Skeptics argue that many of the classic symptoms of the disorder — fidgeting, losing things, not following instructions — are simply typical, if annoying, behaviors of childhood. In response, others point to the serious consequences that can result when those symptoms grow more intense, including school failure, social rejection and serious emotional distress.

There are two main kinds of A.D.H.D., inattentive and hyperactive/impulsive, and children in one category often seem to have little in common with children in the other. There are people with A.D.H.D. whom you can’t get to stop talking and others whom you can’t get to start. Some are excessively eager and enthusiastic; others are irritable and moody.

Although the D.S.M. specifies that clinicians shouldn’t diagnose children with A.D.H.D. if their symptoms are better explained by another mental disorder, more than three quarters of children diagnosed with A.D.H.D. do have another mental-health condition as well, according to the C.D.C. More than a third have a diagnosis of anxiety, and a similar fraction have a diagnosed learning disorder. Forty-four percent have been diagnosed with a behavioral disorder like oppositional defiant disorder.

This all complicates the effort to portray A.D.H.D. as a distinct, unique biological disorder. Is a patient with six symptoms really that different from one with five? If a child who experienced early trauma now can’t sit still or stay organized, should she be treated for A.D.H.D.? What about a child with an anxiety disorder who is constantly distracted by her worries? Does she have A.D.H.D., or just A.D.H.D.-like symptoms caused by her anxiety?

The subjects who were given stimulants worked more quickly and intensely than the ones who took the placebo. They dutifully packed and repacked their virtual backpacks, pulling items in and out, trying various combinations. In the end, though, their scores on the knapsack test were no better than the placebo group. The reason? Their strategies for choosing items became significantly worse under the medication. Their choices didn’t make much sense — they just kept pulling random items in and out of the backpack. To an observer, they appeared to be focused, well behaved, on task. But in fact, they weren’t accomplishing anything of much value.

Farah directed me to the work of Scott Vrecko, a sociologist who conducted a series of interviews with students at an American university who used stimulant medication without a prescription. He wrote that the students he interviewed would often “frame the functional benefits of stimulants in cognitive-sounding terms.” But when he dug a little deeper, he found that the students tended to talk about their attention struggles, and the benefits they experienced with medication, in emotional terms rather than intellectual ones. Without the pills, they said, they just didn’t feel interested in the assignments they were supposed to be doing. They didn’t feel motivated. It all seemed pointless.

On stimulant medication, those emotions flipped. “You start to feel such a connection to what you’re working on,” one undergraduate told Vrecko. “It’s almost like you fall in love with it.” As another student put it: On Adderall, “you’re interested in what you’re doing, even if it’s boring.”

Socially, though, there was a price. “Around my friends, I’m usually the most social, but when I’m on it, it feels like my spark is kind of gone,” John said. “I laugh a lot less. I can’t think of anything to say. Life is just less fun. It’s not like I’m sad; I’m just not as happy. It flattens things out.”

John also generally doesn’t take his Adderall during the summer. When he’s not in school, he told me, he doesn’t have any A.D.H.D. symptoms at all. “If I don’t have to do any work, then I’m just a completely regular person,” he said. “But once I have to focus on things, then I have to take it, or else I just won’t get any of my stuff done.”

John’s sense that his A.D.H.D. is situational — that he has it in some circumstances but not in others — is a challenge to some of psychiatry’s longstanding assumptions about the condition. After all, diabetes doesn’t go away over summer vacation. But John’s intuition is supported by scientific evidence. Increasingly, research suggests that for many people A.D.H.D. might be thought of as a condition they experience, sometimes temporarily, rather than a disorder that they have in some unchanging way.

For most of his career, he embraced what he now calls the “medical model” of A.D.H.D — the belief that the brains of people with A.D.H.D. are biologically deficient, categorically different from those of typical, healthy individuals. Now, however, Sonuga-Barke is proposing an alternative model, one that largely sidesteps questions of biology. What matters instead, he says, is the distress children feel as they try to make their way in the world.

Sonuga-Barke’s proposed model locates A.D.H.D. symptoms on a continuum, rather than presenting the condition as a distinct, natural category. And it departs from the medical model in another crucial way: It considers those symptoms not as indications of neurological deficits but as signals of a misalignment between a child’s biological makeup and the environment in which they are trying to function. “I’m not saying it’s not biological,” he says. “I’m just saying I don’t think that’s the right target. Rather than trying to treat and resolve the biology, we should be focusing on building environments that improve outcomes and mental health.”

What the researchers noticed was that their subjects weren’t particularly interested in talking about the specifics of their disorder. Instead, they wanted to talk about the context in which they were now living and how that context had affected their symptoms. Subject after subject spontaneously brought up the importance of finding their “niche,” or the right “fit,” in school or in the workplace. As adults, they had more freedom than they did as children to control the parameters of their lives — whether to go to college, what to study, what kind of career to pursue. Many of them had sensibly chosen contexts that were a better match for their personalities than what they experienced in school, and as a result, they reported that their A.D.H.D. symptoms had essentially disappeared. In fact, some of them were questioning whether they had ever had a disorder at all — or if they had just been in the wrong environment as children.

The work environments where the subjects were thriving varied. For some, the appeal of their new jobs was that they were busy and cognitively demanding, requiring constant multitasking. For others, the right context was physical, hands-on labor. For all of them, what made a difference was having work that to them felt “intrinsically interesting.”

“Rather than a static ‘attention deficit’ that appeared under all circumstances,” the M.T.A. researchers wrote, “our subjects described their propensity toward distraction as contextual. … Believing the problem lay in their environments rather than solely in themselves helped individuals allay feelings of inadequacy: Characterizing A.D.H.D. as a personality trait rather than a disorder, they saw themselves as different rather than defective.”

For the young adults in the “niche” study who were interviewed about their work lives, the transition that helped them overcome their A.D.H.D. symptoms often was leaving academic work for something more kinetic. For Sonuga-Barke, it was the opposite. At university, he would show up at the library at 9 every morning and sit in his carrel working until 5. The next day, he would do it again. Growing up, he says, he had a natural tendency to “hyperfocus,” and back at school in Derby, that tendency looked to his teachers like daydreaming. At university, it became his secret weapon

I asked Sonuga-Barke what he might have gained if he grew up in a different time and place — if he was prescribed Ritalin or Adderall at age 8 instead of just being packed off to the remedial class. “I don’t think I would have gained anything,” he said. “I think without medication, you learn alternative ways of dealing with stuff. In my particular case, there are a lot of characteristics that have helped me. My mind is constantly churning away, thinking of things. I never relax. The way I motivate myself is to turn everything into a problem and to try and solve the problem.”

“The simple model has always been, basically, ‘A.D.H.D. plus medication equals no A.D.H.D.,’” he says. “But that’s not true. Medication is not a silver bullet. It never will be.” What medication can sometimes do, he believes, is allow families more room to communicate. “At its best,” he says, “medication can provide a window for parents to engage with their kids,” by moderating children’s behavior, at least temporarily, so that family life can become more than just endless fights about overdue homework and lost lunchboxes. “If you have a more positive relationship with your child, they’re going to have a better outcome. Not for their A.D.H.D. — it’s probably going to be just the same. But in terms of dealing with the self-hatred and low self-esteem that often goes along with A.D.H.D.

The alternative model, by contrast, tells a child a very different story: that his A.D.H.D. symptoms exist on a continuum, one on which we all find ourselves; that he may be experiencing those symptoms as much because of where he is as because of who he is; and that next year, if things change in his surroundings, those symptoms might change as well. Armed with that understanding, he and his family can decide whether medication makes sense — whether for him, the benefits are likely to outweigh the drawbacks. At the same time, they can consider whether there are changes in his situation, at school or at home, that might help alleviate his symptoms.

Admittedly, that version of A.D.H.D. has certain drawbacks. It denies parents the clear, definitive explanation for their children’s problems that can come as such a relief, especially after months or years of frustration and uncertainty. It often requires a lot of flexibility and experimentation on the part of patients, families and doctors. But it has two important advantages as well: First, the new model more accurately reflects the latest scientific understanding of A.D.H.D. And second, it gives children a vision of their future in which things might actually improve — not because their brains are chemically refashioned in a way that makes them better able to fit into the world, but because they find a way to make the world fit better around their complicated and distinctive brains.

My problems were too complex and modern to explain. So I skated across parking lots, breezeways, and sidewalks, I listened to the vibration of my wheels on brick, I learned the names of flowers, I put deserted paths to use. I decided for myself each curve I took, and by the time I rolled home, I felt lighter. One Saturday, a friend invited me to roller-skate in the park. I can still picture her in green protective knee pads, flying past. I couldn’t catch up, I had no technique. There existed another scale to evaluate roller skating, beyond joy, and as Rollerbladers and cyclists overtook me, it eclipsed my own. Soon after, I stopped skating.

the end point for the working artist is to create an object for sale. Once the art object enters the market, art’s intrinsic value is emptied out, compacted by the market’s logic of ranking, until there’s only relational worth, no interior worth. Two novelists I know publish essays one week apart; in a grim coincidence, each writer recounts their own version of the same traumatic life event. Which essay is better, a friend asks. I explain they’re different; different life circumstances likely shaped separate approaches. Yes, she says, but which one is better?

we are inundated with cold, beautiful stats, some publicized by trade publications or broadcast by authors themselves on all socials. How many publishers bid? How big is the print run? How many stops on the tour? How many reviews on Goodreads? How many mentions on Bookstagram, BookTok? How many bloggers on the blog tour? How exponential is the growth in follower count? Preorders? How many printings? How many languages in translation? How many views on the unboxing? How many mentions on most-anticipated lists?

A starred review from Publisher’s Weekly, but I wasn’t in “Picks of the Week.” A mention from Entertainment Weekly, but last on a click-through list.

There must exist professions that are free from capture, but I’m hard pressed to find them. Even non-remote jobs, where work cannot pursue the worker home, are dogged by digital tracking: a farmer says Instagram Story views directly correlate to farm subscriptions, a server tells me her manager won’t give her the Saturday-night money shift until she has more followers.

What we hardly talk about is how we’ve reorganized not just industrial activity but any activity to be capturable by computer, a radical expansion of what can be mined. Friendship is ground zero for the metrics of the inner world, the first unquantifiable shorn into data points: Friendster testimonials, the MySpace Top 8, friending. Likewise, the search for romance has been refigured by dating apps that sell paid-for rankings and paid access to “quality” matches. Or, if there’s an off-duty pursuit you love—giving tarot readings, polishing beach rocks—it’s a great compliment to say: “You should do that for money.” Join the passion economy, give the market final say on the value of your delights. Even engaging with art—say, encountering some uncanny reflection of yourself in a novel, or having a transformative epiphany from listening, on repeat, to the way that singer’s voice breaks over the bridge—can be spat out as a figure, on Goodreads or your Spotify year in review.

And those ascetics who disavow all socials? They are still caught in the network. Acts of pure leisure—photographing a sidewalk cat with a camera app or watching a video on how to make a curry—are transmuted into data to grade how well the app or the creators’ deliverables are delivering. If we’re not being tallied, we affect the tally of others. We are all data workers.

In a nightmarish dispatch in Esquire on how hard it is for authors to find readers, Kate Dwyer argues that all authors must function like influencers now, which means a fire sale on your “private” life. As internet theorist Kyle Chayka puts it to Dwyer: “Influencers get attention by exposing parts of their life that have nothing to do with the production of culture.”

what happens to artists is happening to all of us. As data collection technology hollows out our inner worlds, all of us experience the working artist’s plight: our lot is to numericize and monetize the most private and personal parts of our experience.

We are not giving away our value, as a puritanical grandparent might scold; we are giving away our facility to value. We’ve been cored like apples, a dependency created, hooked on the public internet to tell us the worth.

When we scroll, what are we looking for?

While other fast fashion brands wait for high-end houses to produce designs they can replicate cheaply, Shein has completely eclipsed the runway, using AI to trawl social media for cues on what to produce next. Shein’s site operates like a casino game, using “dark patterns”—a countdown clock puts a timer on an offer, pop-ups say there’s only one item left in stock, and the scroll of outfits never ends—so you buy now, ask if you want it later. Shein’s model is dystopic: countless reports detail how it puts its workers in obscene poverty in order to sell a reprieve to consumers who are also moneyless—a saturated plush world lasting as long as the seams in one of their dresses. Yet the day to day of Shein’s target shopper is so bleak, we strain our moral character to cosplay a life of plenty.

(Unsplash) Technology The Collapse of Self-Worth in the Digital Age Why are we letting algorithms rewrite the rules of art, work, and life? BY THEA LIM Updated 17:52, Sep. 20, 2024 | Published 6:30, Sep. 17, 2024 W HEN I WAS TWELVE, I used to roller-skate in circles for hours. I was at another new school, the odd man out, bullied by my desk mate. My problems were too complex and modern to explain. So I skated across parking lots, breezeways, and sidewalks, I listened to the vibration of my wheels on brick, I learned the names of flowers, I put deserted paths to use. I decided for myself each curve I took, and by the time I rolled home, I felt lighter. One Saturday, a friend invited me to roller-skate in the park. I can still picture her in green protective knee pads, flying past. I couldn’t catch up, I had no technique. There existed another scale to evaluate roller skating, beyond joy, and as Rollerbladers and cyclists overtook me, it eclipsed my own. Soon after, I stopped skating. Y EARS AGO, I worked in the backroom of a Tower Records. Every few hours, my face-pierced, gunk-haired co-workers would line up by my workstation, waiting to clock in or out. When we typed in our staff number at 8:59 p.m., we were off time, returned to ourselves, free like smoke. There are no words to describe the opposite sensations of being at-our-job and being not-at-our-job even if we know the feeling of crossing that threshold by heart. But the most essential quality that makes a job a job is that when we are at work, we surrender the power to decide the worth of what we do. At-job is where our labour is appraised by an external meter: the market. At-job, our labour is never a means to itself but a means to money; its value can be expressed only as a number—relative, fluctuating, out of our control. At-job, because an outside eye measures us, the workplace is a place of surveillance. It’s painful to have your sense of worth extracted. For Marx, the poet of economics, when a person’s innate value is replaced with exchange value, it is as if we’ve been reduced to “a mere jelly.” Wait—Is ChatGPT Even Legal? AI Is a False God How Israel Is Using AI as a Weapon of War Not-job, or whatever name you prefer—“quitting time,” “off duty,” “downtime”—is where we restore ourselves from a mere jelly, precisely by using our internal meter to determine the criteria for success or failure. Find the best route home—not the one that optimizes cost per minute but the one that offers time enough to hear an album from start to finish. Plant a window garden, and if the plants are half dead, try again. My brother-in-law found a toy loom in his neighbour’s garbage, and nightly he weaves tiny technicolour rugs. We do these activities for the sake of doing them, and their value can’t be arrived at through an outside, top-down measure. It would be nonsensical to treat them as comparable and rank them from one to five. We can assess them only by privately and carefully attending to what they contain and, on our own, concluding their merit. And so artmaking—the cultural industries—occupies the middle of an uneasy Venn diagram. First, the value of an artwork is internal—how well does it fulfill the vision that inspired it? Second, a piece of art is its own end. Third, a piece of art is, by definition, rare, one of a kind, nonfungible. Yet the end point for the working artist is to create an object for sale. Once the art object enters the market, art’s intrinsic value is emptied out, compacted by the market’s logic of ranking, until there’s only relational worth, no interior worth. Two novelists I know publish essays one week apart; in a grim coincidence, each writer recounts their own version of the same traumatic life event. Which essay is better, a friend asks. I explain they’re different; different life circumstances likely shaped separate approaches. Yes, she says, but which one is better? I GREW UP a Catholic, a faithful, an anachronism to my friends. I carried my faith until my twenties, when it finally broke. Once I couldn’t gain comfort from religion anymore, I got it from writing. Sitting and building stories, side by side with millions of other storytellers who have endeavoured since the dawn of existence to forge meaning even as reality proves endlessly senseless, is the nearest thing to what it felt like back when I was a believer. I spent my thirties writing a novel and paying the bills as low-paid part-time faculty at three different colleges. I could’ve studied law or learned to code. Instead, I manufactured sentences. Looking back, it baffles me that I had the wherewithal to commit to a project with no guaranteed financial value, as if I was under an enchantment. Working on that novel was like visiting a little town every day for four years, a place so dear and sweet. Then I sold it. As the publication date advanced, I was awash with extrinsic measures. Only twenty years ago, there was no public, complete data on book sales. U

Before explaining “3 Ways Past Trauma Can Show Up in Your Present” or “5 Signs of a Highly Sensitive Person,” Dr. Julie will use a visual hook — she’ll pour out a bucket of candy, flip over a giant hourglass, or pose next to a tantalizingly tall stack of dominos (like any skilled content creator, she knows not to give us the final knockdown until at least halfway through) to keep you watching. Does it matter that “high-functioning depression” and “highly sensitive person” aren’t actual diagnoses? Maybe. Or maybe not.

While most full-time therapists whose rates are set by insurance companies max out at around $100,000 per year, therapists who are full- or part-time content creators can make much, much more. @TherapyJeff, real name Jeff Guenther, an individual and couples therapist in Portland, Oregon, says he can make eight or nine times that amount on social media in the form of brand deals, merch, and direct subscriptions. When I clarify whether he’s making nearly a million dollars, he says, “It’s been an especially good year.”

What works on the app is simple, visually arresting videos that make you feel like they landed in your lap with a kind of cosmic destiny (the comments on these videos often repeat some version of “my For You page really said ‘FOR YOU.’”)

Therapists do cute little dances next to cute little graphics about what it’s like to have both ADHD and PMDD; they’ll lip sync to trending songs in videos about how to spot a depressed client who might have made a suicide plan; they’ll hop onto memes as a way to criticize parents who haven’t gone to therapy.

The most successful TikTok counselors don’t typically advertise their one-on-one therapy services; instead, they’ll sell products that establish themselves as mental-health experts but have the potential to net influencer-size salaries.

“I have been accused of being a toxic validator,” he admits. “Like, imagine that your ex-boyfriend is watching my content. Somebody might be coming across, like, a piece of my content that they can use in order to feel better about themselves, even when they should probably actually be doing some work and taking accountability.” But ultimately, who TikTok shows his videos to isn’t in his control.

Even if viewers know watching therapy content isn’t the same thing as actually going to therapy, when a professional therapist comes up on your feed to tell you exactly what you most want to hear at a time when you’re most in need of hearing it — that you are good, that you will be okay, and also here’s a cute little visual hook — you’ll keep watching.

Unlike the “trauma plot,” Parul Sehgal’s coinage for the use of trauma as narrative payoff, the therapeutic plot doesn’t wallow in trauma itself. Instead, it offers formulaic accounts of diagnosis and healing—what Janet Malcolm has called “the streamlined truisms of the age of mental health.”

Book blogs sort recommendations by pathology (severe social anxiety, schizophrenia, body dysmorphia), symptom (anxiety, panic attacks), and trauma (parental suicide, psychiatric stay). Fans diagnose characters with mental disorders (a fan theory diagnoses the character Bruno from another recent Pixar offering, Encanto, with obsessive compulsive disorder). Self-diagnosis even informed the development of Everything Everywhere. In early drafts of the script, Evelyn suffered from undiagnosed attention deficit hyperactivity disorder. Writing and researching her character inspired Kwan to identify and seek treatment for his own heretofore undiagnosed ADHD.

No doubt, such a medical diagnosis can provide relief and resolution. But is such a diagnosis the job of art? What is lost when audiences and creators eschew other ways of discussing fiction (for example, E.M. Forster’s distinction between round and flat characters) and instead reduce characters to clinical profiles?

In ancient Athenian tragedy, catharsis was defined by Aristotle’s Poetics as the ritual purification and purgation of emotions, particularly pity and fear. Pity arises from identification with the tragic hero, whose nobility is compromised by a fatal flaw, and fear is elicited by his excessive punishment. The therapeutic significance of catharsis originated much later in the theories of Sigmund Freud. By applying Joseph Breuer’s “cathartic method,” Freud theorized that hypnosis allowed patients to recall the traumatic experience at the root of their condition. Catharsis was Freud’s first major breakthrough, and his first brush with the powers of the unconscious that would form the underpinnings of psychoanalytic theory.For Aristotle, catharsis was the result of anagnorisis—the humility produced by the tragic hero’s recognition not only of the calamity that had befallen him, but also of his own role in bringing it about. Freud, meanwhile, described an inherent tragedy in the “impossible profession” of psychoanalysis, “in which one can be sure beforehand of achieving unsatisfying results.” It wasn’t that Freud had no faith in his own methods; he simply perceived the enormity of the human condition, and understood that the odds of success were not stacked in the psychoanalyst’s favor.Humility is absent from today’s therapeutic catharsis, which assumes with algorithmic certainty that sharing will lead to understanding, and that understanding will lead to healing. Art’s role, according to Everything Everywhere actress Stephanie Hsu, is “to hold space for trauma and offer catharsis,” and to recognize that “empathy and radical empathy and radical kindness are also a tool.” Buried beneath this gauzy language is the fact that the “empathy” of Turning Red and Everything Everywhere rely on the transformation of the mothers, not their children. The adults must learn that children are individuals rather than extensions of parental will, and when empathy is granted to mothers, it is only through their shared status as victims.

Pity the immigrant women who fled war-torn nations and corrupt regimes only to be subjected to psychoanalysis from hipster filmmakers and their own children

All this is not to say that storytelling holds no empathic power, nor an ability to transcend individual perspectives. But this power lies in art’s ability to overthrow, not reify, easy solutions—to challenge rather than “validate.” The transmission of suffering from one generation to the next is a worthy subject for art, but not because its effect on any particular demographic has been under-represented.

Our approach to culture should account for rigor and complexity, not defer to trite solutionism.