Now, a given individual with a lot of body hair might actually have a glandular abnormality that manifests as abnormal hair growth in addition to other negative symptoms. Being hairy might be considered a potential symptom of this health problem.
But if all the abnormality did was induce more hair growth, there’s no disease process involved: it’s just normal variation.
If someone wanted to get rid of the body hair, and methods of doing so which didn’t involve harming other body systems were available, there aren’t any ethical problems associated with considering their state a treatable condition. But to force it on unwilling people, especially when the treatment affects other aspects of their life, is ethically wrong.
But if someone suffers from a disease, it is sometimes considered correct to treat them without or against their will, particularly when the disease supposedly affects their ability to choose “reasonably”. If someone’s low mood is just a mood state, then we couldn’t force them to seek treatment if they didn’t want it. But if they have depression, we can presume (without evidence) that their reasoning is impaired by their condition and force treatment.
But you’ve moved from a hypothetical possibility to an affirmative statement. What can you show me to demonstrate that ADHD symptoms (or even for that matter, concentration alone) are continuously distributed? Also, what does a person on the other tail end of the purported ADHD distribution look like?
How do you know that ADHD symptomatic impairment is merely a result of societal organization? Sure, it is easy to conceive if you are only thinking about concentration problems - things like school and technical work clearly suffer when you cannot concentrate. But ADHD has also been associated with a number of negative outcomes in addition to poor school or job performance, including a higher likelihood of having accidents, beginning tobacco use or other substance use, being aggressive and ostracizing oneself from peers. It is hard to conceive of how society could restructure itself so that ALL the symptoms of ADHD would be rendered devoid of the possibility of impairment.
Who says it isn’t? (Besides, I believe that there is a disease associated with extreme body hair, which does result in social ostracization for the sufferer, if I recall my Patricia Cornwell correctly). What we have agreed on is that conditions similar in appearance may be determined by multiple factors, and that some conditions may be associated with impairment while others are not. You’ve given me no reason why impairment should not be considered as partially definitive of a disorder. I don’t understand why this impacts the validity of ADHD as a disorder.
We may disagree on some things very fundamental: what is science; what is “objective reality”; and how do know it?
You seem to believe that an approach is scientific if and only if it accurately reflects an objective reality that we know to be true.
In my mind, if we knew the objective reality we’d have no need for science. Those who believe they already know objective reality have had no need for science. That was the Church in the Middle Ages. We have science because we do not know what objective reality is and science is the means by which we model it with increasingly better fit. And science works by using the models you have - the data either fits it and you have more confidence that your model is right, or it doesn’t fit and you modify or replace your model. That is how science works my freind.
The model of the atom as a miniture solar system was scientific even if it is now outdated. Likewise our groupings in the DSM will be revised to better model objective reality as time goes on. It would not be scientific if it was tautologic: if it was a disease because the DSM said so, end of story. This hasn’t been how the DSM has worked. The DSM is merely collecting the patterns. These things travel together and are likely to share natural history and responses to interventions together.
None of this has anything to do with imposing treatment on an unwilling patient. Here you belief that a disease state allows imposition of care is just mistaken. You have every right to refuse treatment for asthma, for pneumonia, and for ADD. The only time that we have an obligation/right to impose treatment is if you are a clear risk to yourself or others. This generally means suicidal or homicidal, not just depressed or manic. And if someone is felt to be incompetent to make informed choices then it must be proven that they are incompetent; someone is not incompentent merely because they have depression.
Medical science - research - doesn’t kno objective reality ahead of time either. That’s why you do the dang study! Clinical medicine is only scientific in a very broad and individual sense of the term. As I interview a patient I am forming hypotheses about what is going on. As the story gets told certain possible explanations move up and down as better fits. I then test my hypotheses with more questions and with my physical exam and modify my model of this patient reality accordingly. If I need to I order focused experiments - lab tests - to help verify or falsify my hypotheses. But the interphysician reliabilty may often be as poor as the DSM is in real life.
Hentor, awfully sparse data to document how reliable the tool is “in the field.”
As to what is “disease” … I do not know if ADD is a disease, a disorder, or a difference. But we live in this particular society. And short of dropping out of it we need to adapt. Even if ADD was indeed evolutionarily beneficial once upon a time (I believe it was and that it still has some advantages in certain contexts), when it fits the defintion of “impairment” across venues, it is handicapping and treatment is worth considering.
No doubt that the clinician to clinician reliabilty data is sparse, I agree. But in the field, the standard of practice for ADHD should be the utilization of a diagnostic instrument. You restricted the evidence to clinician versus clinician reliability (even if I did sneak some “clinician using a diagnostic tool” data in there). I would like to see more data on real world identification of ADHD, without question, but I would also like to see more real-world reliance on validated techniques. And I may be missing some of the data - PsycInfo and Medline do act persnickety from time to time.
I am not aware that I’ve moved to an affirmative statement. My original post was a question, but the hypothesis seemed to be supported by most of the knowledgeable people in the thread (with the exception of tomndebb, who seems to have dropped out). Still, I think I’ve continued to hedge - if I haven’t it was accidental.
Look through your list of symptoms. I guess it would be someone who has supreme powers of concentration, and who never ever feels hyperactive etc.
I’m not saying that as a practical matter it can. I’m only pointing to the theoretical possibility to make the point that the impairment is sometimes a function of society.
True, there are probably diseases that cause extreme body hair. I’m talking about an amount of body hair that would still be considered “normal” and not caused by any “condition” - this could turn around and become a “disease” if the world should change such that it becomes an impairment.
OK, I think you may be looking at disease from a practical treatment standpoint - to my mind it is different. We may have to leave it there.
Most online sources, even journal articles, only mention the paradoxical effect of stimulants in hyperactive children, implying that it only occurs in those children. That’s extremely misleading, (hopefully) unintentional as it may be.
I agree that we may have to leave it where it is, but I just wanted to observe that I don’t think I have said anything about practical treatment in our exchanges on the validity of the disorder. I have demonstrated, or at least discussed, the validity of the disorder regardless of the nature of treatment.