One of the problems is that our models for "physical" nonbehavioral illness don't translate well into neurobehavioral problems.
Something like ADHD is heterogeneous (the AD problems are different from the H problems), but not totally so. Also, attention and behavioral control problems are normally distributed, like the good ol' bell shaped curve. They're fuzzy.
So those who claim it is not a real disease are correct in a sense: it's not like color blindness, or having a missing limb, or Huntington's disease or something like that. They're also right that it's normal to have attention problems at various points in life for various reasons. However, those who claim it is a real illness are also correct: there are people who have very unusual levels or patterns of attention problems, and even though they're not qualitatively different, they're quantitatively different, and they have serious problems as a result, and are not just screwing around or lazy.
Behavior problems are often much more akin to something like blood pressure or weight. So, it's true that you wouldn't say "high blood pressure is a disease." However, it is a state of illness, might reflect a disease, and can lead to death and other problems. Same with excessive weight. Some pudginess is normal, but at some level it becomes medically threatening. The boundary is vague, and arguments about whether or not weight problems are biological or environmental or social or behavioral are misleading: they're all of the above.
The problem is that when people say "I see my neighbor with ADHD, and think they just need to realize that's a normal part of life," part of what happens is that they're assuming that their own experiences with attention problems are the same as theirs, or that their neighbor who might be exaggerating is the same as everyone else with an ADHD diagnosis, or that their neighbor who has mild but clinically problematic attention problems is the same as the person with severe problems.
My favourite analogy, that I can't believe doesn't come up more often in these discussions:
Having a degree of ADHD is like having a degree of nearsightedness. Yes, almost everybody has some. And you know what that translates to? Almost everybody wearing glasses. It's "normal" to be nearsighted... and it's just as "normal" to wear glasses to correct it.
Imagine if people with a small amount of nearsightedness were expected to just struggle through their life without glasses. Wouldn't that be weird?
Thanks for taking the time to write that - I'm going to recycle several of your points in future conversations. This is a frustrating topic for me as I've been through not acknowledging to myself that I had a problem, getting therapy, trying many different medications, investing time and effort to change diet and exercise habits and so on. Many things have led to incremental improvements but it's still An Issue, and explaining things to people from scratch really gets old.
Something like ADHD is heterogeneous (the AD problems are different from the H problems), but not totally so. Also, attention and behavioral control problems are normally distributed, like the good ol' bell shaped curve. They're fuzzy.
So those who claim it is not a real disease are correct in a sense: it's not like color blindness, or having a missing limb, or Huntington's disease or something like that. They're also right that it's normal to have attention problems at various points in life for various reasons. However, those who claim it is a real illness are also correct: there are people who have very unusual levels or patterns of attention problems, and even though they're not qualitatively different, they're quantitatively different, and they have serious problems as a result, and are not just screwing around or lazy.
Behavior problems are often much more akin to something like blood pressure or weight. So, it's true that you wouldn't say "high blood pressure is a disease." However, it is a state of illness, might reflect a disease, and can lead to death and other problems. Same with excessive weight. Some pudginess is normal, but at some level it becomes medically threatening. The boundary is vague, and arguments about whether or not weight problems are biological or environmental or social or behavioral are misleading: they're all of the above.
The problem is that when people say "I see my neighbor with ADHD, and think they just need to realize that's a normal part of life," part of what happens is that they're assuming that their own experiences with attention problems are the same as theirs, or that their neighbor who might be exaggerating is the same as everyone else with an ADHD diagnosis, or that their neighbor who has mild but clinically problematic attention problems is the same as the person with severe problems.