I think I didn’t express myself clearly! I’m truly not suggesting that it’s actually easy to get needed medication--I do think the realities you described are realities and common ones. And that the pill mill telehealth clinics are scams. I was more noticing that shady telehealth scams are sliding in to provide help that is difficult to …
I think I didn’t express myself clearly! I’m truly not suggesting that it’s actually easy to get needed medication--I do think the realities you described are realities and common ones. And that the pill mill telehealth clinics are scams. I was more noticing that shady telehealth scams are sliding in to provide help that is difficult to get from actual healthcare institutions. It seems like for some, it might be easier right now to get a cheap 30-day scrip from a scam company than to get your insurance to cover stable therapy, medication, and monitoring of side effects from your actual doctor. That’s the ugly disconnect I see, that we can have cutesy tiktok memes about how quirky it is to have ADHD, and pill mills embedding those tiktoks to suggest I set up an appointment with them, and also people paralyzed with terror that even getting the formal diagnosis will render them unemployable. All of those things existing together suggests something broken somewhere!
And the dystopia I imagine progresses out from that - not a world where medication is prima facie bad and everybody is a Brave New World zombie, but a world where the easy, scammy, shitty version of psychiatric/neurological healthcare is the one most people can access, and employers and insurers remain unmotivated to provide actual care for people, tailored to their ability to function rather than to the employer’s greatest convenience.
I'd argue that that's an argument for easier access to medication, not towards redirecting people to employ some lifehacks. If the medication is hard to get from reputable healthcare sources, or if people are worried that a paper trail will make them unemployable, people will turn to scams.
I feel like you sort of are making two different arguments here:
1. "Medication should be administered through the correct channels to discourage pill mill telehealth scams."
2. "But also, I believe that my friends with new ADHD diagnoses don't actually need medication and are being convinced they do by a confluence of online personalities and pill mill scams that have accurately recognized that my friends are struggling at work, and we live in a culture that would rather put the onus on the employee to fix their struggle than the employer."
Embedded in the latter is the idea that you can tell that some people don't actually need medication, and if that's not actually at the root of your point, please tell me now - because I think that's where we might be talking past each other.
I don’t have the knowledge or authority to say that any individual person should or shouldn’t be taking medication. I promise I’m not keeping a running list. I also get the sense you feel I’m blaming people for turning to scams in the absence of good healthcare - I promise, that’s the opposite of what I mean! I support increasing access to reputable, high-quality medical care and less ridiculous limits on access to ADHD meds. I bring up other interventions not because I hate medication, but because I think medication works best in the context of a more holistic system of care - a doctor who can adjust your dosage, a therapist who can work with you on emotional regulation and anxiety issues and executive function problems. A scam can’t give you that and I want people to have that; at the same time I acknowledge that in the absence of those other things, a month of scam meds is better than nothing.
But I do suspect that fewer people I know would be taking medication for ADHD if they felt empowered, for example, to tell their employer that there was a limit on video calls they could be expected to sit in on per day, or if their office were not their bedroom, or if their work provided any kind of creative outlet, or if they could more freely set their own schedule, or if there were a single accessible therapist in their insurance network. It’s not that I think taking medication is in and of itself any way bad – but you’ve described in detail how difficult it is to get it, how awful the side effects can be, and how inconvenient it is to change the regimen. I think it would be better if that weren’t the primary intervention available to people, but that they also had ways to change their circumstances and environment.
Of course that’s often not possible, and that’s not the fault of anyone who is seeking help. But I also think it’s a bit dismissive to refer to workplace accommodations that make it easier for people to function as “lifehacks.” I think these accommodations are necessary because the nature of work has changed so much, so rapidly, and we’ve all (who are in a position to work remotely) been expected to be equally ready to cope with it. And we’re clearly not!
Also, I have to admit I’m influenced by the part of online subculture that treats ADHD medication as magic focus candy – you’re not doing that, to be clear, but the same online culture that thinks ADHD is a cute personality trait also seriously downplays that medication often has diminishing returns and is not an intervention with unmitigated benefits for everyone. I know we would agree that taking medication is not a personality, but when an ADHD diagnosis is a personality, and taking medication is your online bona fide proving your diagnosis, the two become inextricable. There’s a sense of, “If my condition could be mitigated or controlled by other factors, maybe it wasn’t real to begin with and I really *do* just suck,” and that’s of course not true! But I think our current culture is telling people that, and that closes off the legitimacy of important non-medication interventions especially for people with mild symptoms aggravated by circumstance.
I think we don't actually disagree on much! I guess I just haven't seen much in the ADHD subculture promoting medication - if anything, I've seen more twee cutesy "it's just a different way of being! I don't need a cure!" anti-medication sentiment among the TikTok crowd. I haven't seen much coupling of the diagnosis with pharmaceutical treatment, probably because there IS a portion of very online people who don't actually need ADHD treatment and just see it as a cute personality quirk. But I'm also not on a lot of social media anymore; I never had a TikTok, I don't use FB/Twitter/Tumblr. Maybe we're just coming from different contexts of how culture treats ADHD?
I don't think we disagree that it would be a better world if accessing high quality wraparound mental health treatment were pedestrian. I don't think we disagree that the world would be better if everyone were in a workplace that accommodating different learning and processing styles. But I do think that we exist in a society that tells people, both explicitly and structurally, 1) ADHD isn't real 2) ADHD medication needs to be strictly limited as a controlled substance 3) symptoms of ADHD are actually just personality defects 4) asking for reasonable accommodations will get you fired 5) there's no holistic help available. The twitterverse is an anomaly in treating ADHD as anything besides shameful or fake. Day-to-day, I don't tell anyone about my ADHD off plurk or on this relatively anonymized substack because no one offline treats it as cute; they act like I'm just making excuses for being inconsiderate and flakey, or like I just want to get a doctor to prescribe me party drugs. I see this all the time with my child clients with ADHD, too, and the way they get treated by SSA and how that changes the instant they get an autism or depression diagnosis added to ADHD.
I used "lifehacks" because that's just a general term that encompasses everything from using a pill calendar to having an accountability buddy - I use plenty of "lifehacks" myself, I'm not meaning to diminish them. But they are inherently accommodations *around* a dysfunction. It'd be nice to not need a pill calendar and endless apps on my phone (also a form of monetizing ADHD treatment outside the medical system) to remind me to do basic things. It'd be nice to be able to just adjust to the technology at my workplace instead of having to go through the tedious, complicated and honestly humiliating process of asking for an accommodation (why can't I just use a Dell computer? idk I just can't because I'm stupid and spacey, your honor, please refer all your questions about my inadequacy through my union steward).
I defer to your experience of it, rather than my totally secondhand view of a very specific subset of adult ADHD diagnosees. I also will cop to not being terribly up on what the Discourse looks like; I mainly see what is sent to me by the people in my life who have begun to adopt the diagnosis as a personality quirk in the way Freddie's post describes. I'm more than willing to accept it's not a representative sample!
I have seen a lot of specifically pro-meds discourse, though - mainly of the kind, "I was SURE I must just be a lazy, useless faker, but then I took Adderall and it made me focus better, so now I know I'm legit and don't have to beat myself up anymore!" which makes me deeply sad. I'd like people to be able to feel like their world as they experience it is real.
I guess there's just something in the competing narratives that's hard to square for me. Again, I'm not disbelieving your experience! I'm trying to figure out how it can be 100% true - and I accept that it is 100% true - that nowhere except online seems to treat ADHD as real, that it takes brutal, humiliating effort to get it taken seriously professionally, that seeking medical help is treated with suspicion and condescension, that it throws up horrible barriers especially for underprivileged kids who get diagnosed, *and* that there has been a tenfold increase in the number of people around me who have received the diagnosis and attendant prescription over the span of two years.
Where is the disconnect between the decreasing stigma online and the ubiquity of it's-ok-to-not-be-ok culture, and the awful work needed to navigate the real world with the diagnosis? Why has one done so little to touch the other? How do we bring them closer together?
I think a few things are at play here, and that those are great questions!
I think one of the experiences of ADHD is that because the symptoms are so stigmatized as just being inconsiderate or lazy, there's a level of gleeful revelation that accompanies a diagnosis that there isn't necessarily for other disorders. ADHD in women looks like being an asshole. Doesn't anyone want to believe it's not their fault that they're an asshole? It's hard to describe the feeling of relief that can come from finding out that no, it's NOT actually as hard for other people as it is for you. I think that sensation of relief is a pretty big driver of why some people online can't shut up about it - in the small online space they've found that accepts ADHD as a real big pain in the ass.
And I think medication can be a proxy for that because taking meds "proves" that it was ADHD all along, the same way not responding to caffeine or cocaine are often used as evidence that the ADHD is real and valid. But I don't think I've seen a lot of people needing the meds to validate their ADHD diagnosis; it's just one of many pathways to getting to say "I have ADHD" online or among SJ-focused PMC types.
I think it's another example of "Twitter isn't the world", the same way racism isn't over just because white men online get told to sit down and amplify Black voices. Wellness culture is actually pretty niche, and we both work in an industry that fosters it, and we both are surrounded by other people who work in that industry or are sympathetic to its causes, and we both follow people on our social media that subscribe to it, and we both listen to sad indie musicians like John Darnielle and Sufjan Stevens who turn not-being-okay into artistic careers, and we both read poetry books about transforming being not okay into grace, etc etc, so the algorithm makes it look a lot more prevalent than it is.
"I think that sensation of relief is a pretty big driver of why some people online can't shut up about it - in the small online space they've found that accepts ADHD as a real big pain in the ass."
Yes! This. This is what I was also trying to kinda get at in my main comment on the post.
Honestly, in that way, I think it's just like most other online-oriented activism. Sorta akin to what "defund the police" is in relation to police brutality. It's wildly disconnected from the reality on the ground, and doesn't seek the dirty, impure work required by real change, and so it doesn't actually do anything to help where help is truly needed. If anything, this kind of rhetoric can make the situation on the ground worse by influencing public perception in really negative ways and by reinforcing shitty stereotypes.
I think I didn’t express myself clearly! I’m truly not suggesting that it’s actually easy to get needed medication--I do think the realities you described are realities and common ones. And that the pill mill telehealth clinics are scams. I was more noticing that shady telehealth scams are sliding in to provide help that is difficult to get from actual healthcare institutions. It seems like for some, it might be easier right now to get a cheap 30-day scrip from a scam company than to get your insurance to cover stable therapy, medication, and monitoring of side effects from your actual doctor. That’s the ugly disconnect I see, that we can have cutesy tiktok memes about how quirky it is to have ADHD, and pill mills embedding those tiktoks to suggest I set up an appointment with them, and also people paralyzed with terror that even getting the formal diagnosis will render them unemployable. All of those things existing together suggests something broken somewhere!
And the dystopia I imagine progresses out from that - not a world where medication is prima facie bad and everybody is a Brave New World zombie, but a world where the easy, scammy, shitty version of psychiatric/neurological healthcare is the one most people can access, and employers and insurers remain unmotivated to provide actual care for people, tailored to their ability to function rather than to the employer’s greatest convenience.
I'd argue that that's an argument for easier access to medication, not towards redirecting people to employ some lifehacks. If the medication is hard to get from reputable healthcare sources, or if people are worried that a paper trail will make them unemployable, people will turn to scams.
I feel like you sort of are making two different arguments here:
1. "Medication should be administered through the correct channels to discourage pill mill telehealth scams."
2. "But also, I believe that my friends with new ADHD diagnoses don't actually need medication and are being convinced they do by a confluence of online personalities and pill mill scams that have accurately recognized that my friends are struggling at work, and we live in a culture that would rather put the onus on the employee to fix their struggle than the employer."
Embedded in the latter is the idea that you can tell that some people don't actually need medication, and if that's not actually at the root of your point, please tell me now - because I think that's where we might be talking past each other.
I don’t have the knowledge or authority to say that any individual person should or shouldn’t be taking medication. I promise I’m not keeping a running list. I also get the sense you feel I’m blaming people for turning to scams in the absence of good healthcare - I promise, that’s the opposite of what I mean! I support increasing access to reputable, high-quality medical care and less ridiculous limits on access to ADHD meds. I bring up other interventions not because I hate medication, but because I think medication works best in the context of a more holistic system of care - a doctor who can adjust your dosage, a therapist who can work with you on emotional regulation and anxiety issues and executive function problems. A scam can’t give you that and I want people to have that; at the same time I acknowledge that in the absence of those other things, a month of scam meds is better than nothing.
But I do suspect that fewer people I know would be taking medication for ADHD if they felt empowered, for example, to tell their employer that there was a limit on video calls they could be expected to sit in on per day, or if their office were not their bedroom, or if their work provided any kind of creative outlet, or if they could more freely set their own schedule, or if there were a single accessible therapist in their insurance network. It’s not that I think taking medication is in and of itself any way bad – but you’ve described in detail how difficult it is to get it, how awful the side effects can be, and how inconvenient it is to change the regimen. I think it would be better if that weren’t the primary intervention available to people, but that they also had ways to change their circumstances and environment.
Of course that’s often not possible, and that’s not the fault of anyone who is seeking help. But I also think it’s a bit dismissive to refer to workplace accommodations that make it easier for people to function as “lifehacks.” I think these accommodations are necessary because the nature of work has changed so much, so rapidly, and we’ve all (who are in a position to work remotely) been expected to be equally ready to cope with it. And we’re clearly not!
Also, I have to admit I’m influenced by the part of online subculture that treats ADHD medication as magic focus candy – you’re not doing that, to be clear, but the same online culture that thinks ADHD is a cute personality trait also seriously downplays that medication often has diminishing returns and is not an intervention with unmitigated benefits for everyone. I know we would agree that taking medication is not a personality, but when an ADHD diagnosis is a personality, and taking medication is your online bona fide proving your diagnosis, the two become inextricable. There’s a sense of, “If my condition could be mitigated or controlled by other factors, maybe it wasn’t real to begin with and I really *do* just suck,” and that’s of course not true! But I think our current culture is telling people that, and that closes off the legitimacy of important non-medication interventions especially for people with mild symptoms aggravated by circumstance.
I think we don't actually disagree on much! I guess I just haven't seen much in the ADHD subculture promoting medication - if anything, I've seen more twee cutesy "it's just a different way of being! I don't need a cure!" anti-medication sentiment among the TikTok crowd. I haven't seen much coupling of the diagnosis with pharmaceutical treatment, probably because there IS a portion of very online people who don't actually need ADHD treatment and just see it as a cute personality quirk. But I'm also not on a lot of social media anymore; I never had a TikTok, I don't use FB/Twitter/Tumblr. Maybe we're just coming from different contexts of how culture treats ADHD?
I don't think we disagree that it would be a better world if accessing high quality wraparound mental health treatment were pedestrian. I don't think we disagree that the world would be better if everyone were in a workplace that accommodating different learning and processing styles. But I do think that we exist in a society that tells people, both explicitly and structurally, 1) ADHD isn't real 2) ADHD medication needs to be strictly limited as a controlled substance 3) symptoms of ADHD are actually just personality defects 4) asking for reasonable accommodations will get you fired 5) there's no holistic help available. The twitterverse is an anomaly in treating ADHD as anything besides shameful or fake. Day-to-day, I don't tell anyone about my ADHD off plurk or on this relatively anonymized substack because no one offline treats it as cute; they act like I'm just making excuses for being inconsiderate and flakey, or like I just want to get a doctor to prescribe me party drugs. I see this all the time with my child clients with ADHD, too, and the way they get treated by SSA and how that changes the instant they get an autism or depression diagnosis added to ADHD.
I used "lifehacks" because that's just a general term that encompasses everything from using a pill calendar to having an accountability buddy - I use plenty of "lifehacks" myself, I'm not meaning to diminish them. But they are inherently accommodations *around* a dysfunction. It'd be nice to not need a pill calendar and endless apps on my phone (also a form of monetizing ADHD treatment outside the medical system) to remind me to do basic things. It'd be nice to be able to just adjust to the technology at my workplace instead of having to go through the tedious, complicated and honestly humiliating process of asking for an accommodation (why can't I just use a Dell computer? idk I just can't because I'm stupid and spacey, your honor, please refer all your questions about my inadequacy through my union steward).
I defer to your experience of it, rather than my totally secondhand view of a very specific subset of adult ADHD diagnosees. I also will cop to not being terribly up on what the Discourse looks like; I mainly see what is sent to me by the people in my life who have begun to adopt the diagnosis as a personality quirk in the way Freddie's post describes. I'm more than willing to accept it's not a representative sample!
I have seen a lot of specifically pro-meds discourse, though - mainly of the kind, "I was SURE I must just be a lazy, useless faker, but then I took Adderall and it made me focus better, so now I know I'm legit and don't have to beat myself up anymore!" which makes me deeply sad. I'd like people to be able to feel like their world as they experience it is real.
I guess there's just something in the competing narratives that's hard to square for me. Again, I'm not disbelieving your experience! I'm trying to figure out how it can be 100% true - and I accept that it is 100% true - that nowhere except online seems to treat ADHD as real, that it takes brutal, humiliating effort to get it taken seriously professionally, that seeking medical help is treated with suspicion and condescension, that it throws up horrible barriers especially for underprivileged kids who get diagnosed, *and* that there has been a tenfold increase in the number of people around me who have received the diagnosis and attendant prescription over the span of two years.
Where is the disconnect between the decreasing stigma online and the ubiquity of it's-ok-to-not-be-ok culture, and the awful work needed to navigate the real world with the diagnosis? Why has one done so little to touch the other? How do we bring them closer together?
I think a few things are at play here, and that those are great questions!
I think one of the experiences of ADHD is that because the symptoms are so stigmatized as just being inconsiderate or lazy, there's a level of gleeful revelation that accompanies a diagnosis that there isn't necessarily for other disorders. ADHD in women looks like being an asshole. Doesn't anyone want to believe it's not their fault that they're an asshole? It's hard to describe the feeling of relief that can come from finding out that no, it's NOT actually as hard for other people as it is for you. I think that sensation of relief is a pretty big driver of why some people online can't shut up about it - in the small online space they've found that accepts ADHD as a real big pain in the ass.
And I think medication can be a proxy for that because taking meds "proves" that it was ADHD all along, the same way not responding to caffeine or cocaine are often used as evidence that the ADHD is real and valid. But I don't think I've seen a lot of people needing the meds to validate their ADHD diagnosis; it's just one of many pathways to getting to say "I have ADHD" online or among SJ-focused PMC types.
I think it's another example of "Twitter isn't the world", the same way racism isn't over just because white men online get told to sit down and amplify Black voices. Wellness culture is actually pretty niche, and we both work in an industry that fosters it, and we both are surrounded by other people who work in that industry or are sympathetic to its causes, and we both follow people on our social media that subscribe to it, and we both listen to sad indie musicians like John Darnielle and Sufjan Stevens who turn not-being-okay into artistic careers, and we both read poetry books about transforming being not okay into grace, etc etc, so the algorithm makes it look a lot more prevalent than it is.
"I think that sensation of relief is a pretty big driver of why some people online can't shut up about it - in the small online space they've found that accepts ADHD as a real big pain in the ass."
Yes! This. This is what I was also trying to kinda get at in my main comment on the post.
Honestly, in that way, I think it's just like most other online-oriented activism. Sorta akin to what "defund the police" is in relation to police brutality. It's wildly disconnected from the reality on the ground, and doesn't seek the dirty, impure work required by real change, and so it doesn't actually do anything to help where help is truly needed. If anything, this kind of rhetoric can make the situation on the ground worse by influencing public perception in really negative ways and by reinforcing shitty stereotypes.