I recently read a New York Times article on Attention Deficient and Hyperactivity Disorder (ADHD), as well as several of the posted comments. This is a topic that polarizes people strongly. Many people think the disease is completely imaginary,and those people often seized on this phrase in the article.

“Children with the disorder typically have trouble sitting still and paying attention. But they may also have boundless energy and a laserlike focus on favorite things — qualities that could be very helpful in, say, an Olympic athlete.”

It seemed to me that describing these characteristics medically is absurdly reductionistic. Why not just say that ADHD kids are very good at doing what they want to do, and very bad at doing what they are told? In which case, having ADHD is simply having all of the characteristics that Americans value the highest. To say that someone is sick because they don’t follow orders sounds like something out of 1984.

However, as I read some of the other posts, it seemed obvious that there are many people who clearly benefit from taking the drugs for ADHD. Consequently I am not willing to say that the whole thing is a conspiracy of Big Pharma.

But why are these the only two alternatives? Philosopher Dan Dennett says we have two different perspectives on human behavior: 1)The Intentional stance, which explains behavior in terms of beliefs, desires, goals and purposes. 2) the Physical Stance, which explains behavior in terms of physics and biochemistry. To call ADHD a disease is to rely on the physical stance. My alternative description uses the intentional stance. Dennett believes that all intentional explanations can ultimately be reduced to physical explanations, a belief I do not share. However, Dennett acknowledges that it is impossible in our real life interactions to explain everything we do in physical terms. Consequently, we cannot ignore the intentional stance without dangerously oversimplifying. One of the comments on this article defends the physical explanation by saying that ADHD is “is as real as grass, in spite of looking for all the world like “laziness” or a lack of caring.” But whoever said that laziness and lack of caring are imaginary? We encounter them all the time. What is needed, I believe, is a recognition that both the Intentional and the Physical Stance are real, and we cannot explain human behavior without both of them.

I think that acknowledging this would mean that using drugs, and the extent to which they are used, would be seen as unique to each individual, and the individual, not the doctor, should be the ultimate authority as to when and how to use them. The drugs must be seen as part of a rehabilitation program that involves self-discipline and careful awareness of one’s own values, so that each person can shape herself into being the person she wants to become. This also means that we need to dismiss the American myth that everyone starts with a clean slate, and therefore everyone deserves full credit or blame for what they are. We assume the false dichotomy that either it’s physical (and therefore not my fault) or mental (and therefore just a sign of laziness). The truth is we are dealt a physical hand of cards, but must figure out how to play them using the concepts of the intentional stance. Some people are born with a bad chemical makeup, just as some people must grow up in dysfunctional families or in poverty. There should be no shame in acknowledging this, because if you don’t know where you are starting from, you have no way of getting anywhere else. All of us can be better than we are, and we should use whatever resources are available to us to help towards our goals. If drugs are the best resources for some people, those people should use drugs.

I think, however, that acknowledging this might enable people to use drugs to take them to a state of mind, and that once there, they can use their own awareness and will power to stay there. Some of my students have said that they used to do Ritalin, but they eventually learned how to maintain its mental benefits without taking the drug. They also told me their doctors thought this was a bad idea, but they did it anyway. I think for some patients this might work, and doctors should not see this a rejection of the entire idea of ADHD. Similarly, accepting the existence of ADHD should not be seen as a complete rejection of explanations that use the intentional stance, such as that ADHD patients are people who march to the beat of a different drummer, and don’t like a rigid school system.

One problem with all psychological categories is that they straddle the intentional and the physical stance. ADHD is not physical in the way that an excess of dopamine is physical. It is a category with blurry borders, and therefore ought to welcome blurry diagnoses, and a recognition by both doctors and patients that the patient must make the final decision. I think it likely that I would have been diagnosed as ADHD, had such a thing existed when I was a kid. And the fact that I am wasting time writing this blog, instead of grading papers or designing next term’s syllabus, is probably a sign that I’ve still got it.