On the recent BBC2 Horizon programme (which is still available to view on BBCiPlayer), Rory Bremner, Britain’s most loved comedian impersonator, took us on his personal journey on discovering his Adult ADHD diagnosis.
It was helpful, interesting, revealing and frustrating to me in equal measure. Cards on the table time. I am on a bit of a personal mission, fuelled by my own experiences, to get the issues surrounding ADHD into the spotlight. It is a modern day epidemic affecting millions of people and like many mental health issues gets the nod of sympathy but not the real empathy that is needed to tackle it.
What did I find HELPFUL?
Well first and foremost round of applause to Rory and the BBC in having the foresight and idea in the first place. Anything that puts ADHD up there, getting some exposure to what this condition actually is and its impact must be positive. It is really, really helpful on national television to have one of the nation’s treasures (sorry Rory to embarrass you but we love you!) being prepared to be vulnerable and expose a personally difficult diagnosis so we can all understand more. Rory saw the diagnosis as he said as an “admission of failure in many aspects of my life”. This honesty and openness will no doubt help people to perhaps get there own diagnosis. Personally my own diagnosis at around the same age and stage in life as Rory was liberating. I saw it not so much as am “admission of failure” but as at least a part “explanation” of many of the difficulties I head faced. The programme also helped to make the condition tangible. The programme showed there was something demonstrably different in the brain that made the condition more real. For those of us living with it we don’t need reminding of the reality but for those who want to understand it more there was concrete evidence. Helpful indeed!
Why did I find it INTERESTING?
It was interesting to see the array of different disciplines that considered the diagnosis. Rory and the BBC introduced us to Neurologists, Psychiatrists, Geneticists, Evolutionary Biologists, Biochemists, Cognitive Behaviour Therapists.
Professor Katya Rubia from King’s College, London showed the real differences in the activation of the brain from MRi imaging.
Professor Barbara Franke showed the genetic research she is undertaking at Radboud University, Netherlands to isolate the genes that may be responsible for predisposing people to ADHD. They had isolated a few but there seemed a long way to go.
There was a bit of a lame but amusing attempt to develop a metaphor of cooking gingerbread men to demonstrate the complex interplay between genes and environmental factors. I particularly loved the shark bait analogy, given by Dr Jonathan Williams a consultant psychiatrist, explaining that there was a reason that populations needed a small group of people with ADHD as the risk takers that kept others safe.
I empathised with Salif Mahamane who is doing research at Utah State on how our physical environment really doesn’t help the ADHD condition. As an ADHDer himself he believes that urban indoor environments (where we spend too much time) lack spontaneity, are monotonous and boring. These really don’t help. He pinned for the outdoors and described those with ADHD as ‘pathfinders’ for communities. My own kids completely recognised this in me. Even remembering the times I spotted the twitches in the undergrowth whilst enjoying a family Kent country walk, with me saying “its a snake” only to reveal an actual bloody snake!
Like with many medical or mental health issues there is no single discipline or approach that will address the underlying causes. Our best hope through research is definitely a multi-discipline approach. It was interesting to me how the programme weaved the story together through the different disciplines.
What did it REVEAL that I didn’t know already?
I have to admit I was expecting the worst when I sat down to watch the programme. I have a personal interest in the real science and don’t expect to learn much from a TV programme that needs to be interesting to a wide audience. While some of the science was superficial in its presentation it was very interesting and I did learn some stuff I hadn’t already come across. I was particularly interested in the historical piece.
ADHD is often portrayed as a ‘modern disease’. There is some truth in this as changes in our diet and other aspects of our modern lives have created health challenges that weren’t so prevalent 100 years ago. Rory took us back to Germany where some of the earliest efforts to understand ADHD were made. The first known description of ADHD appeared in a textbook in 1775 but in the 1840’s a physician, Heinrich Hoffman who also famously wrote children’s books based on his patients told us of a character called “fidgety Phillip” who showed all the symptoms of ADHD.
Whilst the history revealed the fact that this was a condition that has long been known about and researched the programme also revealed the lack of progress in dealing with the underlying causes and how our own medical approach again tends to put all the energy into dealing with symptoms rather than ‘root’ cause. This leads to my next reflection on what I found frustrating about the programme.
Why did I find it so FRUSTRATING ?
Underlying my frustration was the similarity of Rory’s experience to my own when you get to the “so what are we going to do about it?” point following the diagnosis. Unsurprisingly, there was a Doctor providing a pill, Methylphenidate, (a class A drug in other forms!) to treat the symptom without any particular exploration or discussion of real alternatives, emerging science or non-medicated approaches.
Pop the pill, there may be a few side effects (completely underplayed) and this is the rest of your life! Rory quipped to the consultant psychiatrist “How long have you been a drug dealer?” . For me it sums up the approach we have come to accept. It showed Rory after apparently his first dose going on stage and then subsequently describing a difference he felt. Hmmmm! Seems a bit instant. Also the doctor who was diagnosing Rory said that he didn’t know why Ritalin, now conveniently renamed, gets “such a bad press” What!!! The friendly voice over tells us that the doctors say Rory needn’t worry about the medication after all there were over 1 million prescriptions in England alone last year. Well that’s alright then!! As if it was some form of justification.
You only have to look at many of the recent studies that show for example the potentially addictive nature of stimulant drugs like Ritalin and other methylphenidates. They stimulate dopamine which is believed to relief some of the symptoms but the brain builds a tolerance that then requires more and more drugs to have the same effect. This can create dependency and anyway is still not dealing with the underlying cause.
There is a huge growing research base in many neurological disorders like ADHD, Parkinsons ans Alzheimers showing that these conditions can be fixed – yes actually fixed! – by focusing on other non-drug, non-surgical approaches. None of this was even mentioned on the programme which given my own similar experience is frustrating. After my diagnosis and in my first visit to my G.P. I was prescribed a daily dose of 90mg of Concerta with zero discussion about alternatives, my lifestyle, my nutrition, my sleep etc etc.
I am not saying that drugs don’t have their place or that you need to deal with symptoms. My frustration is that a programme like this is a rare opportunity to explore some different thinking, approaches and ideas. Instead we are left with something that just tows the current medical line and I didn’t find helpful or hopeful.
The other frustrating omission for me was the most serious impact I see that those with ADHD having on people in adulthood differently from childhood. We saw a stark demonstration of a young boy with extreme symptoms and the huge impact on the relationships in his family, especially his mum and sister as well as those at school. Yet we didn’t hear much about impacts on relationships with Adults.
In my experience this is by far the biggest impact people are having to cope with in their relationships at home and at work but Rory didn’t really take us into this issue in the programme. Divorce and not being able to hold down a job remain the really difficult issues for those with ADHD and the people they live with. We are loved and drive people nuts in equal measure.
I’d love to hear what you thought. If you manage to watch the programme let me know. Interested to hear your views or any challenges to my conclusions. Please feel free to comment below.