Despite 40 years of increasing prominence in U.S. medical, scientific, and social parlance and practice, attention-deficit/hyperactivity disorder (ADHD) remains controversial. By examining the diagnosis' uptake and the controversies, the dissertation analyzes the epistemological, ethical, and pragmatic grounds for adopting the predominant model of ADHD (med/DSM modelADHD), and the consequences of doing so.
The multilayered, co-constructed med/DSM modelADHD includes aspects of medical and DSM (Diagnostic and Statistical Manual of Mental Disorders) models of mental disorder, the specific DSM symptomatology, scientific theories concerning etiology and mechanism, and social contextualizations.
Chapter 2 explains the medical and DSM contributions to the med/DSM model ADHD. Debates over these demonstrate ways in which the med/DSM model ADHD is value-valenced; i.e., ways in which it embeds values. The DSM's categorical definition reinforces these value valences by dichotomizing “normal” from “ADHD.”
Chapter 3 outlines desiderata of reasoning patterns in biological psychiatric research, then shows ways in which ADHD research adheres to these desiderata and ways in which it falls short of the ideals. The epistemic ideals are embedded in the med/DSM modelADHD; simultaneously, intrascientific controversies show the model's provisionality.
Chapter 4 discusses the many social influences on the med/DSM model ADHD. Drawing on Bruno Latour's actor-network theory, the chapter argues that alliances between groups and individuals with coinciding values establish policies and social structures that contextualize ADHD and help co-construct the med/DSM modelADHD.
Chapter 5 analyzes senses in which values are embedded in scientific literature, then it models a mechanism by which value embedding occurs. The proposed mechanism is a positive feedback loop, implying that scientific methodologies, the conclusions of ADHD science, and contextual values are mutually reinforcing.
Chapter 6 considers influences of the med/DSM modelADHD on the social and ethical landscape and on ADHD-diagnosable individuals. Because values embedded in the med/DSM modelADHD are for the most part negatively valenced, the model has—accidentally—reinforced intolerance of ADHD-diagnosable individuals.
Chapter 7 briefly suggests solutions to the negative consequences of the med/DSM modelADHD. The analysis and solutions are likely apply to other cases as well, given that many of the issues raised apply to other categories in medicine and neuroscience.
