By Omar Kawam

We are pleased to introduce this thought-provoking series by medical student Omar Kawam. In Part 1, he lays the theoretical groundwork, critiquing the socio-economic forces behind ADHD diagnoses and exploring both psychiatrist and patient perspectives. This aligns with CPN’s mission to challenge over-medicalisation and promote systemic awareness in mental health.

Introduction

The prevalence of ADHD amongst adults is estimated at 2.58-6.76% globally¹ and the number is growing among working class individuals and people in white collar markets². A rising number of people are seeking mental health professionals such as therapists, psychiatrists, and psychologists not only to address specific symptoms but with the explicit aim of attaining an ADHD diagnosis and its subsequent treatment^3,4,5. This trend has contributed to a significant rise in demand for ADHD medications and therapies^6,7. Feelings of inadequacy, lack of motivation, and difficulty keeping up with the intensifying stresses of a competitive work environment have driven more people to seek psychiatric care as they believe their experiences may be the result of an ADHD syndrome^5,8,9,10. For many, this is seen as a socially sanctioned avenue to seek solutions for their struggles and to maintain their productivity^11,12.

Patients embarking on this therapeutic journey often begin their search for a diagnosis by going online or seeking a psychiatrist or therapist who can offer diagnostic and therapeutic services for ADHD, especially with the hope they can be offered accommodations or medications to address their symptoms and regain their edge at work^{13,14,15,16,5,17}. Online platforms, including those targeted at professionals such as CEOs, frequently discuss ADHD within the context of workplace stress and productivity; these can include websites that talk about what ADHD is^18,19,20, and they offer insights into the condition alongside plans and approaches for how to cope with it, manage symptoms, enhance focus, and boost productivity in demanding professional environments^11,21.

As publicised and commonly understood, ADHD can present as a lack of attention, distractibility, and inability to complete tasks to the point of impacting one’s quality of life and work^22,23. In most traditional encounters at a clinic, a psychiatrist or therapist will inquire about the patient’s concerns and in response to a request for an ADHD assessment, administer a series of diagnostic evaluations^24,25. These may include tests such as Conners’ Adult ADHD Rating Scales, Brown Attention-Deficit Disorder Scales, and the Wender Utah Rating Scale designed to measure various factors associated with the symptoms described^26,27,28. The diagnosis is determined via a combination of test results, the clinician’s subjective evaluation, and the extent of the patient’s expressed desire for a formal diagnosis and access to treatment options^25,29. Once diagnosed, patients are typically prescribed stimulant medications such as amphetamines aimed at enhancing their focus and productivity³⁰. They may also engage in therapy sessions focused on developing strategies for improving focus, establishing habits, and managing tasks more effectively³¹.

It is worth noting that psychiatric care for ADHD, like many other mental health conditions, adheres to a model that emphasises symptom identification, diagnosis, and a treatment regimen combining therapy and pharmacological interventions^32,25. While this approach often asserts to be grounded in the bio-psycho-social model of health, it frequently neglects the broader economic and social contexts within which diagnoses are made. This omission raises critical questions about the efficacy of such treatments and whether the goals of care align with the needs of both the individual patient and society at large. In this essay I hope to explore the perspectives of a patient seeking psychiatric care for ADHD and a psychiatrist who applies a critical lens to how ADHD is conceptualised, diagnosed, and treated. A critical perspective is needed not only to ensure patients get the best support and care but also to address the consequences of potential systemic over-medicalisation and treatment of patients’ experiences and struggles. Larger, it examines the complex role psychiatry may play in pathologising human struggles within systems that place significant demands on workers. The critical psychiatrist is placed in tension with the traditional medical guidelines for treating patients that encourage a diagnosis of ADHD and treatment with pharmaceuticals. The patient however struggles with symptoms of distractedness or inattention and a larger societal pressure to seek diagnoses and treat pharmaceutically, especially when social, personal, and economic pressures drive them in that direction.

In this essay, I will explain the position of the critical psychiatrist and the patient as well as recommendations for providers and their patients to navigate their moral and pragmatic differences.

Moral View of a Critical Psychiatrist

Initially, it is important to explain the critical perspective of the psychiatrist who encounters patients seeking an ADHD diagnosis. In the spirit of grounded inquiry and concern for the discipline and patients it serves, the critical psychiatrist challenges traditional diagnostic standards and norms within psychiatric practice³³. They question both the criteria used for diagnosis and the therapeutic objectives associated with conditions such as ADHD³⁴. This critical approach requires examining the broader social context in which mental health conditions are defined, diagnosed, and treated. It strives to understand how psychiatric institutions, in collaboration with their associates in the pharmaceutical industry, contribute to the pathologisation of natural variations in human behaviour^35,36,37. Furthermore, it examines how these institutions selectively endorse a narrow range of therapeutic interventions that primarily advance their economic and social priorities, while not fully addressing the complex, multi-dimensional nature of mental health, well-being, and what constitutes a life well lived^38,37.

The critical psychiatrist highlights how, under neoliberal capitalism, psychiatry aligns its diagnostic (via the DSM) and therapeutic frameworks with broader socio-economic imperatives, prioritising the extraction of labour value and, often relatedly, the suppression of resistance and dissent from the population of labourers³⁹. Psychiatric institutions reinforce and normalise neoliberal capitalist hegemony by endorsing ideals that equate mental health with productivity, constant growth, and allegiance to the capitalist status quo^40,39. Within this paradigm, the profession implicitly and explicitly defines “normal behaviour” as the ability to function effectively within prevailing societal and economic systems^39,36. Conversely, individuals struggling to adapt to these conditions—for example through their inability to partake in a company’s competitive growth goals or maintain constant focus and attention in the workplace—are pathologised, with their difficulties framed as intrinsic defects requiring medical diagnosis and, typically, pharmaceutical intervention^12,39.

This framework situates psychiatry as a mechanism of regulation, reinforcing systemic norms by asserting that a person’s dysfunction originates within themselves rather than the socio-economic constructions they navigate⁴¹. Concurrently, there exists a prominent cultural emphasis produced by the multi-billion-dollar self-help industry on therapeutic approaches that promote optimism and positivity, encouraging individuals to adjust their attitudes towards economic struggles and social adversities beyond their control^42,43. This approach emphasises inward reflection when failures or struggles occur and the need for constant growth to remain afloat or competitive in one’s economic environment. It further redirects critical examination away from systemic inequities in the economic and social structures and instead promotes a narrative of personal inadequacy, thereby bolstering the same conditions that contribute to emotional and cognitive distress.

Traditional psychiatry often aligns its diagnostic criteria not only with the capitalist system, but also with the interests of the pharmaceutical industry, displaying a wider reliance on the biomedical model of health³⁵. This model assumes that mental health conditions, rather than being intrinsically related to a patients socio-economic and cultural context, primarily result instead from hormonal, chemical, or genetic imbalances—a narrative that has been repeatedly challenged across multiple psychiatric conditions³⁸. Despite this, the uncritical acceptance of this framework and the proliferation of psychiatric medications over recent decades underline the profession’s bias towards a medicalised approach to mental health^44,37. For instance, the overreliance on stimulant medications in treating ADHD illustrates how psychiatric practice can prioritise capitalist ideals and pharmaceutical interventions, often framing conditions in ways that align with demands of productivity rather than patient well-being, such as using stimulants to “correct” or enhance work performance and manage distress in patient-workers^29,5,17. When the desired outcome is productivity, and a medication can purportedly enhance work performance, an individual falling short of economic demands can be categorised as inadequate, pathologised, and subsequently treated with pharmaceuticals^39,5. In effect, this framework prioritise economic productivity and pharmaceutical solutions over more comprehensive approaches to patient wellbeing.

Thus, a critical psychiatrist is concerned with addressing the role of the pharmaceutical industry not only in advancing medical approaches to treatment, but its role in shaping diagnostic criteria^35,45. This perspective recognises the problematic nature of excessive medication use to treat conditions that are, to some extent, socially constructed or influenced^38,12.

While this critique of social and economic drivers may seem foreign to the traditional tightknit therapeutic relationship between a patient and their psychiatrist, it is essential to uncover in pursuit of a more therapeutically unbiased and liberated support mechanism for patients (which will be discussed in Part 2). Importantly, a critical psychiatrist is neither inherently opposed to medication nor dismissive of the genuine struggles patients experience with focus, attention, and other challenges. Instead, their critique centres on the diagnostic paradigm that often reduces patients to rigid disease categories that are shaped by the priorities of capitalist social and economic contexts^39,46. They challenge the predominantly neurobiological approach to understanding and treating conditions that are not demonstrably related to a clinically significant biological pathology, especially when such a paradigm is utilised primarily to justify a therapeutic model that has the economic gains of the pharmaceutical industry as a significant end^47,44. Moreover, they emphasise the importance of considering the broader social contexts and behavioural patterns that contribute to a patient’s difficulties, advocating for a more nuanced and patient-centred approach to care⁴⁸.

Patient Perspective on Treatment for ADHD

In addition to the critical psychiatrist who struggles with the traditional psychiatric paradigm for diagnosing and treating mental health conditions, there exists the patients who themselves are struggling with their own mental health needs, an onslaught of ADHD advertising, and feelings of inadequacy exacerbated by socio-economic conditions.

Patients seeking an ADHD diagnosis and subsequent care often share common experiences and characteristics that range in severity and degree of disability⁸. It is not a primary interest in this paper to address the extremes of patients suffering from symptoms of severe dysfunction who may also suffer from a range of comorbid conditions. Rather, it is the adult patient who is pathologised for not keeping up. Given the extent of advertisement about ADHD describing a range of normal human struggles as potentially related to or caused by ADHD, many patients seek psychiatric support as means to overcome these challenges^5,49. Such advertisements often dilute severe symptomatology by equating any lapse in focus or attention with ADHD. These patients include white-collar professionals whose roles are becoming increasingly demanding, with employers expecting intensified levels of productivity and efficiency⁴⁰. These individuals present with symptoms commonly associated with ADHD such as difficulty focusing, lack of motivation, and struggles with task completion^23,5. Driven by the demands to succeed or excel in a competitive workplace, workers approach therapists or psychiatrists feeling exhausted by their struggles and seeking a diagnosis²¹. They often internalise the belief that their difficulties result from personal or mental inadequacies, either biological or psychological, and that pharmaceutical interventions might enhance their abilities to keep up with life’s demands⁴³. Consequently, they seek therapy or psychiatric care for a condition framed within the neoliberal capitalist paradigm, namely ADHD, and are likely to request medications such as Adderall to improve their performance^39,17,29.

This phenomenon, wherein patients seek medical solutions for challenges that are otherwise usual responses to ever more demanding office pressures, has extended outside the clinical setting. Non-patients increasingly acquire these stimulant medications through social networks to enhance their productivity. As discussed by Sales et al (2019) such usage reflects a wider societal trend where medications are seen as tools to acquire a competitive edge even outside clinical therapeutic guidance⁵⁰. Individuals use these substances to become more sociable, work longer hours, and remain competitive, aligning themselves with societal norms that prioritise high performance and productivity. In this context, using stimulants is not stigmatised as “cheating,” nor giving into an unreasonably demanding socio-economic system, but is considered a pragmatic solution to increasing real-world demands.

Complying with and enabling a patients’ desire to acquire an ADHD diagnosis and medications to alleviate their personal and professional struggles may be a normal course of action for a traditional psychiatrist following established standards of care³⁸. This psychiatrist may want to support the patient through their struggles, and with the help of the ADHD diagnosis can give patients a framework to understand and overcome their challenges¹². However, it poses a significant struggle for a critical anti-capitalist psychiatrist who not only views their professional responsibilities differently but views such practices as harmful to society at large^48,46. In Part 2, I discuss a framework and course of action for critical psychiatrist who tries to address patients’ concerns while still attempting to resist and overcome the traditional psychiatric imperative to diagnose ADHD and medically treat such individuals.

This is Part 1 of a two-part series. Part 2, exploring practical recommendations and challenges, will be published next week. What are your thoughts? Share in the comments.

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About the author

Omar Kawam is a third-year medical student at Rutgers Robert Wood Johnson Medical School, USA, and an MD candidate in the Class of 2027. He has a keen interest in critical psychiatry and ethical approaches to mental health care.