Where Does the Stigma Against ADHD Come From?

Why is ADHD still so heavily stigmatized in our culture, when it’s one of the most well-understood neurodivergences out there? We need to dig into the history of ADHD to understand where this stigma comes from and how to fight against it in our day-to-day lives.

In today’s episode, we’re covering:

• Theophrastus’ “Obtuse Man,” an ancient example of a person with ADHD traits 
• the medieval tie between spiritual health and mental health 
• Sir Alexander Crichton’s work, which changed the course of neurodivergent history at the very turn of the 19th century

Want to listen? This post is based off of Episode 69 of the Neurodiverging Podcast! Listen on Apple Podcasts | Spotify | Youtube

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Show Notes & Sources:

• Get ad-free podcast downloads by joining us on Patreon: http://patreon.com/neurodiverging
• For further information on the Obtuse Man, see 2000 Years of ADHD? The Obtuse Man and ADHD in Ancient Greece.

• Lange, Klaus W et al. “The history of attention deficit hyperactivity disorder.” Attention deficit and hyperactivity disorders vol. 2,4 (2010): 241-55. doi:10.1007/s12402-010-0045-8
• “Previous Names for ADHD.” History and Medication Timeline of ADHD. VeryWellMind.com: https://www.verywellmind.com/adhd-history-of-adhd-2633127
• Victor, Marcelo M et al. “Attention-deficit hyperactivity disorder in ancient Greece: The Obtuse Man of Theophrastus.” The Australian and New Zealand journal of psychiatry vol. 52,6 (2018): 509-513. doi:10.1177/0004867418769743

Transcript:

Introduction

Hello friends! Welcome to Neurodiverging, Danielle here. Today, we’re talking about the history of ADHD, attention deficit hyperactivity disorder. We’ve talked a bit about how, although ADHD is often considered a modern-phenomenon, and an abnormality or disorder, we actually have good evidence that ADHD is a normal neurodivergence.

The presentation or traits of ADHD are due to a genetic variation, or possibly several, just like autism and some other things most medical literature currently classifies as neurodevelopmental differences. I talk about this more in last season’s episode 107.

Besides current technology that lets researchers actually look at how the brains of ADHD folks work in real-time, we know that neurodivergence is normal in humans because we have a lot of evidence of folks with ADHD in the past. I know a lot of people feel like ADHD appeared out of nowhere in the 1980s and has kind of taken over kids’ brains since then, but that’s not true. People have been writing about neurodivergences that look a lot like ADHD throughout history.

So over the next few episodes, I’d like to review some of that history of ADHD for you! You could definitely write a book, or several, just about this, because there’s a lot of research on this. I’ll link a couple of papers and other sources in the show notes, neurodiverging.com, and I encourage you to go reading, if that’s your thing.

I do want to note that this history is biased toward the west, because I’m an English speaker reading papers written in English. That doesn’t mean there isn’t ADHD in non-English speaking places historically; obviously, there was! The lack of it here is just a reflection of what I could and couldn’t access. If you’re a researcher in this area, I’d love to hear from you!

Before we dive in, just a little reminder to head over to neurodiverging.com for the show notes, to sign up to our mailing list, and to read the blog articles. 

What are the old names for ADHD?

So, let’s get into it! Obviously, people didn’t call ADHD “ADHD” two thousand years ago, or even two hundred years ago, so first, we need to set out how we want to identify ADHD in historical sources. I think there’s probably a ton of different approaches to this problem, but personally, I thought the most direct thing to do would be to look at ADHD traits.

So, the obvious ones should be the ones that we mostly use to diagnose, since we think they apply to, if not all, at least a good percentage of ADHD folks. For the purpose of this exercise, let’s set those traits as inattention (different attention), hyperactivity or excessive activity, and impulsivity. 

When you look at those specific traits, you can find a history of children and adults with probable-ADHD diagnosed under different terminology. These terms change based on the time and place you’re looking at, which is why it looks like ADHD appeared out of nowhere in the 1980s – it wasn’t called ADHD before! Here’s an incomplete list of other names for what we’d now call ADHD throughout Western history.

Some of these terms include:

• Brain-injured
• Brain-damaged 
• Hyperkinetic impulse disorder
• Hyperexcitability syndrome
• Clumsy child syndrome
• Hyperactive child syndrome
• Hyperkinetic reaction of childhood
• Minimal brain dysfunction
• Organic brain disease
• Nervous child

And of course, Attention deficit disorder, the immediate precursor to attention deficit hyperactivity disorder, ADHD.

Now, the history of ADHD is likely as long and complex as the history of humanity itself, but of course, we can only access small pieces of history through whatever documents have been left behind. Because of that, and because I don’t want to just read a book about the history of ADHD to you, I’m going to just select some of the most interesting of those documents to present to you, and of course links for more information on any of this are in the show notes.

ADHD In The Ancient World

Now, the oldest reference to something that looks a lot like ADHD that I could find was in this paper from the Australian and New Zealand Journal of Psychiatry, called, “Attention-deficit hyperactivity disorder in ancient Greece: The Obtuse Man of Theophrastus.” The paper argues that Theophrastus, who was a student of Aristotle  and a Greek native of Lesbos in the 3rd century BCE, gave the Western world the first character who looks like someone who would be considered ADHD in the current day.

Theophrastus wrote a short collection of texts which are basically summaries of character archetypes, where each kind of character is described by about 15 traits. The character of interest to us is translated into English as the “Obtuse Man,” and he presents with features that closely resemble the modern description of attention-deficit hyperactivity disorder. 

For example, The Obtuse Man, an adult, seems to have issues with inattention and hyperactivity. Theophrastus writes that he forgets important appointments and is so active that he exhausts his children when they play. He also has trouble planning into the future and sleeping – these are not ADHD symptoms in and of themselves, but are sleep troubles and executive dysfunctions are very common among the ADHD population.

The authors of this paper compare the Obtuse Man, as Theophrastus describes him, with the modern DSM-5 ADHD symptoms, and conclude that he would probably be currently diagnosed with this disorder as an adult. The authors claim that this is the oldest description of ADHD as we recognize it in adults in the Western literature, and I wasn’t able to find anything older myself.

What I think is so cool about this is that Theophrastus wrote this work in the 3rd century BCE, so roughly 2300 years ago, and yet the symptoms of ADHD are so clearly present that we can recognize them across culture, language, and a great deal of time. If you have someone in your life who is stuck on the idea that ADHD isn’t real, or that it’s a modern-day issue, or something created by a pharmaceutical company or the public school system, you should tell them about the Obtuse Man, our ADHD friend from the 3rd century BCE.

If you’d like to learn more about the Obtuse Man, head over to neurodiverging.com for my blog post on him – check out the information below for the direct link.

Now, we’re going to skip forward quite a bit in time. From around the time that Christianity rose to prominence around the reign of Constantine in the 300s CE (yes, I’m an ancient history nerd, however did you guess!), we start to see neurodivergences viewed in the West more often as forms of mental illness.

The prevailing idea was that mental illness stemmed from some kind of moral deficiency of the individual. So, if you showed signs of mental illness or of mental difference, the assumption was that you had sinned or acted in a way that was deemed religiously or spiritually deviant, and that your mental illness was a punishment for your bad action or thought. This is a simplification, of course, of many centuries of medical and religious thought, but this idea prevailed widely all the way through the very end of the 18th century CE.

So, that is many, many centuries of folks with depression, anxiety, autism, ADHD, OCD, and other forms of neurodivergence being treated as morally inferior and almost morally contagious individuals, often suffering significant abuse from their communities and family members, on top of, of course, not being able to access any form of treatment or help.

Increasing Understanding Of Mental Illness In The 18th Century

This began to change a little in the late 1700s, especially with the work of Sir Alexander Crichton. Crichton who was a Scottish physician born in 1763. He was very interested in mental illness and spent most of his career working with mentally ill patients, often in asylums. These places were considered the best place for the mentally ill at the time, but were terribly abusive and extortionist.

Crichton saw that many of his patients weren’t “morally deficient”, but were suffering what seemed to be a physical ailment, and he was one of the first physicians to conceive of mental illness, and similarly of neurodivergence, as having physiological roots. Crichton became convinced that mental illness and differences in thinking were not due to a patient’s personal failing, but was caused by something in the body and brain, outside of an individual’s control.

In 1798, Crichton published a three book volume (or a 3 volume book?) called, “An inquiry into the nature and origin of mental derangement: comprehending a concise system of the physiology and pathology of the human mind and a history of the passions and their effects.” The books delved into whether the causes of neurodivergences and mental illness could be physiological, as he theorized, and how they might develop. This set of books give us some of the first modern recognition of what we’d now call ADHD, what Crichton called “abnormal” attention. 

Now in this work, Crichton described a kind of spectrum of “abnormal” attention, with inattention on one side and hyperfocus on the other. He refers to these types of attention as “sensibilities of the nerves.”

So Crichton describes a person who has trouble paying attention to one object or task for any length of time, a person who is constantly flitting between different goals, and who has either been this way from birth, or who has had some kind of accident (like a brain injury) that created this behavior.

So obviously, we now know that having ADHD or a traumatic brain injury can sometimes result in similar symptoms, even though these symptoms have vastly different origins, but Crichton sort of lumped these two things together. But traumatic brain injury cases aside, he gives a pretty good description of something we can recognize as the attention variances often found in ADHD folks.

In another passage of this book, Crichton describes the “hyperactivity” part of ADHD, which is again very recognizable. I think this passage also calls to mind the sensory processing differences that a lot of ADHD folks report. Let me read this to you:

“In this disease of attention … every impression seems to agitate the person, and gives him or her an unnatural degree of mental restlessness. People walking up and down the room, a slight noise in the same, the moving a table, the shutting a door suddenly, a slight excess of heat or of cold, too much light, or too little light, all destroy constant attention in such patients, inasmuch as it is easily excited by every impression. When people are affected in this manner, which they very frequently are, they have a particular name for the state of their nerves… They say they have the fidgets.”

Doesn’t this sound like sensory processing disorder, or sensory differences? And again, I suspect that Crichton was grouping together folks whom we might separate under different diagnoses today, but quite a lot of neurodivergent people of all stripes report sensory differences, and sometimes meltdowns related to sensory processing overwhelm. And certainly plenty of ADHD folks fall under that umbrella.

Conclusion

So this is roughly the evolution in the theory of thinking and learning differences in the West from roughly the 3rd century CE to the 18th century CE. Once Crichton introduces this idea that neurodivergence and mental illness are not related to sin or moral character, but are rather physiological in nature, we see several other prominent physicians start to jump on the bandwagon, and through that work, ADHD begins to be investigated from a medical, scientific lens.

I’ll talk more about that next week. In the meantime, please check out neurodiverging.com for some other articles on the history of ADHD, parenting a child with autism or ADHD, or working with a partner with ADHD. Come back next week for ADHD from the 18th century to now!