The “no” of adhd

No!
Photo by Andrea Piacquadio from Pexels.

There exists in every person with adhd a ‘no’ lying in wait. I simply call it oppositionalism. To be oppositional means to stand against something:

ob-” – against
position” – place

In my experience, oppositionalism is a characteristic of every single person I have met with adhd. It is not a pathology, although the DSM would have us think otherwise. It is the way some people are as the result of their experience in the(ir) world. In this way, it is my hypothesis that oppositionalism is not something that is an organic or first order feature of those of us who identify as neurodiverse or a person with adhd. Rather, I think that oppositionalism is produced as a result of living in the world in a very particular way: that way I will simply describe as ‘openness’ in the affirmative and ‘undefended’ as what I think of as the negative space of that idea.

In my experience, oppositionalism is a characteristic of every single person I have met with adhd. It is not a pathology, although the DSM would have us think otherwise. It is the way some people are as the result of their experience in the(ir) world.

Openness/undefendedness is, to my mind, one of the elemental experiences of being a person with adhd. This is not the definition found in any of the research on adhd, nor is it included in the criteria for formal diagnosis. Below is a table with all the diagnostic criteria taken directly from the DSM-V (American Psychiatric Association & American Psychiatric Association, 2013, pp 59-60).

Inattentive

  • Often fails to give close attention to details or makes careless mistakes in schoolwork, at work, or during other activities (e.g., overlooks or misses details, work is inaccurate).
  • Often has difficulty sustaining attention in tasks or play activities (e.g., has difficulty remaining focused during lectures, conversations, or lengthy reading).
  • Often does not seem to listen when spoken to directly (e.g., mind seems else
    where, even in the absence of any obvious distraction).
  • Often does not follow through on instructions and fails to finish schoolwork, chores, or duties in the workplace (e.g., starts tasks but quickly loses focus and is easily sidetracked).
  • Often has difficulty organizing tasks and activities (e.g., difficulty managing sequential tasks; difficulty keeping materials and belongings in order; messy, disorganized work; has poor time management; fails to meet deadlines).
  • Often avoids, dislikes, or is reluctant to engage in tasks that require sustained
    mental effort (e.g., schoolwork or homework; for older adolescents and adults, preparing reports, completing forms, reviewing lengthy papers).
  • Often loses things necessary for tasks or activities (e.g., school materials, pencils, books, tools, wallets, keys, paperwork, eyeglasses, mobile telephones).
  • Is often easily distracted by extraneous stimuli (for older adolescents and adults, may include unrelated thoughts).
  • Is often forgetful in daily activities (e.g., doing chores, running errands; for older
    adolescents and adults, returning calls, paying bills, keeping appointments).

Hyperactive

  • Often fidgets with or taps hands or feet or squirms in seat.
  • Often leaves seat in situations when remaining seated is expected (e.g., leaves his or her place in the classroom, in the office or other workplace, or in other situations that require remaining in place).
  • Often runs about or climbs in situations where it is inappropriate. (Note: In adolescents or adults, may be limited to feeling restless.)
  • Often unable to play or engage in leisure activities quietly.
  • Is often “on the go,” acting as if “driven by a motor” (e.g., is unable to be or uncomfortable being still for extended time, as in restaurants, meetings; may be experienced by others as being restless or difficult to keep up with).
  • Often talks excessively.
  • Often blurts out an answer before a question has been completed (e.g., completes people’s sentences; cannot wait for turn in conversation).
  • Often has difficulty waiting his or her turn (e.g., while waiting in line).
  • Often interrupts or intrudes on others (e.g., butts into conversations, games, or
    activities; may start using other people’s things without asking or receiving per
    mission; for adolescents and adults, may intrude into or take over what others are doing).

Notice that every single diagnostic indicator is behavioural: that is, every diagnostic indicator is in the realm of doing or not doing that can be observed and measured. But none of it gets at or even attempts to get at what produces those behaviours. I will not be able to focus here on all the elemental or primary aspects of the experience of being a person with adhd. Those will follow in future posts. I will focus on the experience of openness/undefendedness and its compensatory orientation: oppositionalism.

Oppositionalism is a stance against something, namely the things to which we are constitutionally open. To understand this compensatory stance, this way of defending oneself (i.e. a deliberate way of combating one’s state of undefendedness), let me first describe the ways in which those of us with neurological differences are open in our the world. I provisionally categorize openness in the following way.

Photo by cottonbro studio from Pexels.

Before reading the list below, it is important to note that It is not the case that everyone with adhd is open to the(ir) world in the same way. I am, for instance, extremely sensitive to auditory stimuli. Anyone who know me knows that I am never far from a pair of noise cancelling headphones or earbuds. The world in which I live is screamingly loud, and that experience of loudness produces in me a sense of being startled, frustration, annoyance, and anger. Like many with adhd, I struggle in a world that is full of sounds that produce in me (notice the passive voice, as “I” don’t have anything to do with the production of those emotions, but I am the one who is locked into experiencing them) very strong emotional and physical states: disgust, anger, and defeatedness to name just a few.

This is my provisional list of ways in which people with adhd are open/undefended in the experience of the(ir) world. I will explore each of these in the weeks that follow.

  • Sensory
    • Auditory
    • Tactile
  • Relational
  • Built environment (architectural)
  • Things (objects)
  • Orderliness/disorderliness (this may be a kind of master category?)
  • The past (our past)
  • Possible futures
  • Existential structures (as per Irvin Yalom – )
    • Death
    • Isolation
    • Freedom
    • meaninglessness
  • The void – the no-thing – “state 2”

In this first post, there isn’t time to interrogate and describe all of these ways in which those of us with adhd are open/undefended against the(ir) world. That is part of the larger project, to categorize properly and describe the ways in which this openness produces the behaviours that we typically associate with the condition. And, in so doing, work toward therapies and interventions that work on the elemental processes and not play whack-a-mole with the downstream behavioural products.

Do people with adhd tend to get distracted, fidget, get emotionally dysregulated more easily than most, and lose their keys? Sure… it is just not very interesting to say so. It doesn’t get really get us very far in the analysis or in determining how to proceed. It is not a very rich way of describing how people with adhd struggle. And this is why therapies directed at this population (of which I am a member) tend to be behavioural or solution focused. Please don’t get me wrong, folks with adhd can benefit from practical solutions. But diligently training oneself to always put keys in the same place so as not to lose them does get at the problem of memory itself.

My project is to describe the processes that produce the struggles that people with adhd experience in their day-to-day. This kind of inquiry has an intimidating name: phenomenological psychopathology.

“Phenomenological” has a long and complex history, but for the purposes of this discussion it has a very straightforward meaning: to simply describe in everyday language the individual’s experience taking seriously their own account. This is a radical departure from the way in which the authors of the DSM construct their understanding: by developing metrics that can be observed. The DSM is a thoroughgoing behaviourist text, and in good behaviourist fashion: you can only measure what you can see. Everything else, they would say, is simply anecdotal.

“Psychopathology” is a term I don’t much like, because it contains in its name the invocation of a disease state. Adhd is not a disease nor is it a disorder. Adhd is a way of being-in-the-world. For some people with adhd, it is an extremely difficult way of being and living in the world. I have known some people with adhd who can only be described as disabled by the ways in which they engage with and experience the(ir) world.

Adhd is not a disease nor is it a disorder. Adhd is a way of being-in-the-world. For some people with adhd, it is an extremely difficult way of being and living in the world.

Nevertheless, phenomenological psychopathology goes back to the early days of psychology, and it stands as a methodology or perhaps more aptly as an orientation that is oppositional to the tradition that dominated the last century of psychological thought, particularly so in the Anglo-American world. I referred that tradition above. It is called behaviourism.

The descriptive language that for me best gets at this project comes from the mid-century Polish/French Psychiatrist, Eugène Minkowoski. He described his orientation for working to determine the causes of mental disorders as looking for “the trouble generator.” That is my task here and in what follows: to try to get at something more substantial than simply saying that people with adhd are fidgety. I want to construct an explanatory frame that says something about why people with adhd are fidgety. And if something like a trouble generator can be located, does it then give us something more substantial to work with when we try not to cure or diminish the symptomology of adhd but rather to find ways, maybe even finds worlds, for people with adhd to live in with some peace.

Notes

  1. I have taken to writing adhd as adhd. Part of the task of reconceptualizing adhd is to rename it. My new name is the old name with the strikethrough. This is an example of my oppositionalism. Much more to come.
  2. For a good and concise introduction to phenomenological psychopathology, have a look at New Perspectives in Phenomenological Psychopathology: Its Use in Psychiatric Treatment.