It's a massive topic to cover in the scope of HN comments. ADHD also tends to be a touchy subject on HN. For a less heated parallel, consider reading up on how the "chemical imbalance" narrative has been harmful for public perception of psychiatry: https://www.psychiatrictimes.com/view/debunking-two-chemical... . People consume a lot of medication ads (in the US) and bite-sized, reductionist narratives about neurotransmitters and walk away thinking that psychiatry is simply about manipulating neurotransmitters up or down. In reality, psychiatry has known for a long time that complex behavioral disorders like ADHD, depression, PTSD, and so on aren't as simple as neurotransmitter balance in the brain, nor do they purely arise from your genetic code.
These "chemical imbalance" narratives tend to do more harm than good by giving patients an idea that their symptoms are purely external to their own choices, and therefore completely out of their own control. Unfortunately, it's very difficult to convince suffering patients that they have some control over their situation without also implying personal blame for their problems, which doesn't go over well. The idea that the problem is faultless ("It's not you, it's just your brain!") and that the solutions are effortless ("This pill will fix your chemical imbalance") is just too tempting. The alternatives ("Read this book on study habits, leave your phone in another room while studying, use timeboxing...") are an unappealing alternative.
Don't get me wrong: Medications can and absolutely do help people, but this idea that the problem can only be treated via medication is demonstrably false. The most successful patients use a combination of medications, therapy, and healthy habit-forming. The least successful patients tend to give up on everything except the medication, reaching for ever-increasing doses or trying to play games of on-days/off-days or saving up extra medication. That's a losing battle.
Thanks for writing this out. My only comment is this: it's a touchy subject because while you are describing one end of the spectrum, the opposite end is almost always applied for those struggling with ADHD - "Just work harder! You'll get over it"
There's definitely a healthy balance of smart lifestyle choices, coupled with medication for those who truly struggle and need to just get from zero to 1.
Thank you very much for writing this! It's very well formulated and expressed. I especially liked
> Unfortunately, it's very difficult to convince suffering patients that they have some control over their situation without also implying personal blame for their problems
I also see it as a big part of the problem, that it's difficult to convince people that they do have control over their lives. In many psychotherapy books, when therapists describe various cases, this is a corner stone of a therapy success: a patient understanding that they do have control over their situation. That it's not the outer world that is so demanding that it leaves them no choice, but them choosing to cope in a particular way, and that there are other ways to react and cope.
The problem with "Read this book on study habits, leave your phone in another room while studying, use timeboxing..." isn't that it's unappealing (and a reasonably smart person should be able to figure out most of these without being told). It's that these approaches don't really work if you don't have some baseline ability to focus. And too often it comes out just as "you're stupid and lazy".
For the reference, where I live we don't have ads for prescription medication. On the other hand everything tends to be diagnosed as depression and treated with antidepressants, no matter what symptoms are.
These "chemical imbalance" narratives tend to do more harm than good by giving patients an idea that their symptoms are purely external to their own choices, and therefore completely out of their own control. Unfortunately, it's very difficult to convince suffering patients that they have some control over their situation without also implying personal blame for their problems, which doesn't go over well. The idea that the problem is faultless ("It's not you, it's just your brain!") and that the solutions are effortless ("This pill will fix your chemical imbalance") is just too tempting. The alternatives ("Read this book on study habits, leave your phone in another room while studying, use timeboxing...") are an unappealing alternative.
Don't get me wrong: Medications can and absolutely do help people, but this idea that the problem can only be treated via medication is demonstrably false. The most successful patients use a combination of medications, therapy, and healthy habit-forming. The least successful patients tend to give up on everything except the medication, reaching for ever-increasing doses or trying to play games of on-days/off-days or saving up extra medication. That's a losing battle.