive medication that helps, some of the time.
And yes, it would be lovely to be accepted for our differences rather needing a label, but we aren’t. Instead we are judged by neuro-normative standards and labelled accordingly – lazy, day dreamer, weird, aggressive, flighty, bossy, out of control, disengaged, difficult, flaky - or worse still, we are misdiagnosed with BPD, anxiety, depression and other disorders that are quite probably a reaction to having to deal with ADHD, alone and unsupported.
Social contagion or mental health crisis?
To understand why so many people may be relating to ADHD as an explanation for their life challenges, letus consider the history of ADHD, particularly in terms of gender differences in diagnosis.
Boys are diagnosed with ADHD far more than girls. The ratio is around 5:1. Adult diagnosis is more like 1:1. Researchers therefore believe that female prevalence is equal to male, but because girls are socialised to fit in, they become masters of masking. Consequently, their ADHD isn’t picked up (there are more reasons for this but masking is a biggy).
Every year, around 25,000 females will be born with ADHD and around 20,000 of them won't be diagnosed at school age. That's if we consider the 8% prevalence rate for ADHD as in the US. In the UK, diagnosis is less common. I’ll leave you to consider why.
I’m one of the ”lost generation” of female ADHDers. I was diagnosed at 53. At least I may have a few years of understanding what on earth is going on with my life before I die – many are not so lucky.
I was born in 1970, when ADHD didn’t exist as a diagnostic category. ADHD only appeared in the DSM diagnostic manual in 1987, when ADD was amended to ADHD, and hyperactivity became an aspect of all types of ADHD. So it’s probably safe to assume that no-one was diagnosed with ADHD until 1987.
That’s over 200,000 girls with ADHD who were missed entirely from 1970 to 1987.
Post ’87, the rate of diagnosis is 5:1 boys to girls. Only 20% of the girls we can assume had ADHD are diagnosed. So in my lifetime, from 1970 to 2023, we’re looking at nearly 600,000 women who have struggled or will struggle with undiagnosed or misdiagnosed ADHD in the future. In fact only 8% of an anticipated 1.5 million people with ADHD have been diagnosed. In a 2021 Big Issue article, ADHD Action noted “If this were any other condition it would be seen as a national emergency, given the sometimes deadly adverse impacts this has on untreated adults. This can be as serious as a 10-year reduction in life expectancy.”
261 year waiting list for ADHD assessment
Waiting lists for ADHD diagnosis are enormous. The wait for assessment is up to 7 years, sometimes longer. In fact, we have waiting lists so long that one local service was estimated to need 261 years to clear theirs at the rate diagnoses were taking place. In reality this is not just an enormous number of people trying to find an excuse not to take self-responsibility, this is a mental health crisis. Is it not better to assume that a large number of people self-identifying as ADHD are right to do so, particularly when the opportunity to find out for sure is so limited? The alternative is to devalue people’s experiences, to invalidate the enormous struggle of living with unrecognised ADHD, to add to the depression, self-doubt and despair so many are feeling. A large percentage of these people, endlessly waiting for validation, are women, who are struggling with self-esteem, not knowing why they can’t seem to function like other people, feeling guilt, shame and depression, desperation. Having discovered that ADHD might just be the reason, they have nowhere to go to confirm or deny this. They have self-diagnosis until, should they wish to wait many many years, they can have a formal diagnosis. I can only hope not too many of them will appear at Philippa Perry’s door.
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