> As a side note, she also mentioned that the newest fad (not quite at gut distress levels yet) is middle-aged men insisting they have ADHD…

The reason for this "fad" is straightforward — there are a lot of middle-aged humans who are undiagnosed because ADHD was effectively "not a thing" when GenX were kids.

> …demanding diagnosis and prescriptions.

Great! People of all ages should advocate for themselves and pursue health care that might improve their quality of life.

> The reason for this "fad" is straightforward — there are a lot of middle-aged humans who are undiagnosed because ADHD was effectively "not a thing" when GenX were kids.

Or to the extent that it was, they only knew of it through narrow or outright inaccurate stereotypes. It's become a somewhat common story over the past few years in online ADHD communities for Gen X and older Millennial parents to get their kid diagnosed and have a "wait, that's not normal?" reaction to the explanation of how the condition actually tends to manifest.

But I think it was normal. Would modern undiagnosed children have flourished in less institutional settings? I think being on the dangerous edge used to be safer than being insufficiently experienced in dangers that were unavoidable and in many cases predatory.

ADHD have symtoms that could fit anyone. It is about a threshold.

I think "advocate for themselves" can be reductive. There is a spectrum of advocacy.

One approach is to work with a medical team over time to document symptoms and impact on your life, experiment and document attempted treatment alternatives, escalate to appropriate specialists as necessary, etc.

Another approach is to spend a weekend reading blog posts, forums and chatting with your bros, then convincing yourself of a particular syndrome/disease you must have, urgently scheduling an appointment with a brand new medical practitioner, refusing to discuss your medical history or symptoms since you already know everything, demanding a particular and specific treatment, refusing to discuss alternatives and then becoming hostile and aggressive when that practitioner doesn't immediately write you a prescription for the particular medication or expensive test that you have already decided that you need.

That second approach is a caricature that unfortunately approaches a modern reality, and it isn't what I'd term as "Great!" for anyone involved. The first approach is equally horrible since our system is so back-logged that the amount of time and personal effort between starting the process and receiving the help you need is onerous.

Note that this applies equally well to gastro-intestinal distress as it does to ADHD or any other chronic condition.

> There is a spectrum of advocacy.

There are plenty of "pill mills" and "scrip doctors", and plenty of patients who will abuse that gray-market system. That is not what I'm referring to when I talk about self-advocacy by people who need actual, legitimate help.

Watch how the lens deforms the content. You "drank the koolaid" on this one. There's a mental trick there, an inversion.

Ritalin is a stimulant that tricks the brain into believing it needs to perform and focus.

Saying

"I have ADHD, so I need my Ritalin to be normal"

is equivalent to saying

"I'm depressed and anxious, so I need my cocaine to feel normal"

It probably does help! If you are stuck in a rut, external tools can break you out and show you what the other side is like. But using drugs is basically lying to your brain.

> What she usually wants to say is: your life sucks, fix it and you will feel better. Go out for a walk, eat healthier food, make some supportive friends, engage in some self-care, meditate, etc.

It’s almost like we haven’t collectively created a society that aims to increase human flourishing and instead of created a living nightmare with the illusion of progress due to shiny new technologies.

This, so much this. My family often jokes about how I'm the health and fitness "freak", because I care about my wellbeing and stress levels. However, this is very normal in my social circle - and I would argue - in my class and generation. A few examples come to mind:

- The rise of social/fitness loci. Young people socialize through sports, cycling groups, climbing gyms. - The advent of data-driven fitness. So many people have wearables, sleep trackers, follow the science behind health (Huberman podcast, Rhonda Patrick, etc.). - More people are opting for healthier living, generally (regular bedtimes, stopping or greatly limiting drinking, removing stigma from mental health diagnoses).

It feels like this generation is the first to really prioritize physical wellbeing as a primary driver of overall quality of life. I sincerely hope this trend sticks, and we look back 20 years from now and are surprised that so many people for so long neglected the fundamentals of health.

Middle aged man with ADHD here. Just found out. Didn’t want it. Although it explains a lot of my almost 50 previous years. I am now sad.

> Although it explains a lot of my almost 50 previous years. I am now sad.

It's a matter of perspective. I find it a relief that many things I thought were my moral failings were simply predictable consequences of a common problem.

> middle-aged men insisting they have ADHD, demanding diagnosis and prescriptions.

My opinions on the matter, as someone with ADHD, is that I do not personally believe that treatments that can improve one's life should be gatekeeped (gatekept?) sheerly by disorders. In other words, if people have symptoms and medicine has the tools to treat said symptoms, then such tools should be used regardless of the condition. If one is struggling to achieve a life that is within their potential, then why should they be denied something that can assist them? It would be like saying, "only paraplegic people are allowed to use wheelchairs. It doesn't matter if your legs are broken, they still technically work, thus you don't deserve to use a wheelchair." It's not like various psychostimulants commonly used for ADHD weren't used for 70+ years prior to being indicated for ADHD and other conditions.

Personally, I have always hated the false dichotomy of either one having ADHD or not. I do not think it's that simple, and it is surely not a binary condition. The condition is nothing more than a label assigned to an arbitrary set of symptoms. Even the diagnostic criteria is not all encompassing of the many symptoms people with the condition struggle with.

Just thinking about the various people I know in my life, I would confidently say not all them have equal attention spans, executive functioning, etc.. So, what's the arbitrary cut-off?

Another issue that ADHD (and many other conditions) is that there is absolutely no way beyond a reasonable doubt to prove who has the condition and who does not. There is not a single biomarker -- no gene test, no urinalysis, no blood marker, no fMRI brain scan, etc. that can be used to definitely diagnose the condition in a clinical setting. The diagnosis is just a professional and clinically informed opinion using heuristics.

How was I diagnosed? I went through a gauntlet of exhausting interviews and somewhat pseudo-scientific psychometrics -- WAIS IV IQ test, Stop/Go test, and plenty of others that I cannot remember the name of. It's about as legitimate as one can hope for currently... or at least a decade ago.

With all the being said, I definitely think it's a completely real condition, I just think we are operating on a model similar to the Plum Pudding Model of the atom -- it's not completely wrong, but definitely not correct -- but it's the best we have at the moment. The question I often ask myself is that, "Is there something actually wrong with me, or is something wrong with the world we live in?" For me personally, this disorder has no negative health affects other than making me completely incompatible with this world. I mean, I'm within in the range of average height for adults males. My height causes me no issues in my life. However, if I were to play in the NBA, it would cause all kinds of issues. Does that mean I would have a height deficit disorder?

One more thing about the medications, people have no idea what they are messing with. Sure, stimulants would help a majority of people be more productive (caffeine/nicotine are common for a reason), but nothing in life is without a cost. They absolutely help me live a life that I would unlikely be able to without them. That doesn't mean they are sunshine and roses. In some ways, I feel like I made a deal with the Devil. I have had many friends with ADHD and many friends without ADHD that lied to get access to the medications too. I've seen these medications help people reach the heavens, and I have seen these medications drag people through utter Hell.

Anyway, sorry if this is all over the place and somewhat pointless. I do have ADHD after all. ;)

I really appreciate this response.

> I do not personally believe that treatments that can improve one's life should be gatekeeped (gatekept?) sheerly by disorders

In my most libertarian moments I totally agree. But I also accept (even if I don't agree) that a large number of people believe that the detriments to society as a whole (including to some individuals in particular) caused by the misuse of powerful and addictive substances outweighs the benefits of un-controlled access.

> How was I diagnosed? I went through a gauntlet of exhausting interviews and somewhat pseudo-scientific psychometrics -- WAIS IV IQ test, Stop/Go test, and plenty of others that I cannot remember the name of. It's about as legitimate as one can hope for currently... or at least a decade ago.

The "fad" I was talking about was individuals showing up to a medical professional and having the totally unrealistic expectation that after a one hour consultation they would be diagnosed with a severe mental disorder and that they would walk out that same day with a prescription for a controlled stimulant.

The real path to treatment in our system is much more difficult. You have to demonstrate and document a history of symptoms and their effects on your life. It can take 6-12 months in many places to get into a specialist like a psychiatrist. Then it can take many more months of experimentation with alternative treatments before being prescribed medications.

That path is, frankly, atrocious. We are so starved for qualified resources that the system purposely slows things down. If you are able to work and live life even minimally - you are low on the priority list in many cases. There are enough truly horrible cases (severe schizophrenia, bipolar, etc.) that involve people unable to function at all that those who are merely suffering can get ignored. Front-line medical workers gate-keep access to specialists out of necessity, not out of malicious intent.

The patience you demonstrated to get the help you need is commendable but also proof that the system delivers for those who need it.

The alternative path that many choose to take is to become hostile, aggressive or abusive. They refuse to push through the system or to even attempt alternatives. They demand a specific diagnosis and a precise medication and they get angry when they don't get it.

> In some ways, I feel like I made a deal with the Devil.

This is is one reason why the system pushes people to try every alternative possible before going down the route of medication. If someone can find any alternative to medication to manage their symptoms - they ought to avoid the diagnosis and avoid the medicine.

It is just the case that many possible alternatives, including life-style changes, are explicitly forbidden to talk about. So while the medical practitioner may want to say: you need better friends, a better job, a better life in general ... they often cannot. Nor are some aggressive and hostile people willing to listen even if they could.

> But I also accept (even if I don't agree) that a large number of people believe that the detriments to society as a whole (including to some individuals in particular) caused by the misuse of powerful and addictive substances outweighs the benefits of un-controlled access.

I completely understand where you are coming from. I really think it is a detrimental society that pushes people into that direction. I have noticed that I mainly take stimulants due to the demands of other people. Do I care if my project is not completed on time? No. Does my employer? Absolutely. I wouldn't be surprised if some of that parallels with others. I hate having to kill myself from the inside out just to function in this world, but I do what I have to do in order to survive.

> The real path to treatment in our system is much more difficult. You have to demonstrate and document a history of symptoms and their effects on your life. It can take 6-12 months in many places to get into a specialist like a psychiatrist. Then it can take many more months of experimentation with alternative treatments before being prescribed medications.

This is where I had a wildly different experience. I guess it is probably because I am not part of the "fad" you are talking about. However, my university had a psych on staff. I scheduled an appointment with him, and I saw him in like a couple days afterwards. He did a basic interview with me, and based on just my behaviors, mannerisms, etc.. He chuckled and said, "You are so ADHD. However, I need to you undergo formal testing out of policy, you should go to <insert name of place.>"

So, I scheduled an appointment, and did all the interviewing testing in two or three sessions, and I was being treated in like two weeks or less. Alternative treatments were actually never even attempted nor suggested. It was straight to medications.

I've still not had many issues getting into doctors, and perhaps I am just very lucky in that regard. I recently left my most recent psych and moved to my GP. He will only treat me because I have a formal diagnosis (e.g. documentation "proving" it). If a psych or another doctor diagnosed me and treated me, that would not be sufficient because my GP claims there wouldn't be enough "evidence" to prove I have the condition. So, I do feel bad for many people who were diagnosed in less formal ways.

I am all for the alternative path, and I am starting to investigate how to go down that path. I have not been very thrilled with psychiatrist. I have many qualms with how psychiatry as a field operates. I am not anti-medicine by any means, but I have never seen nor heard of such a punitive and unscientific field of medicine. Never forget, it's the only field of medicine that can make patients take medicine against their will and involuntarily hold someone against their will.

If you are diabetic, a doctor can prescribe you insulin, but the doctor cannot force you to take the medication. The doctor cannot not commit you despite the fact that abstaining from insulin would cause direct harm. Psychiatrist, however, do have that option depending on the case and the patient.

I have seen around 10 or more psychs/psych NPs in my life. I have always hated how I have had to walk on eggshells around them, so to speak. I feel like they have never taken ADHD seriously and that they act like they are doing me a favor and that I should get on my knees and kiss their feet. Medication not working well? Don't you fucking dare ask for a dosage increase -- what are you some kind of addict?

Not to mention all the random drug tests. Do they test for alcohol or tobacco -- two of the most damaging substances on the planet? Absolutely not. Take CBD with negligible amounts of THC, but enough to pop hot on a urinalysis? Doesn't matter, you are a drug addict. Kiss your prescription, your job, and your life stability good bye. In fact, my previous practice would refuse to treat you and would kick you out of their practice. We had to sign "Controlled Substance Agreements" and all this other horseshit.

Substance Use Disorders are so correlated with ADHD that they are damn near a symptom of untreated ADHD in teens/adults. What field of medicine punishes patients for a medical disorder -- isn't a SUD a valid medical condition? Should a diabetic have their treatment revoked due to a SUD? Not to mention, ADHD medication has plenty of research to back that it does not worsen and may prevent the development of SUDs in people with ADHD.

> So while the medical practitioner may want to say: you need better friends, a better job, a better life in general ... they often cannot.

I completely agree. In fact, I have noticed that myself. I am quite depressed as of lately, however I do not think there is something wrong with me. In fact, it's the opposite. My mind/body is working correctly. I am not in a good place -- miserable job, almost no social life, no hobbies, no goals, no passions, etc.. I mean, who wouldn't be depressed? However, I have been making small steps in the right direction (this isn't my first rodeo). I beat depressions ass many times before, and I will do it again. I refuse medication for it because I feel it would hinder my from making the right steps, and would rather sedate me enough to tolerate my shit situation -- it's what happened last time.

> If someone can find any alternative to medication to manage their symptoms - they ought to avoid the diagnosis and avoid the medicine.

I support this practice too. I do not think medication should be the go-to unless it is completely warranted. Besides, I hate to say it, but honestly, I am not really sure the ADHD meds work all that well to begin with. I often joke that I swear they work better for people without ADHD than those with it.

I mean, are they better than nothing? Absolutely. I still take them for a reason. However, they are far from a silver bullet. I feel like I get about 25%-50% reduction in symptoms, which is enough to help me achieve stability to some degree, but I wish they worked better. The average non-ADHD person is still probably far more productive than I am. Thus, I have been really been considering alternative approaches. It just seems no matter what I do I will always revert to the mean. Maybe that's just how I am supposed to be. =)

This disorder and the trauma that is has caused me will probably always hold me back in life. But hey, in the grand scheme of life, I have a lot to be thankful for, and I am lucky I do not have a worse condition. I'll never be a FAANG developer or work at some fancy start-up, but there is more to living a good life than a maxed out career.

Newest fad, trying to get legal amphetamine.