MELBOURNE: An hour after I swallowed the tablet I walked down to my local shop and the man behind the counter, who I talk to often, said something to me and I said nothing back. I stood there and looked at him and I could see him working out whether he had offended me. The next day I had to go back and apologise.
The tablet was lisdexamfetamine, an amphetamine, and one of the drugs we give to children and adults with ADHD. I’d taken it because a few weeks earlier I had been diagnosed with the condition myself at the age of 46, after more than 20 years working as a psychiatrist.
The assessment came about because I was making a documentary about why ADHD diagnoses have risen so steeply over the past few years and I wanted to know what going through an assessment was actually like. I didn’t really think I’d end up actually being diagnosed with it.
The production company paid £1,200 for a private online consultation and formal psychiatric report and I picked a reputable company who employed a consultant psychiatrist with considerable experience, because this wasn’t about finding rogue clinics but rather understanding the process that thousands of people are going through each year.
I sat in my flat in front of a laptop, as most people now do, and answered an hour and a half of questions she asked me. Prior to this I completed a long list of forms and a family member filled out a questionnaire about what I was like as a child. At the end of it all, to my slight shock, I was told I had ADHD, combined type, the full set of inattention, hyperactivity and impulsivity, and was prescribed a month of lisdexamfetamine. I don’t accept the diagnosis and I’ll come to why, but something happened in the days afterwards that I was not remotely prepared for.
I started to hear a little voice in my mind. I would forget where I’d put my phone, or realise I had read the same paragraph four times, or find myself talking over somebody and the voice would say, “Is that my ADHD?” Nothing about me had changed — I’d lost my phone the week before and thought nothing of it, but now every ordinary human failure or struggle or difficulty came with a footnote and things I had always taken to be simply me were being reclassified as symptoms.
Sociologists call this labelling; the process by which a description hardens into an identity and then begins to generate the very behaviour it claimed only to observe. Medicine has its own version— “diagnostic overshadowing”, where a label is attached and every subsequent difficulty is seen through this prism, so nobody looks for another explanation. What unsettled me was how quickly it got in my head. If it can work on me in the days after a diagnosis, I find it hard to imagine what it does to a nine-year-old told this is simply who he is and always will be.
Because I do have the traits. My timekeeping is so poor that a friend holding a birthday party on a boat once sent me an invitation with a departure time an hour earlier than everybody else’s, on the reasonable assumption that I’d otherwise be waving at the stern from the quayside. I lose my phone several times a day and, left to itself, my body would go to sleep at 4am. I fidget and have to stop my feet moving when I’m sitting with a patient. I work at home with hard techno playing continuously, because the noise stops my mind wandering off.
What I’ve done about it, over many years, is develop strategies. Everything goes in the diary with alarms for when I need to leave and I put flight times in earlier than they are. Every evening I write the next day’s tasks on an index card and carry it in my pocket and cross them off, and without it there is chaos. My inbox is at zero by the end of each day, because if a thousand messages sat in it I would miss something important to somebody.
To me, this is a life being managed, which I’d suggest is what most lives consist of, because we are all dealt a hand and spend our time working out how to play it. The idea that I have ADHD feels like normal human variation and struggles are being medicalised. My traits have infuriated me at times, but they’ve also given me a career I love, several books, a career in journalism, a company I run, a fantastic medical career I love and the energy that gets all of it done. Calling that a disability, which is what I was told during my assessment, doesn’t describe me, and it borrows a word that other people need.
What I find strange is that everywhere else in psychiatry we take a person’s circumstances seriously and we understand that the world someone lives in can impact on how they feel and behave. No competent doctor treating a depressed woman would disregard the fact that she has been made redundant, or is nursing her mother alone, or hasn’t slept properly since the baby arrived, and we’d think it negligent to hand her a prescription and not consider the environmental, psychological and social factors. With ADHD that habit of mind has been mislaid and we have settled on the idea that the difficulty sits inside the child permanently and that the world around him is beside the point.
Yet look at the world we’ve built for him. The criteria have widened over the years, so behaviour once thought unremarkable now falls inside the diagnosis. We’ve handed children devices engineered to capture their attention and then fragment it and built an education system that measures them by how still they sit and how well they do in examinations. We’ve given everybody a way of comparing their chaotic inner lives with other people’s edited outer ones, which leaves them convinced that everyone else is coping and they alone are not. My film examines all of this and I came away thinking that if you set out to manufacture a population with attention difficulties, you’d build something close to the world we now live in. We’ve built an environment in which it’s hard for anybody to concentrate, sit still or feel calm and then diagnosed the people who struggle in it.
Which brings me to the most hopeful thing anybody said to me while making the film. Professor Katya Rubia at King’s College London has spent 30 years scanning the brains of people with ADHD and is a world authority on the subject. She told me that when you look at individual children rather than group averages, many with the diagnosis have entirely normal brains and no scan will tell you who has it, because, as she put it, “it’s a concept which is based on behaviour”.
Then she said the thing we almost never hear, which is that the brain is highly plastic, that brain and behaviour are two sides of one coin and that when behaviour changes, the brain changes with it. So even where a difference shows up, it may be the result of how a child has been living rather than the cause of it, and it isn’t fixed. Nor is there an ADHD gene — only small parts of genes, each of vanishingly small effect and most turning up in depression, autism and schizophrenia too.
Which brings me back to the drug. In the film I took a single dose and some weeks later, with filming finished, I decided a day wasn’t a fair test so I took the rest of the medication I’d been given. I managed three weeks. I hated every moment. I’d assumed the zombie comparison people make meant sleepy and it isn’t that at all. I could sit and work without getting up, which was novel, but I was dulled and flattened, as though somebody had turned the colour down. My thoughts came more slowly, I wasn’t curious about anything and nothing struck me as funny. I write for a living and I could feel that going, which is what finished it, because the slightly frantic way I have of being helps me get everything done. I stopped and I wouldn’t take it again.
Had I been given the diagnosis 30 years ago I’m not sure I’d have bothered building the strategies I rely on every day. Why would you, if you’ve been told there’s something wrong with you and nothing to be done but take the tablets? I’m not arguing that nobody should. There are people whose attention and impulsivity are so overwhelming that day-to-day life is beyond them and if the medication helps them, I’d never take it away. But I don’t believe millions of us have been ill all along and are only now being noticed, and I think we have stopped asking what we are doing to our children, because a prescription is quicker and easier.