Adult ADD

[sweetnpetite]

Myth #10: It is not possible to accurately diagnose ADD or ADHD in children or adults.
FACT: Although scientists have not yet developed a single medical test for diagnosing ADHD, clear-cut clinical diagnostic criteria have been developed, researched, and refined over several decades. The current generally accepted diagnostic criteria for ADHD are listed in the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) published by the American Psychiatric Association (1995). Using these criteria and multiple methods to collect comprehensive information from multiple informants, ADHD can be reliably diagnosed in children and adults.

 

[sweetnpetite]

If I have the choice of hiring the ADD person or the not-ADD person... I pick the one that doesn't have a disorder.

IF you were in charge of hiring people, I would hope that you would be aware of the laws about it

to wit-
Two federal laws -- the Rehabilitation Act of 1973 (RA)1 and the Americans with Disabilities Act of 1990 (ADA)2 -- prohibit discrimination against individuals with disabilities in higher education and the workplace. Some state laws may go further than these federal laws in prohibiting discrimination so check with your state government or an attorney who practices in your jurisdiction to determine your rights under state law in addition to the applicable federal laws. Adults with AD/HD may sometimes be eligible for protection and accommodations in higher education and the workplace under these laws.

Although AD/HD is not specifically mentioned in the regulations, it has been recognized in many court cases as a "mental or psychological disorder" and is therefore covered.


however, as I said, the person must be qualified.

Otherwise Qualified: "Otherwise qualified" means that the individual would be eligible for the educational program or the job with or without a reasonable accommodation, e.g. despite their disability, they meet the basic requirements for a particular job or school program. In one case on this issue, the court upheld the employment termination of a neurologist with AD/HD, arguing that there was no duty to accommodate him because he was a direct threat to his patients.11 The court found that he had made errors in patient charts and dispensing medicine and that he had stated that it was only a matter of time until he hurt someone. The neurologist was not qualified for his job because of his deficits. Despite his disability, he was not eligible for protection under the ADA.


http://www.help4adhd.org/en/systems/legal/legalissues

 

[sweetnpetite]

Like for example- where the hell did 6:00 go (?)

...let alone 7:00

 

[Joe Wordsworth]

I could also claim that I have low blood sugar or high blood pressure or any number of things to get more chances to sit down at a job that requires a lot of standing, just because I'm too lazy to stand up. If I were pregnant, I could claim that I was having cramps when I wasn't, or that I had more back pain than I really did. ANYTHING could be used as an excuse for anybody. Lots of things can be used as an excuses without providing documentation.

So, you essentially agree with my initial assertion.

Trust me, the IRS doesn't give you special breaks if you say "but I have ADD!" not even if you provide documentation. So I fail to see your point? ADD will probably always have a stigma of urban rumour because it's easy for people to beleive that kids just need to be spanked more, and adults need to buck up. Mental health problems are generally harder to prove to a disbelieving mind than a broken arm. Depression- you just need to chear up! Anxiety- just relax! Turret's Syndrom- your just looking for attention. Mildly retarted/low IQ, you just need to try harder.

I think, and no offense, I won't take your word for what the IRS does and doesn't concern itself with. Nor what a court will do with an argument of causality concerning a psychological disorder. I won't because definitively, this is hard to claim "I know" about.

Where would you find two people who are identicle to each other save one having ADD? This is just silly. All that I have read does point out strengths that people with ADD tend to have. No, they are not isolated to ONLY people with ADD, *but* the highly creative, high energy, fireball type people are likely to have a lot of difficulty with other more practical aspects of life like remembering were we set down our keys.

If we entirely ignore the idea of two people are are equal with only one difference--in the attempt to judge the consequences or severity of that difference; then we can pretty much throw all thought experiments out the window. If you cannot see the point being made, I have no other words to explain it to you and hope someone else does.

Like I said, it's rediculous to use the example of two people who are identical in skill qualification, ect, eccept for ADD. You may or you may not need the skills that a person with ADD has. If you don't need there skills, then I suppose there would be no need to overlook their disablitiy. I suppose it would be beside the point anyway. If you do need there skills and you don't hire them because they have a disabilty, then it will be your loss. As was said.

No, it bares a stark contrast from which a clear point can be addressed--that's far from ridiculous. You may not be able to understand the point (which is apparent because you seem unable to address it directly), but that doesn't mean there is nothing to be gained or no valuable information to be concluded from drawing such a distinction.

People want to fly. (Or need to for business or whatever) Just having an airline won't garantee you make money. Giving them a lot of extra's may or may not attract more customers. Free champain might make me book with you. But what if my problem is that I'm tired of showing up all wrinkled and tired? And I don't like being crushed into a small space and having my elbows banged into by the cart? You will make more money by solving my problems, then just by providing me with a place to fly the friendly skys. Money is indeed made by solving peoples problelms. IN this country- we can generally get what we want and there are more than enough places for us to get it. IF you don't understand your customers/clients and solve their problems, they could go anywhere to get what they want. And they will propbably go to the place that does solve their problem.

I said money is made because of supplying what people want, not necessarily just solving their problems per se... those last words are very important, please read my posts thoroughly and literally before arguing with them. It isn't the "solving of problems" per se that is the entirety of money-making. But, by the nature of the money-making being a voluntary act, it has to be done from a forward will (want). Want is the heart of money-making. Provide what people want, whether that be the solving of their problems, gratification when there are none, etc.

I don't feel that I made assumptions or misinterpreted. I feel that I just disagreed. The only assumption I made was that you were not well informed on the topic, not that you hadn't read anything about it. I'm sure you have. But you still don't seem well informed, from your comments. YOu yuorself said you've never read about any special skills or strengths that someone with ADHS would have. If you had read extensively and/or read anything positive about ADHD at all, you should have come accross this information.

I feel that you made several assumptions and misinterpretations. We're bound to differ, then, on that issue. For example... a misinterpretations:

First of all, I never said anything about "reading extensively"--personally, I think that's a bullshit term people use when they think they know something. That's misinterpretation number 1.

Past that, I said that I had read nothing that granted ADD people any special insight abilities. Now, I have read several studies on ADD (I had to for a class), those studies covered a broad range of ideas about the disorder. Now, having read about ADD and having been informed about ADD, this doesn't mean that I'm automatically going to have read that stuff about them having "special insight"--given that those studies aren't the most popular, well-done, best peer-reviewed, most-conclusive, etc. ones out there. I'm sure we could find an ADD study that claimed ADD doesn't exist, but just because you haven't read it doesn't mean you're not well-read about ADD. That's a horrible assumption to make. I'm inclined to believe because I have not read any conclusive study about ADD being a "special insight giver" AND have only read reports about its symptoms, difficulty to diagnose, industry fear of it being "overblown", and effects from the disorder... well, no, I'm afraid a prosey article making a half-splash attempt to attribute creativity to some ADD people is not clear and convincing.

That's me just being intellectually cautious.

IF you were in charge of hiring people, I would hope that you would be aware of the laws about it

That's what I pay my lawyer for.

Adults with AD/HD may sometimes be eligible for protection and accommodations in higher education and the workplace under these laws.

Sometimes is far from always and no employer is required by law to ignore psychological disorders when making employment decisions. I am protected, and my company, by the law should I decide that I don't want someone with a disruptive influence working for me. That includes disorders that may impair job performance or the free exercise of my enterprise. The symptoms of ADD, themselves, represent reasons why people are disconsidered for jobs... that someone claims to have the disorder is not sufficient protection, by itself.

Although AD/HD is not specifically mentioned in the regulations, it has been recognized in many court cases as a "mental or psychological disorder" and is therefore covered.

This kind of statement is why people need to watch what they say. "ADD is not specifically mentioned...some court cases consider it a disorder...therefore it is covered". No, that's just not rational. It isn't specifically mentioned, some courts consider it a disorder, it's still up in the air whether its covered. If all it took was some courts making decisions to change the law everywhere, our system of checks and balances and "laboritories of law" would entirely crumble. It's not "covered", its disputed.

however, as I said, the person must be qualified.

And, as an employer, I have the right to call qualification "clear and convincing reasons as to their ability to perform the responsibilities of the job" and call the responsibilities of the job "tasks including ones demanding a good attention span, reliability, etc.". It's the same sort of protection I have for not hiring someone with a phobia of people because I deem my jobs ones that require interaction with people. I am well protected in this respect, what a horrible system it would be if I weren't.

 

[Guest]

At present ADHD is difficult to diagnose.

Excerpts from Running on Ritalin: A Physician Reflects on Children Society, and Performance in a Pill (Bantam, 1998). (pp.253-6) Copyright Lawrence Diller. Reprinted with permission.

The process of establishing "objective" diagnostic standards for ADD has itself been quite subjective. Official guidelines for evaluating ADD symptoms are vague and open to interpretation--yet they lead to an all-or-nothing diagnosis.

The ADD diagnosis has no definitive medical or psychological marker, and so it is often made exclusively on the basis of a patient's history. The diagnosis is overly focused on the individual and doesn't take sufficient account of family systems and other environmental factors.

In its current phase as a "disorder for all seasons, " ADD has become too inclusive. It has lost relevance to the age-related, developmental nature of some core problems. ADD may look a lot like certain other childhood psychiatric disorders. And many children meet criteria for some, but not all, of the symptoms of several different conditions.


On the other hand, from the Mayo Clinic:

http://www.mayoclinic.com/invoke.cfm?objectid=FA1B63E9-643F-486E-B1B10D857F434410&dsection=2

Attention-deficit/hyperactivity disorder (ADHD)

Signs and symptoms

At various times, ADHD has been called attention-deficit disorder (ADD), hyperactivity, and even minimal brain dysfunction. But ADHD is the preferred term because it more accurately describes all aspects of the condition. Yet changing the name hasn't made ADHD less controversial.

For some time, experts disagreed on how ADHD should be diagnosed — and even on whether it was a real disorder. But in 1998, the National Institute of Mental Health decided that ADHD is a legitimate condition. In addition, most doctors believe that a child shouldn't receive a diagnosis of ADHD unless the core symptoms of ADHD appear early in life — before age 7 — and create significant problems at home and at school on an ongoing basis.

The symptoms of ADHD fall into two broad categories:

* Inattention
* Hyperactivity-impulsive behavior

In general, children are said to have ADHD if they show six or more symptoms from each category for at least six months. These symptoms must significantly affect a child's ability to function in at least two areas of life — typically at home and at school. This helps ensure that the problem isn't with a particular teacher or only with parents. Children who have problems in school but get along well at home are not considered to have ADHD. The same is true of children who are hyperactive or inattentive but whose schoolwork and friendships aren't affected by their behavior.

In most children diagnosed with ADHD, signs and symptoms appear between 4 and 6 years of age, although they sometimes may occur even earlier. They include the following:

Inattention

* Often fails to pay close attention to details or makes careless mistakes in schoolwork or other activities
* Often has trouble sustaining attention during tasks or play
* Often doesn't seem to listen when spoken to directly
* Often doesn't follow through on instructions and fails to finish schoolwork, chores or other tasks
* Often has difficulty organizing tasks or activities
* Often avoids or dislikes tasks that require sustained mental effort, such as schoolwork or homework
* Often loses things needed for tasks or activities, such as books, pencils, toys or tools
* Is often easily distracted
* Is often forgetful

Hyperactivity-impulsive behavior

* Often fidgets with hands or feet or squirms in seat
* Often leaves seat in the classroom or in other situations where remaining seated is expected
* Often runs or climbs excessively when it's not appropriate, or, if an adolescent might constantly feel restless
* Often has difficulty playing quietly
* Is often "on the go" or acts as if "driven by a motor"
* Often talks excessively
* Often blurts out the answers before questions have been completely asked
* Often has difficulty waiting his or her turn
* Often interrupts or intrudes on others by butting into conversations or games

Most healthy children exhibit many of these behaviors at one time or another. For instance, parents may worry that a 3-year-old who can't listen to a story from beginning to end or finish a drawing may have ADHD. But preschoolers normally have a short attention span and aren't able to stick with one activity for long. This doesn't mean they're inattentive — it simply means they're normal preschoolers.

Even in older children and adolescents, attention span often depends on the level of interest in a particular activity. Most teenagers can listen to music or talk to their friends for hours but may be a lot less focused about homework.

Being different isn't ADHD
The same is true of hyperactivity. Young children are naturally energetic — they often wear their parents out long before they're worn out themselves. And they may become even more active when they're tired, hungry, anxious or in a new environment. In addition, some children just naturally have a higher activity level than others. Every child is unique, with a distinct personality and temperament. Children should never be classified as having ADHD just because they're different from their friends or siblings.

Most children with ADHD don't have all the signs and symptoms of the disorder. Furthermore, symptoms may be different in boys and girls. Boys are more likely to be hyperactive, and girls tend to be inattentive. In addition, girls who have trouble paying attention often daydream, but inattentive boys are more likely to play or fiddle aimlessly. Boys also tend to be less compliant with teachers and other adults, so their behavior is often more conspicuous.

At the same time, children diagnosed with ADHD may have some things in common. They tend to be especially sensitive to stimuli such as sights, sounds and touch, for instance. And when overstimulated, they can quickly get out of control, becoming giddy and sometimes aggressive or even physically or verbally abusive. Children with the inattentive form of ADHD may seem to drift away into their own thoughts or lose track of what's going on around them.

Symptoms of ADHD in adults
ADHD always begins in childhood, but it may persist into adult life. The core symptoms of distractibility, hyperactivity and impulsive behavior are the same for adults as for children, but they often manifest differently and far more subtly in adults. Hyperactivity, in particular, is generally less overt in adults. Children may race around madly; adults are more likely to be restless and to have trouble relaxing.

On the other hand, problems with organization and concentration often increase as people get older and their lives become more complicated and demanding. Adults diagnosed with ADHD often say that their biggest frustration is their inability to focus and to prioritize, leading not only to missed deadlines but also to forgotten meetings and social engagements.

As difficult as this is, the impulsive behavior of some adults with ADHD can be even more problematic. The inability to control impulses, which some experts say may be the defining characteristic of ADHD, can range from impatience waiting in line or driving in heavy traffic to mood swings, intense outbursts of anger and troubled relationships.

One set of guidelines used to diagnose adult ADHD, called the Utah criteria, lists the following as characteristic of adults with the disorder:

* A childhood history of ADHD
* Hyperactivity and poor concentration
* Inability to complete tasks
* Mood swings
* Hot temper
* Inability to deal with stress
* Impulsivity



So what does all this mean? Obviously, a difficult and often frustrating situation for parent and child.

Our family suffers through this each and every day. ADHD is just part of our Pervasive Developmental Disorder cocktail. Our children are also blessed with Asperger's Syndrome and pain-in-the-butt giftedness, as well.

Medication does help, and we do see one of the best child psychiatrists from Menninger's. (We have his cell phone number - lol.)

But because heredity plays a role more and more adults are being diagnosed as their children are diagnosed. Try getting past that. It's quite a hurdle to realize you're the cause of their problems and yet also a bit of a blessing because it explains some of the organizational difficulties you experienced in grad school.

But I do have to disagree with a few of the symptoms listed. Anger? Hmmm. And most adults have developed coping skills for their own problems; they've had to. (Anyone use post-it notes everywhere? Countless lists?) Some people function well in clutter; some become extremely neat - as a coping mechanism.

The commercials about adult ADHD are ridiculous and it's quite obvious they're attempting to sell more medication.

Although I like the one on the radio where the person talking says, "ADHD is a terrible problem for many . . . . . Oh look. A duck!"

(A sense of humor helps, too.)

 

[Huckleman2000]

Not too sure what I can ADD to this (hehe, I made a pun!), but I think I can at least sort out a few threads:

1) The validity (or not) of "thought experiments"
Joe Wordsworth asserts that, given two candidates with the same qualifications except that one has ADHD, he would hire the one without it. Sweetnpetite (SNP) asserts that such a decision is shortsighted, and possibly afoul of equal-opportunity hiring laws, but also that the hypothetical situation doesn't bear any relation to reality and is therefore an invalid argument.

My take: Joe is right about the validity of "thought experiments" as a way of isolating the impact of certain factors with regard to an outcome that is unclear. However, a legitimate thought experiment should not be constructed with an outcome that invalidates the very factor which is in dispute. Here, Joe is saying that the symptoms of ADHD are the determining factors which define incompatibility with the (hypothetical) job. It's hardly a legitimate "experiment" if the outcome is defined as something that inherently negates the factors being assessed. If I'm hiring a Salesperson, and I'm looking at two equal candidates with the lone exception that one has sales experience, it's no unveiling of universal truth to state that the one with sales experience is the more desirable hire. Likewise, if I'm looking to hire someone for a position defined only as requiring non-ADHD qualities, the disqualification of someone with ADHD doesn't prove anything in a more broadly applicable sense.

Moreover, JoeW's description of the difference as The comparison was two people with the only difference being a distractive, disruptive, pschological disorder that conflicts directly with ordered workplaces everywhere with deadline demands. assumes that such a disorder cannot be overcome with medication or other intervention that imposes no burden on the potential employer. Surely, one could describe untreated diabetes, thyroid disease, gastric disorders, or even hayfever as "a distractive, disruptive, physical disorder that conflicts directly with ordered workplaces everywhere with deadline demands."

SnP brought up the example of the surgeon with ADHD who posed a risk to his patients, and was therefore not subject to EEOC relief - I think this demonstrates adequate understanding of the point JoeW was trying to make. However, JoeW demonstrated an inadequate understanding of the EEOC laws when he failed to to consider the central tenant of the law, which is the question of "reasonable accomodation". I don't know all the case law surrounding this hypothetical ADHD hiring situation, but I do know that asking about ADHD in a job interview is out of bounds except in the broad question "is there any untreated disability that would prevent you from carrying out the requirements of this job?" Even that question is of dubious legal standing on its face. Just because I can't point to a case where EEOC has granted ADHD qualifying status, doesn't mean that I can ignore arguments that suggest it would likely qualify for protection. I don't need to know all the case law to know that I wouldn't want to be the "test case" in an ADHD hiring dispute.

Point awarded: Sweetnpetite

 

[Huckleman2000]

Untangling thread number 2:

2) Dr. Mabeuse's observation that drugs beget diagnoses, and diagnoses beget diseases.

I like this observation, because it has the ring of truth. Erectile dysfunction was just a shitty situation to be in, until they came up with something that "cured" it.

However, I think this is an observation that is generally made more about mental illnesses than physical maladies - and I cringe to make the distinction, since the trend in medical research is to find more and more physical (even genetic) manifestations of what have historically been viewed as failures of will and thought disorders. If more and more prescriptions for anti-depressants are being written by first-line physicians, is that due to better diagnostic criteria, and more options for treatment, or is it due to big pharma's marketing clout?

I defer to a recent NYT Magazine article by Peter D. Kramer, author of "Listening to Prozac". Apologies for length, but Kramer is the go-to guy in this area.

There's Nothing Deep About Depression
By PETER D. KRAMER

Published: April 17, 2005

Shortly after the publication of my book ''Listening to Prozac,'' 12 years ago, I became immersed in depression. Not my own. I was contented enough in the slog through midlife. But mood disorder surrounded me, in my contacts with patients and readers. To my mind, my book was never really about depression. Taking the new antidepressants, some of my patients said they found themselves more confident and decisive. I used these claims as a jumping-off point for speculation: what if future medications had the potential to modify personality traits in people who had never experienced mood disorder? If doctors were given access to such drugs, how should they prescribe them? The inquiry moved from medical ethics to social criticism: what does our culture demand of us, in the way of assertiveness?

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It was the medications' extra effects -- on personality, not on the symptoms of depression -- that provoked this line of thought. For centuries, doctors have treated depressed patients, using medication and psychological strategies. Those efforts seemed uncontroversial. But authors do not determine the fate of their work. ''Listening to Prozac'' became a ''best-selling book about depression.'' I found myself speaking -- sometimes about ethics, more often about mood disorders -- with many audiences, in bookstores, at gatherings of the mentally ill and their families and at professional meetings. Invariably, as soon as I had finished my remarks, a hand would shoot up. A hearty, jovial man would rise and ask -- always the same question -- ''What if Prozac had been available in van Gogh's time?''

I understood what was intended, a joke about a pill that makes people blandly chipper. The New Yorker had run cartoons along these lines -- Edgar Allan Poe, on Prozac, making nice to a raven. Below the surface humor were issues I had raised in my own writing. Might a widened use of medication deprive us of insight about our condition? But with repetition, the van Gogh question came to sound strange. Facing a man in great pain, headed for self-mutilation and death, who would withhold a potentially helpful treatment?

It may be that my response was grounded less in the intent of the question than in my own experience. For 20 years, I'd spent my afternoons working with psychiatric outpatients in Providence, R.I. As I wrote more, I let my clinical hours dwindle. One result was that more of my time was filled with especially challenging cases, with patients who were not yet better. The popularity of ''Listening to Prozac'' meant that the most insistent new inquiries were from families with depressed members who had done poorly elsewhere. In my life as a doctor, unremitting depression became an intimate. It is poor company. Depression destroys families. It ruins careers. It ages patients prematurely.

Recent research has made the fight against depression especially compelling. Depression is associated with brain disorganization and nerve-cell atrophy. Depression appears to be progressive -- the longer the episode, the greater the anatomical disorder. To work with depression is to combat a disease that harms patients' nerve pathways day by day.

Nor is the damage merely to mind and brain. Depression has been linked with harm to the heart, to endocrine glands, to bones. Depressives die young -- not only of suicide, but also of heart attacks and strokes. Depression is a multisystem disease, one we would consider dangerous to health even if we lacked the concept ''mental illness.''

As a clinician, I found the what if challenge ever less amusing. And so I began to ask audience members what they had in mind. Most understood van Gogh to have suffered severe depression. His illness, they thought, conferred special vision. In a short story, Poe likens ''an utter depression of soul'' to ''the hideous dropping off of the veil.'' The questioners maintained this 19th-century belief, that depression reveals essence to those brave enough to face it. By this account, depression is more than a disease -- it has a sacred aspect.

Other questioners set aside that van Gogh was actually ill. They took mood disorder to be a heavy dose of the artistic temperament, so that any application of antidepressants is finally cosmetic, remolding personality into a more socially acceptable form. For them, depression was less than a disease.

These attributions stood in contrast to my own belief, that depression is neither more nor less than a disease, but disease simply and altogether.

Audiences seemed to be aware of the medical perspective, even to endorse it -- but not to have adopted it as a habit of mind. To underscore this inconsistency, I began to pose a test question: We say that depression is a disease. Does that mean that we want to eradicate it as we have eradicated smallpox, so that no human being need ever suffer depression again? I made it clear that mere sadness was not at issue. Take major depression, however you define it. Are you content to be rid of that condition?

Always, the response was hedged: aren't we meant to be depressed? Are we talking about changing human nature?

I took those protective worries as expressions of what depression is to us. Asked whether we are content to eradicate arthritis, no one says, ''Well, the end-stage deformation, yes, but let's hang on to tennis elbow, housemaid's knee and the early stages of rheumatoid disease.'' Multiple sclerosis, acne, schizophrenia, psoriasis, bulimia, malaria -- there is no other disease we consider preserving. But eradicating depression calls out the caveats.

To this way of thinking, to oppose depression too completely is to be coarse and reductionist -- to miss the inherent tragedy of the human condition. To be depressed, even gravely, is to be in touch with what matters most in life, its finitude and brevity, its absurdity and arbitrariness. To be depressed is to occupy the role of rebel and social critic. Depression, in our culture, is what tuberculosis was 100 years ago: illness that signifies refinement.

Having raised the thought experiment, I should emphasize that in reality, the possibility of eradicating depression is not at hand. If clinicians are better at ameliorating depression than we were 10 years ago -- and I think we may be -- that is because we are more persistent in our efforts, combining treatments and (when they succeed) sticking with them until they have a marked effect. But in terms of the tools available, progress in the campaign against depression has been plodding.

Still, it is possible to envisage general medical progress that lowers the rate of depression substantially -- and then to think of a society that enjoys that result. What is lost, what gained? Which is also to ask: What stands in the way of our embracing the notion that depression is disease, nothing more?

This question has any number of answers. We idealize depression, associating it with perceptiveness, interpersonal sensitivity and other virtues. Like tuberculosis in its day, depression is a form of vulnerability that even contains a measure of erotic appeal. But the aspect of the romanticization of depression that seems to me to call for special attention is the notion that depression spawns creativity.

Objective evidence for that effect is weak. Older inquiries, the first attempts to examine the overlap of madness and genius, made positive claims for schizophrenia. Recent research has looked at mood disorders. These studies suggest that bipolar disorder may be overrepresented in the arts. (Bipolarity, or manic-depression, is another diagnosis proposed for van Gogh.) But then mania and its lesser cousin hypomania may drive productivity in many fields. One classic study hints at a link between alcoholism and literary work. But the benefits of major depression, taken as a single disease, have been hard to demonstrate. If anything, traits eroded by depression -- like energy and mental flexibility -- show up in contemporary studies of creativity.

How, then, did this link between creativity and depression arise? The belief that mental illness is a form of inspiration extends back beyond written history. Hippocrates was answering some such claim, when, around 400 B.C., he tried to define melancholy -- an excess of ''black bile'' -- as a disease. To Hippocrates, melancholy was a disorder of the humors that caused epileptic seizures when it affected the body and caused dejection when it affected the mind. Melancholy was blamed for hemorrhoids, ulcers, dysentery, skin rashes and diseases of the lungs.

The most influential expression of the contrasting position -- that melancholy confers special virtues -- appears in the ''Problemata Physica,'' or ''Problems,'' a discussion, in question-and-answer form, of scientific conundrums. It was long attributed to Aristotle, but the surviving version, from the second century B.C., is now believed to have been written by his followers. In the 30th book of the ''Problems,'' the author asks why it is that outstanding men -- philosophers, statesmen, poets, artists, educators and heroes -- are so often melancholic. Among the ancients, the strongmen Herakles and Ajax were melancholic; more contemporaneous examples cited in the ''Problems'' include Socrates, Plato and the Spartan general Lysander. The answer given is that too much black bile leads to insanity, while a moderate amount creates men ''superior to the rest of the world in many ways. ''

The Greeks, and the cultures that succeeded them, faced depression poorly armed. Treatment has always been difficult. Depression is common and spans the life cycle. When you add in (as the Greeks did) mania, schizophrenia and epilepsy, not to mention hemorrhoids, you encompass a good deal of what humankind suffers altogether. Such an impasse calls for the elaboration of myth. Over time, ''melancholy '' became a universal metaphor, standing in for sin and innocent suffering, self-indulgence and sacrifice, inferiority and perspicacity.

The great flowering of melancholy occurred during the Renaissance, as humanists rediscovered the ''Problems.'' In the late 15th century, a cult of melancholy flourished in Florence and then was taken back to England by foppish aristocratic travelers who styled themselves artists and scholars and affected the melancholic attitude and dress. Most fashionable of all were ''melancholic malcontents,'' irritable depressives given to political intrigue. One historian, Lawrence Babb, describes them as ''black-suited and disheveled . . . morosely meditative, taciturn yet prone to occasional railing.''

In dozens of stage dramas from the period, the principal character is a discontented melancholic. ''Hamlet'' is the great example. As soon as Hamlet takes the stage, an Elizabethan audience would understand that it is watching a tragedy whose hero's characteristic flaw will be a melancholic trait, in this case, paralysis of action. By the same token, the audience would quickly accept Hamlet's spiritual superiority, his suicidal impulses, his hostility to the established order, his protracted grief, solitary wanderings, erudition, impaired reason, murderousness, role-playing, passivity, rashness, antic disposition, ''dejected haviour of the visage'' and truck with graveyards and visions.

''Hamlet'' is arguably the seminal text of our culture, one that cements our admiration for doubt, paralysis and alienation. But seeing ''Hamlet'' in its social setting, in an era rife with melancholy as an affected posture, might make us wonder how much of the historical association between melancholy and its attractive attributes is artistic conceit.


In literature, the cultural effects of depression may be particularly marked. Writing, more than most callings, can coexist with a relapsing and recurring illness. Composition does not require fixed hours; poems or essays can be set aside and returned to on better days. And depression is an attractive subject. Superficially, mental pain resembles passion, strong emotion that stands in opposition to the corrupt world. Depression can have a picaresque quality -- think of the journey through the Slough of Despond in John Bunyan's ''Pilgrim's Progress.'' Over the centuries, narrative structures were built around the descent into depression and the recovery from it. Lyric poetry, religious memoir, the novel of youthful self-development -- depression is an affliction that inspires not just art but art forms. And art colors values. Where the unacknowledged legislators of mankind are depressives, dark views of the human condition will be accorded special worth.

Through the ''anxiety of influence,'' heroic melancholy cast its shadow far forward, onto romanticism and existentialism. At a certain point, the transformation begun in the Renaissance reaches completion. It is no longer that melancholy leads to heroism. Melancholy is heroism. The challenge is not battle but inner strife. The rumination of the depressive, however solipsistic, is deemed admirable. Repeatedly, melancholy returns to fashion.

As I spoke with audiences about mood disorders, I came to believe that part of what stood between depression and its full status as disease was the tradition of heroic melancholy. Surely, I would be asked when I spoke with college students, surely I saw the value in alienation. One medical philosopher asked what it would mean to prescribe Prozac to Sisyphus, condemned to roll his boulder up the hill.

That variant of the what if question sent me to Albert Camus's essay on Sisyphus, where I confirmed what I thought I had remembered -- that in Camus's reading, Sisyphus, the existential hero, remains upbeat despite the futility of his task. The gods intend for Sisyphus to suffer. His rebellion, his fidelity to self, rests on the refusal to be worn down. Sisyphus exemplifies resilience, in the face of full knowledge of his predicament. Camus says that joy opens our eyes to the absurd -- and to our freedom. It is not only in the downhill steps that Sisyphus triumphs over his punishment: ''The struggle itself toward the heights is enough to fill a man's heart. One must imagine Sisyphus happy.''

I came to suspect that it was the automatic pairing of depth and depression that made the medical philosopher propose Sisyphus as a candidate for mood enhancement. We forget that alienation can be paired with elation, that optimism is a form of awareness. I wanted to reclaim Sisyphus, to set his image on the poster for the campaign against depression.

Once we take seriously the notion that depression is a disease like any other, we will want to begin our discussion of alienation by asking diagnostic questions. Perhaps this sense of dislocation signals an apt response to circumstance, but that one points to an episode of an illness. Aware of the extent and effects of mood disorder, we may still value alienation -- and ambivalence and anomie and the other uncomfortable traits that sometimes express perspective and sometimes attach to mental illness. But we are likely to assess them warily, concerned that they may be precursors or residual symptoms of major depression.

How far does our jaundiced view reach? Surely the label ''disease'' does not apply to the melancholic or depressive temperament? And of course, it does not. People can be pessimistic and lethargic, brooding and cautious, without ever falling ill in any way. But still, it seemed to me in my years of immersion that depression casts a long shadow. Though I had never viewed it as pathology, even Woody Allen-style neurosis had now been stripped of some of its charm -- of any implicit claim, say, of superiority. The cachet attaching to tuberculosis diminished as science clarified the cause of the illness, and as treatment became first possible and then routine. Depression may follow the same path. As it does, we may find that heroic melancholy is no more.

In time, I came to think of the van Gogh question in a different light, merging it with the eradication question. What sort of art would be meaningful or moving in a society free of depression? Boldness and humor -- broad or sly -- might gain in status. Or not. A society that could guarantee the resilience of mind and brain might favor operatic art and literature. Freedom from depression would make the world safe for high neurotics, virtuosi of empathy, emotional bungee-jumpers. It would make the world safe for van Gogh.


Depression is not a perspective. It is a disease. Resisting that claim, we may ask: Seeing cruelty, suffering and death -- shouldn't a person be depressed? There are circumstances, like the Holocaust, in which depression might seem justified for every victim or observer. Awareness of the ubiquity of horror is the modern condition, our condition.

But then, depression is not universal, even in terrible times. Though prone to mood disorder, the great Italian writer Primo Levi was not depressed in his months at Auschwitz. I have treated a handful of patients who survived horrors arising from war or political repression. They came to depression years after enduring extreme privation. Typically, such a person will say: ''I don't understand it. I went through -- '' and here he will name one of the shameful events of our time. ''I lived through that, and in all those months, I never felt this.'' This refers to the relentless bleakness of depression, the self as hollow shell. To see the worst things a person can see is one experience; to suffer mood disorder is another. It is depression -- and not resistance to it or recovery from it -- that diminishes the self.

Beset by great evil, a person can be wise, observant and disillusioned and yet not depressed. Resilience confers its own measure of insight. We should have no trouble admiring what we do admire -- depth, complexity, aesthetic brilliance -- and standing foursquare against depression.

Peter D. Kramer is a clinical professor of psychiatry at Brown University and the author of ''Listening to Prozac.'' This essay is adapted from his book ''Against Depression,'' which Viking will publish next month.

 

[sweetnpetite]

I feel that you made several assumptions and misinterpretations. We're bound to differ, then, on that issue. For example... a misinterpretations:

First of all, I never said anything about "reading extensively"--personally, I think that's a bullshit term people use when they think they know something. That's misinterpretation number 1.

Past that, I said that I had read nothing that granted ADD people any special insight abilities. Now, I have read several studies on ADD (I had to for a class), those studies covered a broad range of ideas about the disorder. Now, having read about ADD and having been informed about ADD, this doesn't mean that I'm automatically going to have read that stuff about them having "special insight"--given that those studies aren't the most popular, well-done, best peer-reviewed, most-conclusive, etc. ones out there. I'm sure we could find an ADD study that claimed ADD doesn't exist, but just because you haven't read it doesn't mean you're not well-read about ADD. That's a horrible assumption to make. I'm inclined to believe because I have not read any conclusive study about ADD being a "special insight giver" AND have only read reports about its symptoms, difficulty to diagnose, industry fear of it being "overblown", and effects from the disorder... well, no, I'm afraid a prosey article making a half-splash attempt to attribute creativity to some ADD people is not clear and convincing.

That's me just being intellectually cautious.

A few things.

I never claimed that you had said that you had 'read extensively.' I said that you were uninformed or underinformed. I don't know if I said I "read extensively' either. However, I have read on both sides of the debate- whether that is extensive or not, I'll leave to you. I have read studdies, articles, interviews, books, ect. I have read them for personal as well as educational reasons. I read while attempting to keep an open mind about it while writing a critical thinking paper for a phychology class. If memory serves, I got an A on the paper, indicating that I probobly did a fairly decent job on the stated goals. Since I had been diagnosed with the condition, I had my own questions and uncertainties. However, upon reading it quickly became clear to me that many of the naysayers who insist that it is not a real condition, have no idea what they are talking about. It's difficult to explain this other than to say that if you read a story or article by someone claiming to have attended your school in recent years, you would quickly know from your own experience that they didn't know what they were talking about.

Back to the topic of the first point however. YOu did seem to claim to be talking from an educated point of view and in fact seemed to be arguing that you were. So I think it's fair (and not presumptuous) to challenge that. You stated that you had not read anything concerning postive aspects (or special attributes or however you put it) about ADD, and I posted some. The 'prosy article' is written my a phychyatrist who specializes in ADD and also has it himself. He is the author of one of the main consumer books on the topic, "Driven To Distraction." You still don't have to believe it, I'm just sayin...

It seems to me (and I'll try to stay calm and nice here) that you demand an exremely high burden of proof (and I consider this a social discussion, not an acedemic debate or a meatin' before the faculty to prove worthiness for funds to conduct some highly controversial study), yet avoid that for yourself by never truly aserting anything and merly casting 'intellectually cautious' doubt. Yes, I've said it before. And I've said it less nicely. I realize that peoples minds are hardly ever changed in a forum such as this, however the frustration -in cases with you- is that you seem to give the impression that you could be convinced if somehow the point could be proven to your standard, which it never is. You are a grad student of logic know less, and even a teacher of the topic. I have about 3 semesters of community college- not even an associate degree. I think (and this may be presumptous of me) that I am generally able to hold my own with you, and sometimes even come out ahead (by a nose) but you seem to me to demand certain standards of thoughoughness that I am just not able to deliver, nor do I expect to outside of some kind of acedemic puplishing that I don't aspire to.

All of the above, is of course, and aside, a rant and I appologize. I have gone off topic. Before I have been hesatant to come right out and say, "hey, I don't have a college degree. I'm doing the best I can to make my points." For some reason- maybe I'm feeling less competative at the moment, I just feel like puting that on the table now.

If you notice, I too hop around a lot trying to make my point. I'm an ADD basketcase myself (attempt at humour, not excuse) But I think you'd hire me anyway. Because I'm good at certain things, and pluswize I'm darn cute

Peace.

 

[sweetnpetite]

SnP brought up the example of the surgeon with ADHD who posed a risk to his patients, and was therefore not subject to EEOC relief - I think this demonstrates adequate understanding of the point JoeW was trying to make. However, JoeW demonstrated an inadequate understanding of the EEOC laws when he failed to to consider the central tenant of the law, which is the question of "reasonable accomodation"...
Point awarded: Sweetnpetite

I'll take it

Thanks.

 

[sweetnpetite]

On the topic of taking advantage of disabilties- yes i agree that it is possible- in fact easy to do so. Real or imagined. I don't see that as anyway conected to the validity of anyone elses diagnosis or to the existence of the disease or disorder. and that was the point I wanted to make about that.

I know a man who had to have two legs amputated. He has a real physical disability- there is no desput to that. Yet, he is capable of far more than he ever attempts. He uses it fully to his advantage and in fact he is lazy, unmotivated, ect, ect, ect- all of those things. Yet still, none of that proves that he's not in fact, actually disabled.

1)There are always people who will take advantage.

2)People with disabilities aren't suddenly saints. They are just like the rest of the world. Some are lazy, some are not. I know a surviror of childhood cancer who grew up to be a physically abusive ass. They are really separate issues. People with disabilies shouldn't have to be morally better than the rest of the world in order to qualify as disabled. Disabled or not disabled- we're all a bag of mixed nuts

 

[Joe Wordsworth]

I took a lunch, today, with the Psych Department (where I started grad studies in Clinical and just found myself bored before moving onto what I've done) and asked them many of the same questions about ADD discussed here. The responses were, as I figured they would be, so varied as to be inconclusive.

This summarizes that whole lunch:

ADD may be real, in much the same way that MPD may have been real when it was first coming into popularity. That is to say, something is wrong, but whether that something is a genuine disorder or a sub-clinical disorder is up in the air because very few conclusive things have ever been produced about it. A hyperactivity disorder has been identified, however this too is difficult to diagnose (and as a result, even more difficult to study) because the symptoms, specifically, are symptoms people can have without necessarily having the dirsorder. This in contrast to things like Schizoprenia, where there is a unique, abnormal thing going on that doesn't share its key symptoms with normal people.

As a result, a lot of ink is being spilled by all sorts of people trying to explain what this is--too many of them are people choosing to establish it's pro's and con's and results before the clinical world has a solid grasp on what the problem is to begin with. Medications have been prescribed and popularized (one of the major problems) to treat symptoms that the clnical community still isn't certain are beyond normal human occurance. That isn't to say that medication doesn't work, obviously Vallium works to mellow people out, but that doesn't mean everyone has true anxiety disorders.

In the end, the popular community of doctors or pharmacists (the number of these that are in bed together has been one of the most shameful things about Psychology in general, and Psychiatry, specifically) have a lot of studies about a condition that may or may not be "diagnosing something within the normal range". Now, none of that means ADD doesn't exist, but it means that we are only starting to understand it and may find that many of our assumptions (even well studied assumptions) are only based on more assumptions... we may find that this isn't a disorder at all--or that people considered to have this disorder have something else wrong with them entirely.

The popularizing of ADD wasn't the discovery of Small Pox. It wasn't even the discovery of anti-social personality disorder. It is more akin to the discovery of cancer... people have it, and on some level of analysis every human being on the planet has it in some way or another, but the cause may not be necessarily this thing or that thing, the treatments may not be good treatments, and it doesn't exist yet in a defined and truly clinical manner.

My favorite quote from that lunch was the only one I bothered writing down:

"ADD is the whiplash of the psychological world... we don't know enough about it to nail down a why, or even a 'is it real', but that doesn't mean we haven't been able to treat it with some success. We may find in ten years we were treating a variant of a basic stress disorder and wonder what all the hoopla was about."

 

[Joe Wordsworth]

You are right, though, sweet. I am very discriminating about the level of "conclusive" I require of people. I can try and scale that back, but its not easy. In some sense we have to be patient about it.

 

[sweetnpetite]

You are right, though, sweet. I am very discriminating about the level of "conclusive" I require of people. I can try and scale that back, but its not easy. In some sense we have to be patient about it.

I feel like this deserves a comment. I was afraid that instead of making my point I would just end up offending you, but you saw what I was saying, and agreed with me (!) and well I'm glad it turned out good.



I'm on a bit of a high right now, so I won't bother to try to argue any more for the moment