Would you still have ADHD without capitalism?

(kinda? sorta? not really?)

a former snailpost on this topic

"I would still have ADHD if capitalism didn't exist" is a common response to the social model of disability as applied to ADHD, but this argument overlooks two things:

1. how disorder categories are socially constructed

2. how deeply entwined biology is with society

It’s also an example of biological determinism, the belief that human behavior is determined by your genes or some other part of your physiology from conception. But biological determinism is, um, biologically incorrect!

Physicist Evelyn Fox Keller has said that we need to stop thinking of genes as static codes and start understanding the genome as reactive:

“...one might say that what makes a molecule — any molecule — biological is its capacity to sense and react to its environment.” 

Psychologist Marino Pérez-Álvarez says of genes:

“As development resources more than deterministic ‘programs’, everything related to genes depends on the context.”

For instance, the 7R variant of the DRD4 gene has been associated with ADHD, but only in specific contexts, as Robert Sapolsky explains in his book, Behave:

"..kids with the 7R variant are less generous than average. But only if they show insecure attachment to their parents. Secure-attachment 7Rs show more generosity than average. Thus 7R has something to do with generosity — but its effect is entirely context dependent...7Rs are worse at gratification-postponement, but only if they grew up poor." [italics mine] 

We have decades of data that show the adverse health effects of socioeconomic inequality. You are a product of your time and place, and everything that came before you. And so is ADHD!

The category of ADHD as we understand it currently did not exist until the 1980’s. It went through several name changes over the last century, like minimal brain damage, hyperkinesis, encephalitic lethargica, and ADD. 

Those were not just name changes, they were products of social and economic forces shaping the way we understood the presentation of certain behaviors in children (and eventually, with the expansion of ADHD from school to the workplace, adults).

Many popular historic accounts point to George Still’s work on hyperactivity in the beginning of the 20th century. He was the first to call for more research into what he said was “defective moral control” in children whose symptoms included “passionateness”, “lawlessness”, and “wanton mischievous-destructiveness”, as Bruce Cohen cites in Psychiatric Hegemony.

Behaviors like hyperactivity and inattention have existed in humans throughout history, of course, but they didn’t start to be seen as a major medical problem until mass mandatory education became a thing in the US at the end of the 19th century.

Public schools brought large groups of kids together where they could be observed and compared, and introduced an environment where they needed to be controlled.

In the 1960’s, education in the US shifted toward a focus on accountability in the form of test scores and grade level requirements. In his paper Canaries in the Coal Mine, Thomas Armstrong explains the health effects of rushing children through their development:

“American educators besieged the Swiss developmental psychologist Jean Piaget and asked him how his cognitive stages of development could be speeded up, a problem he regarded as ‘the American question.’ One unintended outcome of this American drive for speed and achievement was a new phenomenon termed by developmental researcher David Elkind (1987) (who was a disciple of Piaget), ‘the hurried child syndrome.’”

Symptoms of which included: “headaches, nausea, irritability, learning dysfunction, attentional difficulties, and behavioral problems.”

The rise of neoliberalism in the 80’s gutted social services and resulted in what’s been called “target culture” in the public sector. Thinking that it would make them more efficient, institutions like schools began to be run more like businesses, which meant more focus was placed on meeting certain grade point targets and better student performance became crucial for schools to receive state funding. 

Public school was also the training ground for the country’s future workers, as Cohen explains:

The expansion of ADHD from a rare disorder to a popular disease among young people over the past 35 years can be understood as a result of capitalism’s need to enforce discipline, compliance, and authority on the future workforce at a younger age.

You can see this in the amount of times that mentions of “work” have been added to the DSM, especially in the ADHD category, and especially since 1980: from 10 mentions in the DSM1 to 385 mentions in the DSM5. 

The DSM is often thought of as some kind of medical bible, but it’s constructed, too, and not even from careful research. Diagnoses are voted on by a small task force of experts, almost 70% of which had financial ties to the pharmaceutical industry when working on the DSM 5. 

Pharma companies are very active in the construction of disorder categories, and the ADHD label was developed over the last century alongside the drugs used to treat it.

Amphetamines were discovered to make kids more manageable on accident — Charles Bradley was trying to alleviate headaches from a painful diagnostic procedure he conducted on kids in his children’s home. Nobody noticed or cared about his discovery for decades, though.

Keith Connors, who created the widely used Connors Scale, recounts a story in ADHD Nation about the early days of ADHD research in the 1950’s, when a pharma rep came to see him and his colleague, silently giving them a $5,000 check to continue their work studying the effects of stimulants on hyperactive children.

These early studies were done by psychiatrists on children in institutions who had no power or agency, but in recent decades, adults with ADHD have been quite active in shaping and expanding the category.

This started in the early 90’s, with popular news articles about adult ADHD circulating widely, the publication of Ed Hallowell and Jon Ratey’s bestselling book Driven to Distraction, and a collaboration between the advocacy group CHADD and Ciba-Geigy, the makers of Ritalin, which resulted in government lobbying for policy changes and public education campaigns.

ADHD wasn’t expanded to adults by the writers of the DSM alone — they were reflecting what was happening in society. From a sociological standpoint, it’s easy to see why ADHD adults are often such fierce advocates for the biomedical model. ADHDers are socially and economically disadvantaged for their way of being, and medicalization is really the only way to get legal and medical support.

For adults, it’s a matter of survival, but also dignity and respect, as our worth is tied to our ability to produce and accomplish. This is probably why many adults report good experiences with ADHD diagnosis and psychiatric medications, whereas many children, who aren’t yet concerned with these abysmal truths of capitalist life, do not.

The ADHD market has now been exported around the globe in a sort of psychiatric imperialism, an imposition of American values on the rest of the world, and it's forecast to be worth $24.9 billion by 2025.

All of these things happened because of capitalism, so no, you wouldn’t have an ADHD diagnosis without it, because the diagnostic category would not exist outside of the specific historic and socioeconomic context that produced it. 

Hyperactivity, distractibility, and impulsivity — the constellation of behaviors we call ADHD — would, of course, exist! But the institutional labelling of those behaviors as clinically abnormal wouldn’t have happened without wealthy eugenicist statisticians first defining “normal”. 

And, since our bodies are not static codes but reactive nodes in dynamic systems, there is no way for us to know what we would be like in a timeline where the industrial revolution, mass mandatory education, capitalism, and neoliberal austerity never happened. What we do know, though, is that all of these things have had dire health effects on society. 

None of this makes your experiences or your distress less “real” or less deserving of care. The social model just offers a more complex explanation than the simple, individualistic story that you have a broken brain, and it opens up more political possibilities to do something about it together.

This is why I also don’t agree with those critics who would throw out ADHD as a category altogether. Imperfect and pathologizing as the term’s origins may be, it does describe a type of person, and we use it to find community and talk about our shared experiences. I think there is political potential in that, if we can let go of biological determinism and understand ourselves and our struggles more collectively.

Neurodiversity scholar Robert Chapman argues that autism, for instance, doesn’t have to be biological in order to be socially and politically useful as a category, because it describes people who are marginalized in the same way for the same material reasons. Borrowing a term from feminist philosopher Iris Marion-Young, Chapman calls the grouping a “serial collective”.

“Neurotypical” is a serial collective too, one made up of people who have “clusters of socially useful psychological or behavioral characteristics” that fit into an environment that’s been built to support them.

Chapman writes:

In contrast, other clusters of psychological characteristics may for contingent, social, historical reasons be perceived as relatively useless or undesirable. As with the clusters of “positive” characteristics, the explanation of the unity of such “negative” clusters is largely given by their perceived economic or social disutility (which is socially and historically contingent), rather than by a natural grouping. Moreover, far fewer social resources are invested in supporting individuals with such characteristics, insofar as society is not structured around their needs, thus reinforcing their initial marginalization (Milton, 2016b; Robertson, 2010). They are, thus, comparatively disabled by their environments.

This kind of framing allows us to drop the “born this way, would always be this way” argument without having to deny our material experiences of disability, but it is conceptually more difficult to chew on and swallow. I just spent 1,600 words trying to explain it, and I still feel like there’s much, much more to be said.

This is a start, at least, and I hope some of the texts I’ve linked throughout this post will open up new rabbit holes for you.