Sarah Rose // Features Editor
The crusade against the feminine in psychiatry began with the father of psychoanalysis himself. In Studies on Hysteria, Sigmund Freud first introduced the notion that hysteria was idiogenic: an idea or memory that makes one ill without physical disease at cause.
Part of rejecting the female experience of ADHD is an overarching rejection of emotional affect. Puzzling, when the frontal cortex and limbic system which are central to mood lability and emotional regulation constitute two of the four functional brain regions most strongly impacted by ADHD.
The limbic system contains three interworking structures: the hippocampus, amygdala and hypothalamus. If laid bare from its counterparts, the amygdala only sees the world in binary, monochromatic shades of emotional values, like viewing life with total colour blindness. The hypothalamus takes the emotional code received from the amygdala and manifests it within the body: a pounding heart, hitched breath, skyrocketing blood pressure. Throughout this process, there is only how—the hippocampus is responsible for imposing a why. To the body, there’s no differentiation between a stomach twisting from fear or excitement. It takes memory regulated by the hippocampus to inform us that the excitement of going on a date is different than the fear and anxiety of failure… Isn’t it supposed to be?
Vis-à-vis, emotion and memory are inextricably linked.
That said, relationships can feel like a holy elixir for the ADHD brain. They’re a non-stop biochemical symphony of dopamine, and stimulation that disrupts the everyday feeling of ricocheting off the walls like a giant pinball machine of sadness. Ultimately without proper treatment, that too will cause long-term pain. The key to successful relationships with ADHD is successful treatment.
The go-to approach in therapy is usually Cognitive-Behavioral Therapy (CBT) and it’s a good example of the masculine-centric approach of modern psychology. CBT assigns primacy to rationality over affect, to the unconscious, and the alleged “irrational” emotional (a language code for “feminine”) aspects of experience. It seeks to break down the phenomenological into a cool, decidedly mechanistic approach. There’s a Cochrane Review worth of evidence to support that it may improve core symptoms of ADHD—but for whom? We know ADHD research has chronically excluded women. Prior to being diagnosed, CBT often sent me spiralling into self-flagellation. “You are in control of your emotions,” it asserts. (Then why couldn’t I think or stop myself before I called my boyfriend an asshole and slammed the door?) “Recognize how negative thoughts lead to rumination,” it touts. (So why am I unable to stop thinking about them to the point of obsession?) It’s not to say CBT doesn’t work, rather it doesn’t address the fractured ADHD limbic system from the start.
My mom enjoys casually joking about how the principal’s office was her second home when I was in school. Most of the time, she was there campaigning for my right to do things like get up and walk around the classroom because: “I don’t know, that’s just the way she is. Is she hurting anyone?” Apparently, I was. Those messages are cemented in my memory, creating the destructive language I used to describe myself. This is a core feature of ADHD: sensitivity to criticism.
I went on to fail three grades, but I did learn the important lesson that girls don’t have an equivalent to the accountability cop-out of “boys will be boys.” Classroom criticism extended naturally to peer rejection. Male behaviour seems allowed to exist on a continuum of social acceptance, and the negative is rarely ever attributed to personal affect.
Instead of a diagnosis, girls especially will often drown in an endlessly expanding grave of criticism and rejection from their teachers, parents and peers. Without context, the symptoms of ADHD read as carelessness and neglect. Socializing becomes a nightmare, symptoms resemble and even overlap with autism to the observer: struggling to interpret socially appropriate behaviour, particularly nonverbal cues like body language and eye contact, interrupting, invading personal space and having meltdowns.
A 2017 study found that 31 per cent of girls and young women experience symptoms of anxiety, compared with 13 per cent of boys and young men. Girls feel more pressure, and endure more of the physical symptoms of psychological strain. Chronic stress takes its idiogenic toll, increasing the risk for related diseases like fibromyalgia (also predominantly affecting women).
Despite research that shows ADHD affects girls and boys in nearly identical distribution, girls are far less likely to be diagnosed (a rate of 1:7) or even seen as symptomatic. Instead, symptoms are written off as personality and even gendered problems. Inattentive girls are ditzy, dumb blondes. Hyperactive and impulsive girls are weird, aggressive, overemotional.
When you’re young and struggling to figure out who you are, the one thing most kids try and hold on to is individuality. Not unlike the way DNA expresses in our genes, one’s sense of self can be warped into something positive or negative depending on the environment. For ADHD kids who face an average of seven times more criticism from authority figures than their peers, the environment is overwhelmingly negative and even hostile. When you’re also an undiagnosed woman whose symptoms are viewed instead as personal failures, fostering self-esteem feels impossible.
ADHD is not in and of itself maladaptive, self-hatred is. The ability for the ADHD limbic system to feel things more deeply, intensely and longer than others isn’t defective or volatile, it’s a variation. We need to let go of the ridiculous notion that we must internalize criticism and rejection, and instead embody the radical idiogenic idea that we are loved.