ADHD and narratives of illness
Airdre Grant | PhD
One of my most beloved books is The Illness Narratives Suffering, Healing & the Human Condition. Although first published in 1988, much that it offers still stands. In it, Arthur Kleinman, a Harvard psychiatrist and anthropologist, interrogates the art of diagnosis, the subtle and complex role of the healer and how illness presents in various and shifting ways. He writes about the narratives patients bring and how vital it is to listen these stories, with all their nuances.
One of the significant features of holistic treatment is that the practitioner offers a treatment that is built around deep listening, and the taking of time. In this space, a holistic practitioner deals with the subtleties of illness, knows that what is unsaid is as important as what is said. There is always a hidden narrative running alongside the overt consultation. The story that a patient brings to clinic will manifest in different ways and they will be transmitting signals the whole time: from the clothes they wear, the way they sit, their attentiveness, punctuality and more, much more.
These signals inform your treatment.
Which brings us to ADHD and the neurodivergent client. One in 20 Australians is diagnosed with ADHD. That’ s a lot and the number have increased with late adult diagnosis. Diagnosis often requires a psychiatrist, although there is a lot of self-diagnoses, and dealing with ADHD in a professional setting requires informed understanding. There is significant media chatter about ADHD, plenty of wellness advertisements spruiking the efficacy of different strategies and supplements( including mushrooms and other psychotropics) and lots of commentary and trivialisation of what neurodivergence means. It’ s complicated. Treatment for ADHD can be tricky as the person may have a history of masking, mirroring and rapidly working out what is wanted, then giving it. These learned behaviours can be the survival strategies of the neurodivergent built up over years of being misunderstood and frequently criticised for not being‘ normal’ or‘ right.’ These defences and coping mechanisms can present in a consultation and blur the real issues.
There are relatable issues in ADHD treatment that resemble working with chronic illness. Here is a long-term, embedded ailment that has shaped life and health. Attention to narratives, patience and being informed about the complexity of the condition are important to effectiveness of practice.
Consider this story from a young woman in her twenties, who came to my office and slumped in the chair.
‘ I went to the naturopath,’ she said,‘ to see if there were any supplements or stuff I could take to help with my grasshopper brain. I explained I had a diagnosis of ADHD and was taking Ritalin daily. The therapist told me that ADHD is a fad and that there is a lot of over-diagnosing and reliance on meds when in fact it is a body-mind alignment thing. She said that if I do yoga and eat lots of mineral-rich foods, I will be able to manage my skittishness naturally. I felt very confused and guilty. I wished I hadn’ t mentioned it.’
Descriptions of neurodivergence as a fad, or the latest thing to have, are troubling,
222 | vol31 | no4 | AJNM