What is a “mental disorder”? Where is the line that separates an inconsistent personality, maybe a creative genius who is also socially awkward, from a clinical condition that may need medical intervention?

More importantly, who should decide if someone is mentally disordered? What if our self-doubtpsychiatrist is wrong? Such labeling not only creates self-doubt in the patient’s mind, it also attaches a social stigma that is often hard to dispel.

“Harmful dysfunction”

Some cases are easy to diagnose. If someone shows unusual behavior that can be harmful to himself or others, he clearly needs professional help; for example, patients suffering from major depressive disorders often have suicidal thoughts, and are likely to attempt it if not given timely help.

This example easily fits the notion of “harmful dysfunction” that Dr. Russell Barkley, a renowned psychiatrist and ADHD expert, proposes to describe the criteria for mental disorder. I agree with Dr. Barkley, up to this point.

Is there a “universal” human behavior?

But then he continues (italics are mine for added emphasis),

For there to be a legitimate, valid disorder, there must be hard scientific evidence that there is a failure or a deficiency in some mechanism that is universal in human beings, a physical mechanism like a heart, a liver, a stomach, a brain. But it can also be a mental mechanism such as … behavioral inhibition.

and again,

Mental disorders are failures or serious deficiencies in mental mechanisms that are universal to the design of this species.

I can not disagree more! I do not have to be a psychiatrist to know that unlike a hyperactivityphysical mechanism like heartbeat, where even a slight irregularity can cause serious bodily harm, the range of human behavior is just too vast to have a “universal standard”.

Take the lack of behavioral inhibition, or “disinhibition” as Dr. Barkley calls it, which is considered by many as the strongest symptom of ADHD in kids. But each of us, ADHD or not, shows almost a continuous range of behavioral responses, from sublime poise to annoying impulsiveness. Where should we draw the line, and stamp someone (mentally) disordered?

Is ADHD behavior pattern a harmful dysfunction?

I am not at all convinced there is enough evidence to call ADHD behavior even a dysfunction, let alone harmful. I argue instead that it falls within the wide behavioral range of normal people. (Small wonder that the biggest disagreement today about ADHD in kids is on what is a normal behavior.)

You have two choices. One, accept Dr. Barkley’s (and most others’) view of a narrow range of what constitutes permissible normal behavior, determined by his “universal mental mechanism” (which I believe to be flawed). It is then easy to banish all ADHD-related behavioral patterns outside this restricted range, and brand them dysfunctional.

Or, accept my expanded view and broaden your tolerance for normal behavior to include ADHD. If ADHD is normal, by definition it cannot be harmful. That is, I believe ADHD should be taken as a special class within the highly variable human personality (with some unique traits), rather than a clinical disorder.

It is intriguing that while Dr. Barkley talks of universality to make his case for dysfunction, he invokes “cultural context” to argue potential harm from ADHD. In addressing the question “Does ADHD produce harm to the individual?”, he says (italics are mine),

Now that of course is going to be culturally relative because it depends on the demands that the culture makes on that mental mechanism.

In other words, if your culture is made up of happy-go-lucky folks who love fun and games (as some European cultures are), ADHD is probably a blessing. Whereas, if you belong to a culture that is more work and less fun (as is much of today’s western culture), ADHD can harm your life and career prospect.

That is, unlike most physical (and some mental) deficiencies, ADHD with its behavioral oddities can at most cause only long-term harm, and can possibly be even “cured” by a suitable career move that suits your special abilities.

Is ADHD a real disorder?

To wrap up for now, my answer to this question by Dr. Barkley is that ADHD is real alright, a real personality, not a disorder.

In a later post, I will use evolutionary insights to argue further in favor of ADD being a normal trait. Stay tuned.