Is ADHD a Mental Illness?

Mental illnesses, brain disorders, neurobiological brain disorders—what do these words mean? Where does ADHD fit into this lexicon? As we learn more about the brain through PETscans, SPECT imaging, MRI, and genetic research, we learn more about the nature of brains that don't function well. Abnormal and unacceptable behaviors that scientists once attributed almost exclusively to faulty nurturing, we are now attributing more frequently to faulty nature, to a flawed genetic inheritance.

Those with severely abnormal behaviors, we call mentally ill; while those with milder forms of abnormal behaviors we call disordered or disturbed. Psychiatrists still carefully side step the issue of whether these individuals with disordered, disturbed, or moderately impaired brains also have mental illness. To me, when something is wrong in the structure or functioning of the brain and the this faultiness results in a significant negative impact on how well we function in our daily lives, then it is a mental illness.

Although my thinking might bring the wrath of the ADHD community down on me, hear me out. To me, it seems appropriate to call ADHD a mental illness. Years ago it might have been reasonable to separate the severely abnormal behaviors seen in the "mentally ill" (i.e. when a person became psychotic) from the lesser abnormal behaviors, seen in those with ADHD, but our new knowledge about the brain eliminates this distinction for me.

All of us with DSM-IV diagnoses have some faulty functioning in our brain, severe enough to impact how well we function in our daily lives. Some of us have more severe brain problems than others; some of us have been more helped by medications than others. But to me, we all are on a continuum of difficulties in how well our brains allow us to function.

We suffer from mental illness when we do not perform as well as we need to in our daily lives and our poor performance is directly attributable to our faulty brain functioning. I believe that some day in the future, we will be able to pin point the exact areas of the brain that are not functioning well enough, and take medications or other remedies that will target those specific areas of the brain. There will no longer be a DSM that tries to categorize and describe the increasing range of mental illnesses. Instead, we will have a map of the brain and a list of meds and other strategies to employ when a particular part of the brain is not working up to snuff.

Dr. Ratey, in his book Shadow Syndromes, talks about no one having a perfect brain although most people have "healthy enough" brains which allow them to function adequately or, even better than adequately, in their daily lives "Healthy enough" brains would not be considered faulty in their structure or functioning. People with "healthy enough" brains are considered "normal." "Healthy enough" brains, while not perfect, are acceptable.

If we think about brains on a bell-shaped curve, the people with "healthy enough" brains are in the majority, while those of us with less than "healthy enough" brains or even severely impaired brains are in the minority. Those with less than" healthy enough" brains run the gamut of brain illnesses, from mild to severe. Dr. Ratey writes that when we inherit a few faulty genes, we may get a mild version of a disorder. When we inherit a great number of faulty genes, then the disorder has a more severe presentation.

I like to compare how we think about our brains with how we think about our bodies. How many of us consider ourselves to have "perfect" bodies? How many of us would want to participate in a Miss or Mister America contest? Yet most of us have bodies healthy enough to allow us to function acceptably or even better than acceptably in our daily lives. Most of us have bodies and physical health that would fall in the "acceptable" or normal range. However, there are some people who have physical disabilities or physical illnesses that significantly impair their bodies' ability to function within the normal range. These people, we say, have impaired physical functioning, or impaired physical health.

Similarly with the illnesses of the brain. When they significantly limit our ability to function well in our daily lives, we have impaired mental health, we have brain disorders, we have mental illness.

The big finding, about eight years ago, was, "Hey, adults have ADHD." "Kids with ADHD don't outgrow it." More recently, the big news is that adults and kids with ADHD often have more than one thing going on with them, e.g. learning disorders, depression, obsessive-compulsive disorder, anxiety disorder, bipolar disorder and so forth. Clinicians now have to be even more skilled in diagnoses, teasing out which of several co-occurring conditions a patient might have and figuring out which ones to medicate for and in which order.

Beyond this, there is developing a body of knowledge showing the linkage between a range of brain disorders. Earlier researchers were hoping to find one abnormal gene to explain alcoholism, or ADHD, or bipolar. Now researchers commonly believe that there is a cluster of faulty genes causing a range of disorders. Different family members inherit different faulty genes in the cluster, and thus the malfunctions in their brain will not be exactly like other family members. However, everyone in the family is more at risk for inheriting one or more of the faulty genes when the family's genetic pool contains these faulty genes.

Drs. Hudson and Pope of McLean Hospital in Massachusetts were the first to propose the concept of affective spectrum disorders—a range of mental health problems that run in families. Their research is showing that these various affective disorders are related to each other. In fact, medications taken for one disorder often ease the symptoms of other disorders the person has.

Another way to understand the connection between these disorders is to see the range of illnesses often exist in one extended family. While one member may have ADHD, another has bipolar, while another might suffer from depression. Here are the illnesses that have so far been identified as part of the affective disorder spectrum.

• Affective disorder (unipolar, bipolar, schizoaffective)
• Attention deficit hyeractivity disorder
• Body dysmorphic disorder
• Catapley
• Eating disorders (bulimia, anorexia, bingeing)
• Fibromyalgia (includes chronic fatigue)
• Impulse-control disorders
• Irritable bowel syndrome
• Kleptomania
• Migraines/severe headaches
• Narcolepsy
• Obsessive-comulsive Disorder
• Panic Disorder
• Tourette's Disorder

The following conditions, while not as closely tied into the affective disorder spectrum, also seem to have some connection, to the conditions mentioned about:

• Anxiety Disorder
• Autism
• Chronic Pain
• Intermittent Explosive Disorder
• Pathological gambling
• Pyromania
• Personality Disorders
• Post-traumatic Stress Disorder
• Substance Abuse and addiction (includes alcoholism)
• Trichotillomania

How many of these conditions exist within your family? Within your extended family? How ready are you to believe that these conditions are significantly caused by faulty brain structure and chemistry? How much compassion and understanding do those of us with ADHD want for ourselves from others? In turn, I challenge you—how much compassion and understanding are you giving to others who also suffer from brain disorders. We are not alone. If all of us with brain disorders, with mental illnesses, would join together for adequate medical care, for adequate education, and for opportunities in a tolerant, knowledgeable and understanding world, what a wonderful place it would be.

Cynthia Hammer was diagnosed 11 years ago at age 49 with ADHD. Her life improved so much after the diagnosis that she started a support group in Tacoma for adults with ADhD. From that small beginning, ADD Resources, a non-profit organization, has now grown to a national organization with over 800 members with Cynthia serving as it's part–time director.

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