The ADHD Academic Advocate - Connecting research with real-world strategies for ADHD activists. - The ADHD Academic Advocate

I apologize for not updating the site in a few weeks. Due to some significant family issues that arose, I have not been able to post. I have a new post that will be coming later this week. In the meantime, check out the amazing review that fellow ADHD blogger Douglas Cootey wrote over at his site: A Splintered Mind. If you haven’t checked out the rest of his site yet, you’re REALLY missing out! Until next time!

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Most people have heard of, if not seen, the movie 12 Angry Men (I prefer the 1957 version). Of the IMDb’s 250 top movies of all time12 Angry Men comes in at an impressive 6th place. This captivating story follows the deliberation of 12 unnamed jurors as they determine the fate of a young man’s life, who is accused of murdering his father. The “hero” of the movie is Juror #8, who at the beginning of the deliberation, is the only juror unsure of the defendant’s guilt. All of the other juror’s came into the room convinced that the young man had killed his father. Juror #8, however, feels that it is only right to interrogate each piece of evidence against the young man before convicting him of murder. Rather than being certain of his innocence at the onset, Juror #8 takes on a critical role as a “Devil’s Advocate” in order to make sure that both sides of the case are given a fair evaluation. As Juror #8 goes through each piece of evidence, the other 11 jurors, one-by-one, begin to doubt their initial certainty. The outcome is, as many of you could guess, that the young man is acquitted of all charges. Good triumphs, the underdog goes free, reason saves the day, and, most importantly, our faith in humanity - not to mention the fairness and impartiality of our judicial system – is redeemed. The perfect recipe for a classic story.

 

12 Angry Men, despite being a cinematic classic, also provides some important lessons for ADHD advocates. These lessons, however, do not arise from what the story or narrative depicts per se. Rather, what’s instructive about the story is how it idealizes both the judicial process and our assumptions about how individuals typically persuade and are persuaded. Despite the insistence on impartiality and judgement based on facts, the decision-making processes by jurors are often guided and influenced by more fundamental characteristics related to human communication and how people make sense of events. Understanding some of these overarching characteristics in the context of the legal system can actually give insight into how the general public evaluates and “judges” the ADHD controversy in the court of public opinion.

 

As explained by Walter Fisher, prominent professor (Emeritus) of communication from the University of California’s Annenberg School for Communication, human beings experience, understand, and communicate about life as a collection or series of stories or narratives. Fisher’s Narrative Paradigm helps us understand how all facts and appeals to reason within a specific situation (i.e., the deliberation of a court case) are organized and processed by individuals in a narrative format. As communication and political science professors W. Lance Bennett and Martha Feldman explain in their book, Reconstructing Reality in the Courtroom, “In order to understand, take part in, and communicate about criminal trials, people transform the evidence introduced in trials into stories about the alleged criminal activities” (p. 4). In other words, regardless of how it’s presented, people tend to make sense out of each side’s collection of facts and testimonies through a larger organizing narrative – they tend not to evaluate each piece of information or “fact” in a vacuum.

 

More importantly, specific narratives related to a situation or context are evaluated not only in comparison to other stories that have similarities (the narrative’s “coherence”), but also in comparison to our own individual experiences and beliefs about the way the world works (the narrative’s fidelity). A hypothetical example might help here. Imagine a friend is telling you about a recent experience at a restaurant that made her or him believe that everyone should avoid it. She or he tells you about how from the moment they stepped into the place, the staff were extremely rude. Even more, the food took 45 minutes to be prepared when no other customers were there, and the food wasn’t  even cooked all the way through. The icing on the poorly baked cake was that the server commented on how cheap she or he was because the tip was only 12%. This collection of “facts,” without necessarily intending to, form a type of narrative – at least, this is typically how others inadvertently organize and interpret the information. Someone listening to this story, without realizing they are necessarily doing it, will compare this narrative against other restaurant horror stories that they have heard before (narrative coherence), and their own personal narratives and beliefs (narrative fidelity). Now, imagine that the person listening to this story knows and frequents the restaurant the story-teller is talking about. Not only that, but the listener’s personal experiences at that restaurant have been nothing but pleasant. In other words, the listener has a competing or counter narrative, organized around those personal experiences, that conflicts with the story-tellers narrative – violating the listener’s perception of narrative fidelity. It’s possible that this violation of narrative fidelity will make the listener discredit the story-teller’s narrative as a fluke or an over-exageration. At minimum, it creates doubt in the mind of the listener. Even mere doubt is potentially harmful to a story’s ability to persuade an audience.

 

The potential persuasive power of narratives shouldn’t be underestimated. In their 2000 book, Minding the Law, Anthony Amsterdam and Jerome Bruner (a civil rights lawyer and cultural psychologist, respectively) explain that, “We now understand that stories are not just recipes for stringing together a set of ‘hard facts’; that in some profound, often puzzling way, stories construct the facts that comprise them. For this reason, much of human reality and its ‘facts’ are not merely recounted by narrative but constituted by it” (p. 111). What this means is that much of the way we perceive the world around us is partially structured through narratives. These can be very specific narratives – such as a story about the experience of an individual. However, these narratives that help structure how we see the world can also be very broadly themed. Common examples of these types of narratives would be the idea of the American Dream or the related Horatio Alger Myth.

 

This argument applies not only to the court room, but also the court of public opinion – that placeless place where the media interacts with the general public. However, it is mostly these more broadly themed narratives like the American Dream that are problematic for ADHD advocates. Just as these larger narratives tend to structure how we see the world and decide to act in it, ADHD advocates need to understand these narratives in order to construct their own competitive narratives more persuasively. The importance of this is even greater in the court of pubic opinion than in the actual courtroom. The court of public opinion doesn’t offer any formal guidelines for evaluating controversial issues. The danger of doubt becomes much more pronounced because, typically, the general public will form their own opinions in line with the side who’s overarching narrative “rings true” more than the other. In a way, ADHD advocates are in the role of the plaintiff or prosecutor who must prove their case. ADHD critics get the more comfortable role of the defense they technically don’t have to “prove” anything – just cast enough reasonable doubt. ADHD critics have been very successful in this role by drawing on larger social narratives that many people accept as “truth” without discrimination. While this list isn’t complete, nor are all of these narratives necessarily independent of each other, here are some of the overarching narratives I’ve observed being used by ADHD critics:

  1. Nostalgia for the past: perceptions that the past was simpler, easier, and preferable in contrast to the increasingly complex, chaotic, and disconnected present. (for more info, see the upcoming post about the YMCA’s print advertisement)
  2. The moral bankruptcy of society: An offshoot of Nostalgia. This narrative claims that the values and associate practices (or lack thereof) associated with contemporary society are to blame for many of the world’s problems. This is the narrative that typically leads stigmatization of families of people with ADHD through mother or parent blaming.
  3. Personal responsibility or the “boot-strap” narrative: This narrative emphasizes importance of the individual to consciously decide to work hard enough to overcome any obstacle. This can get translated into a narrative about how those with ADHD (or other mental illnesses) can be “normal” if they just try hard enough. The even more damaging inference is that if someone struggles with ADHD, then they are doing so because they don’t care to try hard enough. (my upcoming post about the Vyvanse “You do the Rest” campaign will talk about this more)
  4. The mental hygiene conspiracy: This narrative suggests that diagnoses like ADHD are part of a movement supported by mental health professionals and the drug industry to make a profit by making people conform to a certain perspective of “normal” thought that squashes creativity and independent thinking. This also relates to the boot strap narrative in that people allow themselves to be “duped” by these groups are looking for an easy way out of personal responsibility.

The implication of these larger narratives for ADHD advocates in the court of public opinion is that messages by ADHD critics often infuse these larger narrative themes into their more specific narratives about possible alternative causes of ADHD or what we “confuse” as ADHD. Rather than having the burden to prove that these specific narratives are “true,” ADHD critics often just have to create doubt in their position as the defense. This can be done by overlaying grander narrative themes within the message that are easier for an audience to relate with – in other words, these grander narratives “ring truer” than the more specific cases being made by ADHD advocates. These grander themes are hard to trump for the general public. The most influential competition to the perceived fidelity of grander themes is personal experience. In other words, those that are likely to find ADHD advocates’ narratives more persuasive than the larger narrative themes in ADHD critics’ messages are already diagnosed with ADHD or personally know and care about someone with ADHD. And now we return to a theme that I started in a previous post: ADHD advocates are preaching to the choir.

 

So, now the question becomes: How can we learn from all of this? How can we overcome some of these problems?

  1. The first step is to start seeing and attending to the implicit narrative structures not only in opposing perspectives, but also in those of ADHD advocates.
  2. Understand that these narratives surrounding the ADHD controversy don’t exist in a vacuum. Just as we tend to organize individual facts into narrative form, we also tend to evaluate narratives in relation to other relevant narratives.
  3. More importantly, we need to understand how this influences those that should be the most important consideration when constructing a persuasive message – the target audience, skeptics in the general public.

Returning to the realm of making cases in a courtroom, Thomas Hollihan and Kevin Baaske, professors of rhetoric and argumentation and authors of the textbook Arguments and Arguing: The Products and Process of Human Decision Making, explain that each side, the plaintiff/prosecutor and the defense, have similar, but different strategies available to them when constructing narratives. In general, the side with the clearest, easiest to understand, and most complete narrative is often the victor (which are all dependent on the specific audience or jury). While this is a challenge for ADHD advocates - considering all of the different perspectives about ADHD – it is still an important goal to strive for. Considering ADHD advocates get cast as the plaintiff/prosecutor in the court of public opinion, with all if not more of the burden of proof associated with it, more attention needs to be paid to the multiple narrative strategies associated with ADHD critics’ messages (remember, it’s the message we’re mostly concerned with – not so much those that composed it). More importantly, we need to examine the different ways that ADHD critics’ messages create that “shadow of doubt” on the ADHD controversy.

 

Probably the most important lesson that I hope you take away from this post is a different understanding about how the general public, in their roles as the court of public opinion, make decisions not on independent facts or through critical, unbiased evaluation. It is the narrative that organizes information, and it is through narratives that we need to try and change the conversation.

 

Having served as the foreperson of a jury recently, I got the opportunity to see the way narratives influence opinion and decision-making for myself. Even after receiving explicit instructions for how we were to judge the trial based on the facts and as impartially as we could, the first impulse of most of the jury members were to reframe everything through each sides’ “story.” Everyone wanted to speculate about what the missing pieces were in the stories. Eventually, I began hearing people propose what they thought were probable substitutions for the missing parts. It was like the worst fan-fiction I have ever read! More importantly, many of these people were coming to what they thought were probable explanations based on generalizations or larger narrative themes that seemed to ring true to them.

 

What was more interesting was that many of them changed their minds throughout the deliberation process. When they discussed the case in terms of the narratives provided (and also the holes that they filled in themselves), many saw the verdict one way. When I tried to bring the decision back to the independent facts and explicit criteria given to us by the judge, those same people saw the verdict the other way. Ultimately, it was the narrative that won out over critical thinking and reason.

 

So, far from a dramatization of the real-life criminal justice system, 12 Angry Men represents its own idealized narrative theme that extends beyond the specific story and might account for why it’s still so popular. Sometimes narratives can become so persuasive that even our own experiences are overridden when evaluating their fidelity. And herein lies the difficulty of trying to challenge these larger narrative themes – whether they be associated with the ADHD controversy or any controversy: sometimes it’s not how much the story actually rings true, sometimes its how much you want the story to ring true. The appeal of 12 Angry Men might be in the desire to believe that Lady Justice truly is blind; that if we were ever in the position of the young man who was on trial, those that determined our fate would do so without bias or prejudice. In a way, perhaps, we want to believe in this larger narrative because then we don’t have to confront our own biases that might prevent us from making the right decision. Such is the case with the appeal of larger narratives used in ADHD critics’ messages. Maybe, if those adjudicating in the court of public opinion can latch on to the idealized narratives, then they don’t have to confront their own fears that ADHD might actually be a problem that needs to be addressed with care and consideration.

I want to thank you for taking the time to read what I have to say. I’m very excited about this new endeavor I’m embarking on. I’m very passionate about the topics that I’m going to write about, and I hope that passion is contagious!

 

I’ve been thinking long and hard about what to write about for this first post. I have so many different topics that I want to address in this blog, and of course I have to resist the urge to try and talk about them all at once. However, over the past few days, I’ve had a couple of brief exchanges with a friend and mentor via Facebook that made me think about an issue that, for me, is foundational to my outlook on the public controversy of ADHD. More importantly, this issue is important to how I approach the problems that I’m interested in addressing in this blog. Rather than looking at a specific controversy or example of public discussion about ADHD, this post will try to set the tone for how I approach the study of these issues. I will also try to explain the long-term goals of my project.

 

Some context: Before I created this blog, most of my activist work consisted of using Facebook to raise awareness about ADHD issues that I thought were important. I occasionally share news articles and other blog posts in the hope that people in my network would read them and consider ADHD-related controversies from a perspective other than the way that the media typically represents them.

 

Usually, I’m lucky if someone likes one of these posts, let alone actually comments on it. However, when I posted this article, my friend responded in a way I wasn’t quite expecting:

 

Friend: I have an idea — force our kids to focus!

 

Me: I think the evidence indicates that it’s more than a matter of learning how to, or “making” kids focus. In a way, that’s like telling someone that if they just ignore the voices in their head, then they’ll go away. Or, if someone would just work hard enough, then they wouldn’t be poor anymore. While I know one case doesn’t justify a generalization, my mother, grandparents, and teachers exerted a lot of effort trying to get me to focus. The best I have been able to do – even with meds – is learn how to deal with inattention once it occurs. Even that took me until I was almost done with undergrad to get a handle on.

 

Friend: I’m not saying there aren’t legitimate cases of ADD/ADHD, but it is entirely over-diagnosed, and in most cases, it is a matter of families sticking their kids in front of video games, TVs, and cell phones and not requiring kids to focus.

 

I never responded to this last comment. Honestly, I got distracted with other things going on, and then I started working on this blog. It wasn’t until I launched and promoted my blog on Facebook that the conversation started back up:

 

Friend: uh oh…we gonna clash on this? :) I like seeing you being an activist though!

 

Instead of responding to the Facebook post itself, I thought I would kill two birds with one post, so to speak. The short answer to my friend’s question leads to a longer explanation:

 

Me: Not necessarily…

 

I don’t think that my perspective on ADHD necessarily “clashes” with my friend’s. Instead, I think that I would differ more in degree and emphasis.

 

Now, before you jump to conclusions about my position, please let me explain…

 

Obviously, I believe that the descriptions and “symptoms” associated with what we call ADHD are real. My personal experience tells me that something about the way my brain works and the way I think differs from a lot of other people. We have certain social and cultural expectations about the way people interact and communicate with themselves (intrapersonal communication) and with others (interpersonal communication). These expectations seem to come from a common assumption that people, or at least “normal” people, have brains that are structured in a similar way (I reject the idea of a “normal,” “typical,” or “average” person – more on this in future posts). Since there is an assumption about the “typical” or “normal” structure of the brain, there are also assumptions about the “typical” or “normal” function that follows – in other words, we assume (often without thinking about it) that people typically think about and understand ideas and concepts in a similar way. It isn’t until these expectations and assumptions are violated that we notice them. For someone who has ADHD, these expectations are often violated on a daily basis – whether we notice them as such or not (often confusion is experienced as opposed to an outright recognition that an expectation has been violated). Living in a world where most people around you think and understand things in a way different from yourself makes the reality of ADHD visible in a way that someone without ADHD (or another brain difference) will never see or fully understand.

 

However, I also acknowledge that in all likelihood, there are instances where ADHD is improperly and incorrectly diagnosed. There are also probably times when ADHD medication is prescribed prematurely. Privately, I doubt there are many ADHD advocates or healthcare providers that would disagree with this assessment. But publically, admitting this is problematic because it casts doubt in the minds of skeptics about the ability to determine who has ADHD and who doesn’t. Or even worse, some would use this admission to support the argument that ADHD is a “made up” diagnosis. Many of those that criticize ADHD and the perceived “epidemic” already exaggerate the strength of their arguments by asserting that there is rampant misdiagnosis and pill-pushing. Many in the general public hear this assertion frequently enough that its validity is rarely questioned. (There are many other factors about the ADHD controversy that contribute to buying into this assertion – too many to address in one post. Please forgive the oversimplification.)

 

Many ADHD advocates often try to deflect this argument in one of two general ways: they either emphasize the people that suffer in silent confusion because they are not diagnosed with ADHD, and/or they try to encourage public and professional awareness/understanding of ADHD as a corrective. While I also believe that both of these arguments are important and necessary, they don’t sufficiently counter the original assertion for much of the general public.

 

And here lies an important component to how I study public discussions about ADHD: despite my belief in the validity and importance of arguments like these made by ADHD advocates, their actual validity and importance aren’t of concern when evaluating how effective or useful they are. Despite Plato’s insistence, the “truer” or “righter” argument is not always the one that ends up being more persuasive.

 

When thinking about how ADHD advocates should make arguments to persuade the general public, we need to think less like scientists or medical researchers trying to establish the “truth” of a biological or neurological condition. Instead, we need to think more like politicians – with the exception of their arguably unethical strategies. When politicians and political speech writers think about which arguments to make to the public, they often aren’t as concerned with the “truth” of their argument as much as they’re concerned with how persuasive the public will find their arguments. This concern applies to deciding which arguments to make, but it also applies to coming up with different ways of supporting a political position or objective to address existing beliefs of different audiences.

 

An example might help clarify what I mean. Think of the difference between the ways that arguments are made in a presidential primary campaign as opposed to the general election. In a primary campaign, arguments are more politically biased and “extreme” so that potential candidates of one party can rally the strength and support of the public that identify with that same party – these citizens are often referred to as that political party’s “base”. In other words, they are preaching to the choir – in a general election, the “base” will typically vote for that party’s candidate regardless of who the other party’s candidate is. Once the primary election is over, the general election campaign, and all the millions and millions of dollars spent, is mostly about appealing to a relatively small percentage of the population – independents and undecided voters. Each candidate typically changes the way that they make the same arguments to be more persuasive to a general audience.

 

Essentially, what I see many ADHD advocates doing is essentially running a primary campaign when we need to be focusing on the general election. Like most scientists and primary political campaigners, we’re preaching to the choir. Unfortunately, critics of ADHD have already been campaigning for the primary election for a long time. More importantly, we’re missing a crucial opportunity to engage and shape the discussion about ADHD and related problems (the role of medication, the process of diagnosis, the role of the education and healthcare systems) in a way that avoids what psychologists might call the “unintended damages” of their words. These “unintended damages” occur regardless of what a critic’s best intentions are. I believe that many of these critics are likely well-intentioned individuals who are just concerned about the health and welfare of our society and its children (of course, there are those whose motives I question as well). However, there are still consequences of these words for those that are diagnosed and experience ADHD.

 

Whew…sorry if that was a lot. This post probably raised more questions than it answered. And, in a way, that’s what it’s supposed to do. There are a lot of parts to this commentary that will be fleshed out and elaborated in their own posts. What I set out to do in this post was provide some foundational perspectives on how I view the ADHD controversy, how I study those controversies, and some over-arching, long-term objectives that I would like to see come out of my advocacy. I would like to figure out a way to engage in public discussion about some of the perceived problems with the ADHD diagnosis and medications that are prescribed, while also acknowledging the reality of the many individual lived-experiences with ADHD. More importantly, I would like to find a way to shift these discussions with ADHD critics so that it is harder and less acceptable for them to make sweeping and poorly substantiated generalizations that ultimately stigmatize those with ADHD and those that care most about them (this is a topic that will receive much attention in future posts). I realize this is a lofty goal. However, having the end-game in sight helps us develop more productive steps that can help us reach that objective in the long-term.

 

Next Week’s Post: Why we’re losing in the court of public opinion – and how to
change it!

 

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There are lots of exciting topics I have planned!

 

Also, I encourage comments, feedback, and any suggestions that you might have. I love to hear from  people about these topics, and welcome the opportunity to discuss them!