Another reason why ADHD diagnoses are "skyrocketing"?
Psychological diagnosis involves a deviation from "normal" ... so what happens when we're all looking at "normal" through an algorithmic lens?
Salutations, I’m Skye. I’m a psychotherapist, diagnosed ADHD, and I write about therapy, therapy culture (yes, they’re different things), neurodiversity, trauma, creativity, addiction, psychology, meaning and relating.
I am also, unequivocally, a small woman. Which matters, for the purposes of today’s opening gambit.
Yes we’re online, so for all you know I’m an uncommonly articulate 6’8” trucker with a crawlspace full of torsos, but you’re just going to have to take my word for it. I’m short and wiry. The kind of skinny that makes Italian grandmothers try to foie gras me with cannoli. But for a few years in my early 20s, I would catch an unplanned glimpse of my body in a shop mirror, or the side windows of a bus, and do a double take. Just for a moment.
Holy shit, why do I look huge?
No, it wasn’t vanity or insecurity (though I’ll cop to having a certain amount of both at the time). Objectively, I knew I was a slim woman, just as I had been a skinny kid. Logically. Factually. I could step on a set of scales, and I owned a pair of eyes. But this weird WTF moment kept happening where I was shocked at the size of my body when I clocked it in photographs or reflections. Not like, “Oh no! I need to try that diet where you eat wet cotton balls,” more like: “My brain is glitching out because my internal picture doesn’t match external reality and I don’t like it.” 404 error. Wheel of death.
What was wrong with me?
Body dysmorphia, you say? Don’t quote the DSM at me, I promise I will eat you in a diagnosis rap battle. This isn’t about that. It’s about programming, if we continue the computer metaphor. A bug in the code I couldn’t seem to find.
I managed to stumble across the answer one day through sheer dumb luck (which my developer pals tell me is par for the course when debugging code). I was a copywriter in those days, and the ad agency I was working at had decided to trial some wretched hotdesking thing in an effort to improve morale and efficiency (lol). So I turned up one day, all my stuff was missing, and I was informed that where I used to sit was now the “retouching department”. While I waited for HR to tell me where to go, I loitered about chatting and managed to catch a glimpse of what the guy next to me was working on.
“Hold up. That’s the new account, right? The shark trucks?”
“Ya.” He was busy airbrushing the chub lines out of a chunky baby leg.
“You guys do … that … on all the catalogue images? Every single one?”
“Ya.”
“What the fuck.”
Allow me to translate briefly.
“Shark trucks” are, sadly, way less cool than they sound. They’re companies with truck fleets that drive around poor suburbs selling horribly overpriced goods to people with no money and bad credit, a bit like sad adult ice cream vans. Think loan sharks, but instead of getting a cash advance with skull-crushing interest you’re getting kids’ clothes, or food, or Christmas presents with skull-crushing interest. The companies that do this are exactly as grim and charmless as you’d imagine. The marketing is garishly ugly, done cheap and fast. What my boss called “sausage-factory work”. But hey, it was post-2008. Razor-thin margins and morally questionable clients would at least give us a shot at keeping the lights on for another month.
“Retouching” is the ad agency department in charge of photo editing (or at least it was back then, I suppose robots do it all these days).
So. Keeping those definitions in mind, what I had just discovered was that every single image in the trashy, printed-on-receipt-paper shark truck catalogues we were churning out still went through “retouching”, which always involved heavy editing of human bodies.
Chubby baby legs become smooth and lineless. Thigh gaps widen. Arms and waists are shaved down. Legs and necks elongate. Torsos stretch.
At this moment, I realised just how seldom I had ever seen untouched images of actual human bodies. If even the models in the future hillbilly toilet paper we were printing had all their shoulders shaved into points and all their hips pinched in, I had almost never seen a person unless I was looking at them in the flesh.
My mind had been trained over the years to recognise unreal images as human. What had been fed into my brain as “person-shaped” was not what “person-shaped” actually is.
Hence. When my brain viewed my real body, it blue-screened for a couple seconds.
Now. Hang on, because here’s the bit where I’m going to try and sprout a new — but related — premise from the core of this story.
Perhaps part of why self-identified ADHD rates are “skyrocketing” isn’t just about greater awareness, expanded diagnostic criteria, misdiagnosis, or TikTok.1
It’s about how few real lives we see outside of our own, and at the same time how relentlessly the retouched lives of others are beamed into our eyeballs, and how (I think) this has become a collective delusion about how we’re supposed to live.
Because diagnosis, of any form of psychiatric malaise, tends to occur only when you have a problem. When you deviate from the norm.
And most of us are watching lives that are not normal, all day every day.
Ask yourself: when was the last time you saw a living room, bathroom or kitchen that was (a) not your own, (b) was not featured as part of a reel/TV show/article, and (c) was not very likely hurriedly polished and tidied and made to look not-lived-in before you visited?
I don’t use a lot of social media anymore (Substack on desktop excepted). So I’m not exactly an expert on what people are doing online. But I do talk to people all day, and more and more I’m meeting people who think there’s something painfully wrong with them because they cannot stay on top of 180 things every day that they believe are absolutely essential and which everyone else appears able to manage with ease.
For the record, these things are life essentials:
You need to eat and drink water.
You need a safe roof over your head.
You need to stay reasonably clean.
You need to move your body reasonably regularly.
You need your living space to not be a biohazard.
You need people you love.
You need work of some kind, and you need meaning of some kind. If you’re lucky, perhaps these two things overlap.
That’s it.
You do not need a 12 step skincare routine. You do not need your bathroom sink to be clean enough to eat tiramisu out of. You do not need decorative things you must move whenever you want to sleep or eat. You do not need a perfectly cultivated garden. You do not need to cook everything you eat from scratch. You do not need to be beautifully manicured every second of the day. You do not need a “side hustle”. You do not need to post every day on LinkedIn. You do not need to check the news multiple times a day to “stay informed.”
Unless you want to.
You may choose to do these things. You may love doing them. You may decide they are essential for you. But don’t walk into my office and tell me you definitely have ADHD because you can’t stay on top of your to-do list, then proceed to give me a to-do list that involves impossible maths. If you have 23 hours worth of things to do every day, without allowing time for relaxing or leisure or cleanup if the sink overflows or the cat pukes on your shoes, you have an impossible maths problem, not an incurable medical diagnosis.2
Nobody is doing all this shit.
I mean it. Not even the high-powered CEOs. I should know, I’ve talked to enough of them. If anything, they do less of it, so they can focus on bossing.
Nobody is doing all this shit.
Not every day, not without staff. People are making it up to sell you things, or make themselves look good, or both. Maybe there’s the odd being who can make it all add up (and who only needs three hours of sleep a night) … but so what? There are people that can run an Ironman every day for a month. These people are exceptional, and we recognise them as such.
The human brain, much like an AI model, is “trained” over time to recognise things. You start life with no idea what a “chair” is, and that (for example) an armchair, a dining chair, a bar stool, a sofa and a chaise are all types of “chair”, but eventually you’ve seen enough, learned enough and had enough practice at categorising that it all happens on autopilot. You don’t need to think to look at a chair and know that it is a chair.
In the opening anecdote, my brain was going brrrr because I had a mind picture of what “slim woman” looks like based on about a thousand sliced and stretched images a day, and it didn’t compute with my real world “slim woman” body which had (for example) arms that get wider closer to the shoulders and room in the waist for internal organs.
I was seeing way more pictures than people at that time in my life (for reasons I’ll maybe write about one day) and I think that’s why the difference was so striking. Also, it was circa 2009. The world didn’t have plus size models, even though all the photos were edited to fuck anyway. We had “Lollipop Chic” and “the salmonella cleanse” (I wish I was making this up).
I suspect, though I can’t prove it, that the same phenomenon is happening with “what life should look like.” What an average human can expect to get through in a day. How ordinary houses look much of the time. That most people look just as unflattering as you first thing in the morning.
I’m not saying standards don’t matter. Far from it. Having high standards in the things you value is key to building a life thats’s enjoyable to experience. I’m saying that most of us spend far, far more time watching curated lives that aren’t real — training our brains to recognise those images as what life looks like — than we spend hanging out with real people in their real lives.
Even “realistic” or “normalising” content still contributes to the problem. The moment you set up a camera, edit a clip, and post it to an audience, you’re retouching.
I would go one step further and argue that the moment you imagine an audience, you start bending reality around you to be witnessed and consumed.
I’m old enough to remember when we could collectively at least grasp some awareness of this. I remember the birth of reality TV, and the scepticism. How “real” can it be when there are four cameras in the room, and one of them is right in the middle of these two people having an histrionic argument we are supposed to believe is authentic?
We used to remember that the camera changes things. That the observer alters the outcome.
You don’t have to understand quantum physics to grasp this, just watch any online reel and remember that someone chose to set up a camera and film this moment.
ADHD is “real”
Look. I can’t believe I’m having to say this, but to be clear: I believe ADHD is a thing. Obviously I do. I have an official diagnosis, I write about it, I take medication for it. I use apps to help me track and time all my shit so I can manage the essentials of life, and without systems things get really dicey. I’m talking basic, embarrassing shit like remembering to brush my teeth and not leaving the house after I’m already late. If you believe you fit the diagnosis, wonderful! My own diagnosis has been life-changing in terms of how I understand my challenges and manage things day-to-day.
But I also believe useful diagnosis is a complex endeavour, and it’s worth being as thoughtful and accurate as possible about what the issue is because this gives you the best chance of an effective treatment pathway. I’ve seen compelling research that shows kids are far more likely to receive an ADHD diagnosis if they’re amongst the youngest in their school year. In other words, it’s unlikely that all these children have a crippling, lifelong medical condition. They’re almost a full year younger than some of their peers, of course they’re not as good on average at concentrating, completing tasks and sitting still.
For many of these kids, the problem is that the expectations are wrong.
Perhaps it’s worth considering if part of what’s driving current trends is the changing lens through which our minds recognise the image of “normal”.
What if sometimes, the “problem” really isn’t you?
Writing for a Cause
All subscription funds raised by Painting with Lightning go towards funding independent research in psychotherapeutic treatment development. My areas of experience and interest include suicide bereavement, sexual trauma, ADHD, addiction, and the use of AI in psychotherapy.
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This post was written and edited without the use of AI.
Part ≠ all.
It should also go without saying that even doing the bare essentials of life becomes incredibly challenging if you spend 4 hours a day on your phone (which is about the average).
They are skyrocketing because all of the incentives align to push them upwards: more money for providers & pharma, more status for individuals (like the endless number of people who include 'ADHD' in their self-description, as if that's a meaningful detail for others), and more activity for counselors, researchers, educators, etc.
The only factors that might limit this trend are self-respect and self-discipline. Some people might not want to advertise their diagnoses to others in order to gain status, and some people might decide that they can manage their problems on their own, without engaging with a vast mental health bureaucracy that is, in the aggregate, undeniably making things far worse. But these qualities are rare (because they're difficult to maintain) and it's much easier to simply seek the privilege and accommodations and pharmaceutical benefits of a diagnosis. Why would someone NOT want to be diagnosed with ADHD? That's the real question. A diagnosis (any diagnosis) should be (socially) negative; it indicates some dysfunction or abnormality. It's a problem that must be identified and addressed. But our culture is involved in a project of trying to reward dysfunctions (at least the fashionable ones - autism, ADHD, DID, etc.; I notice that NO ONE ever advertises their NPD or schizophrenia diagnosis) and of trying to pretend that there IS no such thing as abnormality.
The biggest problem is that we're relentlessly self-absorbed. If rising ADHD diagnoses make people feel better about themselves and let them access new tools and adopt coveted labels then they will continue to rise... until they become unfashionable or unprofitable, at which time they will plummet. Welcome to modern mental health treatment.
https://jmpolemic.substack.com/p/rule-1-you-are-responsible
I enjoy your writing style! It’s very good. 😊
I can appreciate that the world is heavily edited. Human bodies edited, faux perfect lives sold to us as achievable life goals.
But the idea that an explosion in ADHD diagnoses might be because we are being sold lifestyles that aren’t real, is a thin line to tread, especially when written by a person themselves diagnosed with ADHD!
The line that “diagnosis is not an exact science,” suggests a potential bias leaning towards many new cases being misdiagnosed? Again, that’s a potentially precarious place to be in! It suggests your diagnosis was spot on and has helped you — but others may just be a case of feeling like they need 10 different side hustles and a spotless house.
I can imagine many people diagnosed with ADHD feeling threatened with a seeming explosion of cases. It might threaten the validity of the condition.
And while you might have a worthy point here for some new cases, I think there are plenty of other areas to take into account too, and then there’s the suggestion that cases really aren’t exploding at all — we are just getting better at diagnosis.
So that would be a tremendous thing, that now there is the help for these people. I’m 50, and have diagnosed myself as being on the ADHD spectrum just this year. It’s a relief because I’ve never fitted in, and I’ve had all these quirky idiosyncrasies and stumbling blocks and suddenly there’s a really decent explanation.
Interestingly, according to one study, diagnoses were around two times higher in the most deprived areas. I wonder what correlations might be drawn from that, whether diet, poor sleep, and environmental factors, might be at play. Etc. There is also a strong genetic component.
So whilst it’s possible that some people think they have ADHD simply because they don’t fit in to an unreal version of the world sold to us by the media and online, it’s still possible there are other factors at play too!
Might there be potential correlations with a rise in various vaccines, too? And could Covid brain fog contribute to a rise in ADHD-like symptoms? Etc. I’d be asking questions like these, too!