Oh, Pretty Little Liars, no! (Or "the media once again epically Fails in its depiction of ADHD")
So, I was going along happily, catching up with what's aired of the second half of this season's Pretty Little Liars. and then I got to the point where a character is illegally using ADHD medications (presumably ritalin, since fiction thinks that's the only kind that exists) and was BLINDED BY RAGE. And still am.
THANKS FOR CRIMINALIZING MY BRAIN AGAIN, FICTION.
(I'm borrowing that phrase from
metatxt , who also provided feedback, but it's very accurate.)
Note: Most of what I'm going to say here is based on my personal experiences (and so more skewed to ADD and ADHD) and discussions with others (both friends with ADD or ADHD, and medical professionals I've consulted with over the years) as opposed to an intensive study conducted for the purposes of this post or any such. In addition, some things vary by regions and doctor preferences, but the gist should remain true throughout.
I have ADD, not ADHD, but score high enough on overlapping symptoms that I'm technically diagnosed for both. And aside from perpetuating bad stereotypes and helping to further the idea that ADD and ADHD aren't real, EVERYTHING about how that played out is ridiculously unrealistic. I know, the wrong complaint to make about this show, but still. (And it's hardly the first time the show has epically failed in this general area.)
But here's the thing: to start with, a teenager calling a doctor and saying "Hey, my kid suddenly has ADHD, something she's never shown symptoms of before and never been diagnosed with (or possibly hasn't taken anything for for years, if she has been). Can you prescribe some meds right off the bat?" would, at best, be laughed out at. A doctor won't even talk to you about medication for ADD or ADHD until you actually visit a psychologist and get an official diagnosis. Most likely, the psychologist will also discuss medication options with you at that time, as well as coping mechanisms. THEN your doctor will meet with you (and your parents, if you're a minor) to discuss options. Because there was a period where doctors, not yet knowing much about the condition because it was only recently accepted within medical fields, would overdiagnose ADD and ADHD for almost any disruptive behavior or inattentiveness or problems with studying. This time is long gone, and because of it, they're now extremely strict with the diagnosis and prescriptions. Most people, however, don't bother to learn about ADD or ADHD (for that matter, most think it's the same thing) and so their opinion of it falls into tow main categories. The first is that ADD and ADHD is a term used to describe disruptive behavior and learning problems in youths, and that this is not an actual medical condition, but something that you grow out of. The second (and the one being endorsed by the show) is that ADD and ADHD still aren't "really real" and instead the condition is an excuse used to get drugs. You also have people who are forgetful or prone to going off at the mouth who spend 5 minutes on google and self-diagnose themselves but "don't need to see anyone about it." These stereotypes are incredibly harmful. Because of them, people who do have the conditions get bullied, dismissed and treated like addicts because, you know, their brains don't really exist, they're just making them up.
The type of medication that we always see in fiction that has an almost instant influence on energy and focus and then just as quickly stops working after a certain period of time (henceforth usually referred to as "XR" or "ritalin and the like") will rarely be the first recommendation. Pretty much never, these days. Like, at all, with options such as strattera, which is safe for everyone, though unfortunately, also a medication that you can eventually build up a resistance to, available. When it is prescribed, it will usually be for a child, who only really needs it for a certain period of time each day. Older teenagers and adults, who also have to worry about work, caring for their living space, being responsible for other people, driving, etc will be put on slow release medications. There are a variety of these, but most will take several days or even a couple weeks to take full affect, and just as long to completely stop working. This is so that you won't actually have drastic changes in behavior, and to prevent withdrawal symptoms if you run out, switch medications (either because the one you have doesn't work right for you, or because your body has built up a resistance to it, which sometimes happens) or even if you decide you want to see how you'll do without it. While there are many adults and teens who take ritalin and the like, they will most likely only be prescribed to them if nothing else works for them. Oh yes, there's also the bit where some doctors "don't feel comfortable" prescribing these medications (been there, done that) or will only prescribe certain ones. If they can't help you, they'll refer you to someone else. So, pretty much, no one is getting a prescription for ADD or ADHD meds the same day they first bring it up to a doctor, unless they just have an extremely unprofessional and careless medical professional. In which case, they need to go shopping for a new one. And unless you get your kid diagnosed and then literally steal medication from children, you probably aren't getting the kind that has the immediate affect. And if you're insisting to your doctor that you need that kind, alarm bells are going off in the doctor's head. Loudly. While i've always been able to get my prescriptions filled by fax (I've only taken sustained release meds as an adult) I'm told that in some areas, you can only get a prescription filled by hand delivering an original copy to a pharmacy. Some of these drugs will also require a legal adult to pick them up, even if they're prescribed to a teenager. Depending on what you're taking, in the first 6 months to a year that you're on a medication, the doctor will often want to see you more frequently to follow your progress and see how it's working.
Next up is just what these drugs do. The purpose of these medications is not to supercharge you and trigger hyperfocus. Yes, ritalin and the like can have this effect, but that actually largely takes place when it's kicking in and wearing off. The most basic way to describe ADD and ADHD is that the control centers of the brain don't work properly. The core difference between ADD and ADHD is how the control centers don't properly function, and how it outwardly manifests. Typically, the issue is actually that the brain is already hypercharged. For example, tell someone to quickly make a mathematical equation that equals 4, and and most people will probably come up with one of these: "2+2," "1+3," "2x2," "(1+1)x2," etc. Tell someone with ADD or ADHD to do the same, and you're going to get something more like "([{1x32}/16]x4)-4." This is not to say that ADD or ADHD make you brilliant mathematicians, but that people with ADD and ADHD have brains where every subject or thought process is like a ping pong ball bouncing around inside their heads, competing with other ping pong balls for space. We will, typically, reach the same point as everyone else, but in a very convoluted way. (Also, unless you're using it as an allegory for the plot of a mystery novel, "([{1x32}/16]x4)-4" serves little to no practical use when "2+2" is also an available option.) There's also multitasking. People think that those who have ADD and ADHD are good at multitasking, but that isn't actually what's going on. What's going on is that we can't NOT multitask. Our brains have 5 or so ping pong balls bouncing around at all times, all demanding our attention, and typically, we lack the ability to filter out stimuli. So what you have is a person who is constantly easily distracted, always has 5 things demanding attention, and lacks the typical controls to just focus on one topic at a time. There's also the fact that, when you constantly have that much going on, things slip through the cracks. This means you get distracted midsentence and don't even realize it, or you abruptly switch topics in the middle of discussing one, or you don't realize when someone is trying to talk to you (like, say, a teacher who thinks you're goofing off), or you simply space out while thinking about something (if in public, people start thinking you're staring at something, often them, but really, you aren't even aware of what it is that you're apparently staring at) and you suddenly lose 20 minutes of your life. You know that thing where you think you forgot to turn off the oven, and worry about it all day? For ADD and ADHD, that can be twenty things every day. The problem is, there's a good probability that you DID forget to turn off the oven, mail your bill, and call to renew your prescription. But you did remember to preorder that movie that Amazon had for 50% off this morning, because no matter what you tell it to do, your brain is going to prioritize by what it likes, not what you need. The even bigger problem is that, as you get older, you KNOW that you're doing this, which, in turn, can start causing anxiety problems, especially when your brain doesn't have an off switch or pause button that will let you stop or reroute a process, even when you know you should. And then you have a minimeltdown because you're having difficulty scheduling an appointment, because you know that if you can't get this accomplished right now, you might not be able to get your brain to prioritize doing this important thing again. This is also part of why people with ADD and ADHD are often very prone to headaches, because the brain simply isn't meant to operate that way.
Most people believe that medications create hyperfocus, but in actuality, they help reduce the need for it. Hyperfocus is a defense mechanism that people develop over time, forcing their brains to go from one extreme (5 things ping ponging around in your head at once) to the other (exclusive focus on one subject, and completely blocking out anything else). The problem with hyperfocus is that it's also hard to control. You learn it so you can get things done, but it can be triggered by pretty much anything, and it's difficult to snap yourself out of it. Typically, hyperfocus will only end when either the task is completed (or you run out of whatever you were doing) or an outside stimuli forces itself in. What medication does is it helps bridge the gap in your brain between the two. It doesn't prevent either the ping ponging or the hyperfocus, but it helps make you aware of both when they're happening, and increases your chances of being able to control it, as well as your ability to control how various stimuli affect you. Because it eases the stress on your brain, it also helps with the headaches and anxiety. Stimulants can also make you sleepy, and one reason the doctor will want to see you fairly often early on is to see if this is a drug your brain needs to help it function more peacefully and effectively, or if you need to be on something else.
And finally, there's availability. Contrary to popular belief, doctors have this funny thing where they tend to be strict about medication that affects how your brain works. These stories where teenagers and the like are selling part of their prescription to others is, generally speaking, laughable. While there are certainly irresponsible practitioners out there who don't monitor these things, most practitioners do. (If not for ethical reasons then because, you know, they want to keep those licenses they worked hard for.) These are medications where you take a certain amount each day, and you only get enough to supply you for a certain period of time. (True of most prescriptions, but people seem to think not for ADD and ADHD.) If you say you need an emergency refill once because you lost it, you might get a pass and a lecture. Do it again a few months later and MAYBE a very trusting doctor will take into account that you have a condition that makes you prone to losing and forgetting things in general, and which is extremely amplified in certain situations. Most likely, though, your doctor is going to want to see you before giving you anything else, because you're probably setting off those alarm bells again. Your doctor is also going to want you to keep your six month (or however often) checkups, and isn't going to automatically renew your prescription if you're skipping out. Why? Because, like most prescription drugs, it's possible that taking these prescription drugs can affect your body in other ways as well, and your doctor is going to keep an eye on that.
Also, the latest episode is almost entirely that character having a hallucination because of withdrawal. Because the best way to make a statement about drug abuse is to criminalize the use of legal medications that many people need to be able to function normally, because no one really has ADHD or ADD after childhood, and it's only used after that by students who don't really need it, but think abusing it will help them with their grades.
BAD SHOW BAD.
(Also, the hallucination was a B&W noir story in which the character pieces together various bits of the ongoing mystery, and normally I'd love that, but the context made that impossible.)
I likely won't make a separate post for spoilers and whatnot for these episodes, but feel free to ask whatever you want in comments. (And I still love it overall and have no intentions of dropping it, but this plotline is too personal and too "how people see me" for me to really be able to talk about other parts of the show without prompting.)
i've been informed that at least one other show is also indulging in this variety of fail right now, which makes it even more depressing.
THANKS FOR CRIMINALIZING MY BRAIN AGAIN, FICTION.
(I'm borrowing that phrase from
metatxt , who also provided feedback, but it's very accurate.)
Note: Most of what I'm going to say here is based on my personal experiences (and so more skewed to ADD and ADHD) and discussions with others (both friends with ADD or ADHD, and medical professionals I've consulted with over the years) as opposed to an intensive study conducted for the purposes of this post or any such. In addition, some things vary by regions and doctor preferences, but the gist should remain true throughout.
I have ADD, not ADHD, but score high enough on overlapping symptoms that I'm technically diagnosed for both. And aside from perpetuating bad stereotypes and helping to further the idea that ADD and ADHD aren't real, EVERYTHING about how that played out is ridiculously unrealistic. I know, the wrong complaint to make about this show, but still. (And it's hardly the first time the show has epically failed in this general area.)
But here's the thing: to start with, a teenager calling a doctor and saying "Hey, my kid suddenly has ADHD, something she's never shown symptoms of before and never been diagnosed with (or possibly hasn't taken anything for for years, if she has been). Can you prescribe some meds right off the bat?" would, at best, be laughed out at. A doctor won't even talk to you about medication for ADD or ADHD until you actually visit a psychologist and get an official diagnosis. Most likely, the psychologist will also discuss medication options with you at that time, as well as coping mechanisms. THEN your doctor will meet with you (and your parents, if you're a minor) to discuss options. Because there was a period where doctors, not yet knowing much about the condition because it was only recently accepted within medical fields, would overdiagnose ADD and ADHD for almost any disruptive behavior or inattentiveness or problems with studying. This time is long gone, and because of it, they're now extremely strict with the diagnosis and prescriptions. Most people, however, don't bother to learn about ADD or ADHD (for that matter, most think it's the same thing) and so their opinion of it falls into tow main categories. The first is that ADD and ADHD is a term used to describe disruptive behavior and learning problems in youths, and that this is not an actual medical condition, but something that you grow out of. The second (and the one being endorsed by the show) is that ADD and ADHD still aren't "really real" and instead the condition is an excuse used to get drugs. You also have people who are forgetful or prone to going off at the mouth who spend 5 minutes on google and self-diagnose themselves but "don't need to see anyone about it." These stereotypes are incredibly harmful. Because of them, people who do have the conditions get bullied, dismissed and treated like addicts because, you know, their brains don't really exist, they're just making them up.
The type of medication that we always see in fiction that has an almost instant influence on energy and focus and then just as quickly stops working after a certain period of time (henceforth usually referred to as "XR" or "ritalin and the like") will rarely be the first recommendation. Pretty much never, these days. Like, at all, with options such as strattera, which is safe for everyone, though unfortunately, also a medication that you can eventually build up a resistance to, available. When it is prescribed, it will usually be for a child, who only really needs it for a certain period of time each day. Older teenagers and adults, who also have to worry about work, caring for their living space, being responsible for other people, driving, etc will be put on slow release medications. There are a variety of these, but most will take several days or even a couple weeks to take full affect, and just as long to completely stop working. This is so that you won't actually have drastic changes in behavior, and to prevent withdrawal symptoms if you run out, switch medications (either because the one you have doesn't work right for you, or because your body has built up a resistance to it, which sometimes happens) or even if you decide you want to see how you'll do without it. While there are many adults and teens who take ritalin and the like, they will most likely only be prescribed to them if nothing else works for them. Oh yes, there's also the bit where some doctors "don't feel comfortable" prescribing these medications (been there, done that) or will only prescribe certain ones. If they can't help you, they'll refer you to someone else. So, pretty much, no one is getting a prescription for ADD or ADHD meds the same day they first bring it up to a doctor, unless they just have an extremely unprofessional and careless medical professional. In which case, they need to go shopping for a new one. And unless you get your kid diagnosed and then literally steal medication from children, you probably aren't getting the kind that has the immediate affect. And if you're insisting to your doctor that you need that kind, alarm bells are going off in the doctor's head. Loudly. While i've always been able to get my prescriptions filled by fax (I've only taken sustained release meds as an adult) I'm told that in some areas, you can only get a prescription filled by hand delivering an original copy to a pharmacy. Some of these drugs will also require a legal adult to pick them up, even if they're prescribed to a teenager. Depending on what you're taking, in the first 6 months to a year that you're on a medication, the doctor will often want to see you more frequently to follow your progress and see how it's working.
Next up is just what these drugs do. The purpose of these medications is not to supercharge you and trigger hyperfocus. Yes, ritalin and the like can have this effect, but that actually largely takes place when it's kicking in and wearing off. The most basic way to describe ADD and ADHD is that the control centers of the brain don't work properly. The core difference between ADD and ADHD is how the control centers don't properly function, and how it outwardly manifests. Typically, the issue is actually that the brain is already hypercharged. For example, tell someone to quickly make a mathematical equation that equals 4, and and most people will probably come up with one of these: "2+2," "1+3," "2x2," "(1+1)x2," etc. Tell someone with ADD or ADHD to do the same, and you're going to get something more like "([{1x32}/16]x4)-4." This is not to say that ADD or ADHD make you brilliant mathematicians, but that people with ADD and ADHD have brains where every subject or thought process is like a ping pong ball bouncing around inside their heads, competing with other ping pong balls for space. We will, typically, reach the same point as everyone else, but in a very convoluted way. (Also, unless you're using it as an allegory for the plot of a mystery novel, "([{1x32}/16]x4)-4" serves little to no practical use when "2+2" is also an available option.) There's also multitasking. People think that those who have ADD and ADHD are good at multitasking, but that isn't actually what's going on. What's going on is that we can't NOT multitask. Our brains have 5 or so ping pong balls bouncing around at all times, all demanding our attention, and typically, we lack the ability to filter out stimuli. So what you have is a person who is constantly easily distracted, always has 5 things demanding attention, and lacks the typical controls to just focus on one topic at a time. There's also the fact that, when you constantly have that much going on, things slip through the cracks. This means you get distracted midsentence and don't even realize it, or you abruptly switch topics in the middle of discussing one, or you don't realize when someone is trying to talk to you (like, say, a teacher who thinks you're goofing off), or you simply space out while thinking about something (if in public, people start thinking you're staring at something, often them, but really, you aren't even aware of what it is that you're apparently staring at) and you suddenly lose 20 minutes of your life. You know that thing where you think you forgot to turn off the oven, and worry about it all day? For ADD and ADHD, that can be twenty things every day. The problem is, there's a good probability that you DID forget to turn off the oven, mail your bill, and call to renew your prescription. But you did remember to preorder that movie that Amazon had for 50% off this morning, because no matter what you tell it to do, your brain is going to prioritize by what it likes, not what you need. The even bigger problem is that, as you get older, you KNOW that you're doing this, which, in turn, can start causing anxiety problems, especially when your brain doesn't have an off switch or pause button that will let you stop or reroute a process, even when you know you should. And then you have a minimeltdown because you're having difficulty scheduling an appointment, because you know that if you can't get this accomplished right now, you might not be able to get your brain to prioritize doing this important thing again. This is also part of why people with ADD and ADHD are often very prone to headaches, because the brain simply isn't meant to operate that way.
Most people believe that medications create hyperfocus, but in actuality, they help reduce the need for it. Hyperfocus is a defense mechanism that people develop over time, forcing their brains to go from one extreme (5 things ping ponging around in your head at once) to the other (exclusive focus on one subject, and completely blocking out anything else). The problem with hyperfocus is that it's also hard to control. You learn it so you can get things done, but it can be triggered by pretty much anything, and it's difficult to snap yourself out of it. Typically, hyperfocus will only end when either the task is completed (or you run out of whatever you were doing) or an outside stimuli forces itself in. What medication does is it helps bridge the gap in your brain between the two. It doesn't prevent either the ping ponging or the hyperfocus, but it helps make you aware of both when they're happening, and increases your chances of being able to control it, as well as your ability to control how various stimuli affect you. Because it eases the stress on your brain, it also helps with the headaches and anxiety. Stimulants can also make you sleepy, and one reason the doctor will want to see you fairly often early on is to see if this is a drug your brain needs to help it function more peacefully and effectively, or if you need to be on something else.
And finally, there's availability. Contrary to popular belief, doctors have this funny thing where they tend to be strict about medication that affects how your brain works. These stories where teenagers and the like are selling part of their prescription to others is, generally speaking, laughable. While there are certainly irresponsible practitioners out there who don't monitor these things, most practitioners do. (If not for ethical reasons then because, you know, they want to keep those licenses they worked hard for.) These are medications where you take a certain amount each day, and you only get enough to supply you for a certain period of time. (True of most prescriptions, but people seem to think not for ADD and ADHD.) If you say you need an emergency refill once because you lost it, you might get a pass and a lecture. Do it again a few months later and MAYBE a very trusting doctor will take into account that you have a condition that makes you prone to losing and forgetting things in general, and which is extremely amplified in certain situations. Most likely, though, your doctor is going to want to see you before giving you anything else, because you're probably setting off those alarm bells again. Your doctor is also going to want you to keep your six month (or however often) checkups, and isn't going to automatically renew your prescription if you're skipping out. Why? Because, like most prescription drugs, it's possible that taking these prescription drugs can affect your body in other ways as well, and your doctor is going to keep an eye on that.
Also, the latest episode is almost entirely that character having a hallucination because of withdrawal. Because the best way to make a statement about drug abuse is to criminalize the use of legal medications that many people need to be able to function normally, because no one really has ADHD or ADD after childhood, and it's only used after that by students who don't really need it, but think abusing it will help them with their grades.
BAD SHOW BAD.
(Also, the hallucination was a B&W noir story in which the character pieces together various bits of the ongoing mystery, and normally I'd love that, but the context made that impossible.)
I likely won't make a separate post for spoilers and whatnot for these episodes, but feel free to ask whatever you want in comments. (And I still love it overall and have no intentions of dropping it, but this plotline is too personal and too "how people see me" for me to really be able to talk about other parts of the show without prompting.)
i've been informed that at least one other show is also indulging in this variety of fail right now, which makes it even more depressing.