Announcing .... The Report.

The Senate report on the ADHD enquiry totals 304 pages, but the important bits are in the first sections. Pages 15-17 list the recommendations of the full committee, although the Greens members added a lot more of their own at pp239-244. There is no mention of how much this business cost. There were seven senators sitting on the committee, who had a "secretariat" of twelve fairly senior public servants and made a number of trips around the country for hearings. That doesn't include time donated by various individuals and companies (I put about 20 hours into my submission and I know other people gave a lot more), so the total cost would be many millions of dollars. At a time of serious national and international pressures, this has been a huge distraction.

It must be understood: this is not a scientific document, nor does it make any pretence of being so. It starts with the unshakeable belief that ADHD is a real thing and goes from there. The overwhelming majority of submissions were from people who believe devoutly that there is a biologically-based disease of the brain which affects about 1.5million people in this country and costs the community well in excess of $20billion a year. Apart from a few submissions such as the Critical Psychiatry Network of Australia, and Dr Martin Whitely of Curtin University, in Perth, there was no attempt at a balanced analysis of the evidence. Speaking on behalf of the CPNA, Prof. Jon Jureidini, of Adelaide pointed to the inherent bias (pp235-236):

The group that developed the (diagnostic) guideline are all people for whom diagnosis of ADHD benefits them ... There was no attempt, as far as I can see, to collaborate with people like us who take a strong, scientifically based stance, who would have been happy to collaborate and cooperate and come to a consensus on these things but were never consulted in the process.

And that, essentially, is all anybody needs to know. The report carries no scientific weight just because it failed to consider the possibility the whole thing may be a mistake, or a misunderstanding of the nature of mind, or a beat up by people who stand to make a lot of money from it. It is propaganda simpliciter so unless you have a particular interest, it isn't worth reading except it does show one important point: Anecdotes do not add up to a general truth.

There were many hundreds of submissions from people who clearly haven't had a good time in life but who's disputing that? The question is not whether Johnny has a miserable time at school or Julie keeps failing at jobs, that's nothing new. The question which this enquiry should have answered is this: What is the cause of these problems? There are well-developed protocols for answering this type of question in many different fields but, as Prof. Jureidin noted, they weren't followed. The committee was dominated by a couple of people who were determined that their beliefs were all that counted, so the enquiry was set up to find evidence to support their beliefs, not to analyse them critically. That is the very antithesis of science.

My feeling is the report will be killed in Parliament but we'll have to wait and see. As I mentioned a month or two ago, certain members of the committee and their adulatory supporters plan to bombard parliamentarians who don't come to the ADHD party with messages to try to sway them. Fortunately, two can play that game. I will be emailing MPs and senators to tell them they should not make any decisions based on the recommendations in this report. I don't think they'll need much pressure. Regardless, in time, more and more people will add this to their list of self-diagnoses, just because of the intense peer and personal pressure to do so (see commentary here; original article here). In tandem, the drugs will become far more widespread, more people will drift on to pensions and out of the workforce, and apart from the people making lots of money from it, nothing much will change. People will still fail at school or at work, people will still break laws and so on, all that needs to be decided is: Why? Because until that question is answered, nothing sensible can be done.

One final point: on p4, there is a list of definitions, ending with these:

• Neurodiversity—diversity of human minds and all the unique and different ways that people can exist, think, act, process, feel and function;

• Neurodivergent—an umbrella term to describe an individual whose mind or functioning diverges from dominant societal norms, standards or expectations including learning, processing, interpreting, feeling, behaving, communicating and more;

• Neurotypical—describes an individual who is functioning within dominant societal norms;

• Neurodiverse—describes a group or population of people who all have different minds or brains compared to each other. Society is neurodiverse, an individual cannot be neurodiverse as they only have one brain;

• Neuronormativity—a set of standards, expectations and norms that centre certain ways of functioning as the right way.

All this looks impressive, except for one problem: it's meaningless. These words, which were invented only recently, are designed to sway people's thinking in a particular direction without offering any hard facts as support. There is a technical term for this, introduced by the Princeton philosopher, Harry Frankfurt, who died in July, aged 94 (he was working until almost the end) and we'll come back to it. The problem is that odd prefix, "neuro-". What does this mean? In fact, it has no meaning. If you take it away, nothing changes. Relating to people, the word "typical" describes "an individual who is functioning within dominant societal norms." What does "neurotypical" describe? An individual who is functioning within dominant societal norms. Same thing. Tweedledum and Tweedledee.

Similarly, "Neuronormativity—a set of standards, expectations and norms that centre certain ways of functioning as the right way." Delete the neuro bit and we're left with "normativity—a set of standards, expectations and norms that centre certain ways of functioning as the right way," which is true: that's exactly what normativity means: "Normativity is the phenomenon in human societies of designating some actions or outcomes as good, desirable, or permissible, and others as bad, undesirable, or impermissible." And three cheers for that. I'm glad we have some things permissible and some prohibited, should be more of it. Politicians lying, rich companies stealing, drug companies cheating with results, drink-driving, rape, murder, bombing civilians and so on. If we didn't have standards, what would we be? Thomas Hobbes answered that, 375 years ago:

In such condition [of no authority offering protection against violence] there is no place for industry, because the fruit thereof is uncertain: and consequently no culture of the earth; no navigation, nor use of the commodities that may be imported by sea; no commodious building; no instruments of moving and removing such things as require much force; no knowledge of the face of the earth; no account of time; no arts; no letters; no society; and which is worst of all, continual fear, and danger of violent death; and the life of man, solitary, poor, nasty, brutish, and short (Leviathan, Ch 13).

Without normativity, there is nothing. What then is the point of adding "neuro-" to all these words? It comes from the Greek, meaning "of or relating to nerves," as in the physical things in the body. So we have neuroanatomy, which studies the physical anatomy of the nervous system; neurosciences, those sciences relating to physical nerves and brains; neurosurgery and so on. But they're very specific terms with precise meanings. If, however, we just start adding "neuro-" to whatever takes our fancy, we end up with something that seems important and reliable but which is actually nothing. "Neurodiversity—diversity of human minds and all the unique and different ways that people can exist, think, act, process, feel and function." That's fine, I have no problem with that. I like diversity (as long as it stays within the bounds of normativity) but who says diversity has anything to do with the physical brain? We are led to believe diversity has something to do with physical nerves, and if it has to do with nerves, it's medical and we're not supposed to judge but we can drug it. In fact, all the word diversity means is "be tolerant, don't judge because who are you to judge?" Why is that neurological? But this is where the late Harry Frankfurt comes into it. He said it's all bullshit.

Frankfurt distinguished an extra category between truth and falsity. Truth is fairly clear while lying, he said, is a very precise act. A person wants you to believe something he knows is false but he also doesn't want you to know that he knows it's false. He gave this superb definition:

Telling a lie is an act with a sharp focus. It is designed to insert a particular falsehood at a specific point in a set or system of beliefs, in order to avoid the consequences of having that point occupied by the truth. This requires a degree of craftsmanship... [1].

However, in addition to truth and falsehoods, people can say things which may or may not be true, they don't care, because all they want to do is sway the audience. What they're saying may be true or it may be false, but that's irrelevant because it is designed to produce an emotional response in the audience, not to inform them. It's bullshit, in other words. This is exactly the case with all the "neuro-" words listed in the Senate report: they have no relation to truth or falsity, they are simply designed to sway the reader emotionally, to make you think this material has the same reliability as standard medicine when, as a matter of demonstrated fact, it doesn't. But the definitions are the foundation of the report, the report is built on them. If the definitions are crap, then the whole thing is bullshit from beginning to end. It carries zero weight.

And what better example than all the anecdotes? Anecdotes prove nothing, they only show that on that occasion with that person, X was the case. Again, they are designed to sway the reader emotionally: "Oh, that poor person, we have to do something to help." By all means, but make sure you know exactly what it is you're "helping" before you jump in, because there is nothing in any of the anecdotes (and no, I haven't read all the submissions, nor am I going to), nothing that shouts: "This is NECESSARILY a case of a brain disease and NOT a case of personality disorder." It can't say that because the signs and symptoms of what is called ADHD are drawn from the same list of signs and symptoms as personality disorder. The only difference is how they are arranged and the weight they are given, which is entirely subjective and, by definition, is non-scientific.

If you want to start yarping about brains and neurotransmitters and genes and all that scientific stuff, then you can't cherry-pick the evidence to suit yourself, which is exactly what this enquiry has done. You're either following the canons of the scientific method, or you're bullshitting. Unfortunately, the whole Senate report is built on this and it falls apart when you look at it closely. But that won't stop the true believers. Maybe this thing just has to run its course until people realise that science isn't just being a stick-in-the-mud, it's about distinguishing reliable fact from dangerous fantasy.

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References:

1. Frankfurt H (1986). On Bullshit. Raritan Quarterly Review 6 (2): 81–100. (Fall 1986).

Some years ago, I published a paper listing some of the bullshit in psychiatry:

McLaren N (2016). Psychiatry as Bullshit. Ethical Human Psychology and Psychiatry 18: 48-57.

Nothing I've heard or read since has moved me to change a word of it, except it's getting worse.

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This material is copyright but can be quoted and republished as long as the author is acknowledged.