The Mental Health Industrial Complex has manufactured a mental health crisis to sell medication, to blame the individual for societal problems, and to function as a final act of destruction as the Western neoliberal hegemony collapses. This is according to psychiatrist and author of Searching for Normal, Sami Timimi. Diagnoses of ADHD, autism, depression, and anxiety disorders are all on the rise. But, to focus on one example, the expansion of what counts as ADHD, the idea that ADHD is a lifelong condition, and the notion that medication should be a common treatment for it, are all modern phenomena that lack any scientific basis.

The architecture of neurodiversity and the mental health crisis, in decaying capitalism

In the last few decades, a mutation of constructs has allowed labels such as Attention Deficit Hyperactivity Disorder (ADHD), Autism Spectrum Disorder (ASD), childhood depression, anxiety disorders and others to expand both horizontally (incorporating new behaviors and experiences, or ones of lesser severity) and vertically (to incorporate new, previously untapped populations).

Take ADHD, for example. When I first started practicing as a child and adolescent psychiatrist in the UK in the early 1990s, the department I worked in didn’t make any psychiatric diagnoses. Problems were described rather than categorized, and we would routinely think in terms of family and broader systems around the child. We knew about what was considered a rare condition called “hyperkinetic disorder,” which emphasized high levels of motor activity in the child, and could not be made if the young person had significant learning difficulties, given that this would be deemed sufficient to account for their relatively high level of activity, disruption and/or distractibility. Therefore, in my first 9-month placement in child and adolescent psychiatry, I came across precisely zero children who were diagnosed with ADHD or indeed “hyperkinetic disorder.”

SUGGESTED READING The neurodivergence paradox By Lucy Johnstone In the mid to late 1990s, ADHD clinics started appearing in the UK, often using medication quite sparingly. In fact, I led the establishment of one of these early ADHD clinics in 1998. We used a systemic and narrative therapy approach, collaborated with schools, had input from a paediatrician to deal with associated physical problems, and only about 10% of this small segment of the local population who attended the clinic ended up taking psychiatric medication. At this point, ADHD was thought to affect about 0.5% of children (or less) and was considered developmental—i.e., you expected most kids would grow out of most of the behaviors by early adulthood.

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Therefore, in my first 9-month placement in child and adolescent psychiatry, I came across precisely zero children who were diagnosed with ADHD

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As we moved into the new century, successive changes in the conceptual basis for ADHD took place. None were related to new scientific empirical evidence establishing what ADHD is at a neurobiological level. ADHD prevalence expanded to encompass a purported 3-5% of young people—and it is rising. Medication (stimulants, mainly amphetamine based—the type of substance whose dangers to body and mind we rightly warn of when taken recreationally) became the most common form of “treatment.” The idea that it is a lifelong condition, and genetically and neurologically hard-wired, became established, and so Adult ADHD was born.