“Adult” ADHD

[PikminOC]

I know! Been busy trying to put my life together. I decided it was time to roam the 'ol stompin' grounds dispensing truth and wisdom in the likeness of Red Foreman.

I'm confused as to what that means. Pls elaborate

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[Ceke2002]

I know! Been busy trying to put my life together. I decided it was time to roam the 'ol stompin' grounds dispensing truth and wisdom in the likeness of Red Foreman.

It's good to see you. I'm not around much in these parts myself, but I did notice your absence. Hope the break has helped with whatever it needed to help.

 

[Shikima]

I'm confused as to what that means. Pls elaborate

Hard to answer if I don't know where you're lost?

 

[PikminOC]

Hard to answer if I don't know where you're lost?

I don't understand anything you wrote at all. Are you working or not?

 

[TexasPhysician]

It's pretty easy just takes like 20 minutes to administer. There is nowhere near the sophisticated scoring/statistics of an MMPI or PAI.

Here's a good paper discussing TOMM and other measures:

Tracy, D. K. (2014). Evaluating malingering in cognitive and memory examinations: a guide for clinicians. Advances in psychiatric treatment, 20(6), 405-412.

This paper also is interesting but I can't find which items they embedded into the Connors:

Harrison, A. G., & Armstrong, I. T. (2016). Development of a symptom validity index to assist in identifying ADHD symptom exaggeration or feigning. The Clinical Neuropsychologist, 30(2), 265-283.

Is there a way for MD’s to obtain this? Pearson says MD’s are not qualified to purchase the TOMM.

 

[WisNeuro]

Is there a way for MD’s to obtain this? Pearson says MD’s are not qualified to purchase the TOMM.

Not sure why you would want to, really, terrible sensitivity for the most part.

 

[Liquid8]

Hard to answer if I don't know where you're lost?

What a setup for a Red Foreman "foot in ass" punchline...

 

[Stagg737]

Seriously, the one time I unintentionally put a patient into a hypertensive crisis that got them hospitalized was by giving them 225 mg of Effexor. If you are super worried about BP with stimulants you better be worried about BP with a lot of other common drugs we use first.

I mean, depends on the dosing. I'm also more worried about patients BP when they're on 450mg of Wellbutrin or 225 of venlafaxine than I am when they're on 5-10mg of Adderall, but I also assume they'll probably need to be on much higher doses of stimulants than that. I don't disagree that we should be cognizant of BP with plenty of our meds, but I still see a lot more BP related issues with stimulants than with other meds unless we're pushing the upper limits of recommended doses for those meds.

 

[pyrrion89]

I am so tired of dealing with lazy, incompetent or spineless NPs and MDs who are basically diagnosing ADHD and prescribing stimulants to anyone who asks for it... These patients then end up transferring to me and are shocked to hear maybe they don't have ADHD and they get argumentative and difficult. Also, many of these patients transform ADHD into their identity, externalize their problems onto the diagnosis, and thus they will never accept that they may not have ADHD. This mindset is creeping into my other patients. I have treatment-refractory depressed patients, borderline patients, bipolar II patients who, through word-of-mouth, think that "this whole time it was ADHD!" but have absolutely no childhood history, or they ret-con and rationalize some story that "I got straight As but it was hard" or "I got straight A's but didn't live up to my potential" somehow. Invariably they do not have childhood records and don't want their parents interviewed because "they don't believe in ADHD and will sabotage me."

Now half my intakes are patients specifically wanting an ADHD diagnosis or continuation of ADHD treatment.

In this environment, I recommend anyone who is going into outpatient psychiatry demand they have some control over who their intakes are, unless you like spending most your day arguing with your patients about ADHD.

 

[docksan]

Thank God these patients come to you and get fixed. Whatever would the adult ADHD community do without you.

 

[PikminOC]

Now that starting May 1 I think they can't just prescribe controlled subs online again for the initial visits, the number of prescriptions may decrease

 

[AcronymAllergy]

I am so tired of dealing with lazy, incompetent or spineless NPs and MDs who are basically diagnosing ADHD and prescribing stimulants to anyone who asks for it... These patients then end up transferring to me and are shocked to hear maybe they don't have ADHD and they get argumentative and difficult. Also, many of these patients transform ADHD into their identity, externalize their problems onto the diagnosis, and thus they will never accept that they may not have ADHD. This mindset is creeping into my other patients. I have treatment-refractory depressed patients, borderline patients, bipolar II patients who, through word-of-mouth, think that "this whole time it was ADHD!" but have absolutely no childhood history, or they ret-con and rationalize some story that "I got straight As but it was hard" or "I got straight A's but didn't live up to my potential" somehow. Invariably they do not have childhood records and don't want their parents interviewed because "they don't believe in ADHD and will sabotage me."

Now half my intakes are patients specifically wanting an ADHD diagnosis or continuation of ADHD treatment.

In this environment, I recommend anyone who is going into outpatient psychiatry demand they have some control over who their intakes are, unless you like spending most your day arguing with your patients about ADHD.

To be fair, this happens with lots of potentially-inaccurate diagnoses (e.g., PTSD, Borderline PD vs. Bipolar d/o, ASD). But yes, I've had folks get very upset when told, IMO, they didn't have ADHD. It used to also happen a decent amount in the opposite direction (i.e., folks surprised/relieved to learn they had ADHD and that it was probably contributing to the problems they'd been noticing for years); don't see that quite as often anymore.

I'm seeing more psychiatrists' websites explicitly state that they will not continue stimulants/controlled substances started by another provider.

 

[randomdoc1]

I am so tired of dealing with lazy, incompetent or spineless NPs and MDs who are basically diagnosing ADHD and prescribing stimulants to anyone who asks for it... These patients then end up transferring to me and are shocked to hear maybe they don't have ADHD and they get argumentative and difficult. Also, many of these patients transform ADHD into their identity, externalize their problems onto the diagnosis, and thus they will never accept that they may not have ADHD. This mindset is creeping into my other patients. I have treatment-refractory depressed patients, borderline patients, bipolar II patients who, through word-of-mouth, think that "this whole time it was ADHD!" but have absolutely no childhood history, or they ret-con and rationalize some story that "I got straight As but it was hard" or "I got straight A's but didn't live up to my potential" somehow. Invariably they do not have childhood records and don't want their parents interviewed because "they don't believe in ADHD and will sabotage me."

Now half my intakes are patients specifically wanting an ADHD diagnosis or continuation of ADHD treatment.

In this environment, I recommend anyone who is going into outpatient psychiatry demand they have some control over who their intakes are, unless you like spending most your day arguing with your patients about ADHD.

I wholeheartedly agree. In so many patients this path causes great harm. And stims are no miracle maker. They are truly a massive pain to deal with for providers and patients. Even harder with the DEA reducing the national supply, which I applaud. It had to be done as a forced function so we ration it to people who truly need it and put a lid on the spiraling problem. Non psych prescribers need to get better at saying no. It’s the same concept as saying no to a patient demanding antibiotics. Many also take stims and benzos too casually and that first prescription is how the problem starts. Once the patient tastes it, it’s so hard to get them to let go. They prescribe it for daily dosing for years and realize it’s escalated to a hot mess and then, that is when they refer to psychiatry. Perhaps what may help non psych settings is to provide them contacts for offices that are taking new patients without a massive wait. They are out there and many of them are grateful to have a place to refer to. Are there incompetent psych prescribers? Yes. But some of the most loose prescribing I’ve seen was from pcps. Many still think xanax 1mg qid is a low dose. My office does have a strict policy on controlled substances which we tell intakes from the start. Otherwise most of the days would be arguing with patients over adderall. The alarming part is most don’t want to hear anything that sheds legitimate question on anything other than what they want to hear, which is a fast path to nowhere. Many are with severe comorbid personality disorders. And after a visit like that, good luck trying to get them to pay for the visit. They may even tip you with a lovely google review for actual evidence based care. No thanks all around, I have a clinic to protect and incomes of many hard working employees. If you have an agenda, won’t be met here and we are completely transparent soon as that first phone call.

 

[pyrrion89]

Thank God these patients come to you and get fixed. Whatever would the adult ADHD community do without you.

I'll take that as a compliment.

If you look at the ADHD reddit, it's like a horoscope where any kind of vague life problem is chalked up to "my ADHD acting up again." Someone needs to give them a reality check - either they learn the truth or they are left with the eyebrow-raising "I know more than my psychiatrist about psychiatry."

 

[sloh]

It’s hopeless

The White-Girl Speed Party Crashes

In 2021, some 41 million prescriptions were dispensed in the United States for Adderall (and its generic varieties), an amphetamine used to treat Attention Deficit Hyperactive Disorder, symptoms of which include inattention, hyperactivity, and impulsivity. During the Covid era, pharma-startups...

compactmag.com

“What’s remarkable about all of this isn’t that telehealth took pill mills online, making them accessible to anyone with a smartphone. It isn’t remarkable that people are trying to game them, either—that has been happening for a long time. What’s remarkable, rather, is the number of cultural ills and personality types the Adderall epidemic seems to intersect with.

There are the people who want to get high, using Adderall recreationally with the certain knowledge that that’s what they want. There are the people who are so inured to the feel of Adderall that it’s tantamount to a cigarette or cup of coffee to them: It’s not a high—it’s a chemical dependency. Then there are people who treat it as a performance-enhancing drug, like Bay Area software engineers who use it to accomplish high volumes of rote tasks or writers who need to pump out thousands of words a week. There are people who are using it as a sort of off-label antidepressant. There are even those who use Adderall as an anesthetic, who experience an emotional blunting effect from it and long for that. They are hyper-focused, but they aren’t too happy, not too sad; their lives continue in a steady hum of fixation. They crash, then go to bed.

And then there are the TikTok types, who don’t understand why they aren’t operating at the same level anymore—people who seemingly think an Adderall high is a reasonable baseline for their mood.

Their Adderall escapism is about unfettered positivity. These women don’t want to be automatons with a machine-like capacity to work, or at least that isn’t what they describe. They want to live their lives with a vibrancy that only the next best thing to methamphetamine can provide. For most people, before you hit your tolerance wall, Adderall feels like any other stimulant does: unending possibility. There is a reason why MDMA’s street name is “ecstasy.”

It feels silly to speculate why any of this might appeal to someone, or if there is a meaningful difference between that and just wanting to get high. The simple answer is that stimulants feel good. No one needs a think piece about why cocaine feels good—it’s cocaine. But our Adderall obsession comes on the heels of a subsection of the population being fixated on what’s been called “toxic positivity,” an excessive preoccupation with maintaining optimism no matter the situation.

Adderall prescriptions are (or were) booming alongside New Age practices like “manifestation,” which teach that you can will your desired life into reality. If some portion of Millennials and Zoomers are using an ADHD diagnosis to play the victim, then maybe another portion is using it to hack reality in the style of people who, 15 years ago, subscribed to The Secret.

It’s uncharitable to call this emotional or intellectual entitlement. My sense is that people just don’t know better. They are not only at sea, but there is no one and nothing to guide them back to the shores of the good life. Some conclude that life is a never-ending quest to “feel good.” And if a pill can offer that—why not?”

 

[PikminOC]

It’s hopeless

The White-Girl Speed Party Crashes

In 2021, some 41 million prescriptions were dispensed in the United States for Adderall (and its generic varieties), an amphetamine used to treat Attention Deficit Hyperactive Disorder, symptoms of which include inattention, hyperactivity, and impulsivity. During the Covid era, pharma-startups...

compactmag.com

“What’s remarkable about all of this isn’t that telehealth took pill mills online, making them accessible to anyone with a smartphone. It isn’t remarkable that people are trying to game them, either—that has been happening for a long time. What’s remarkable, rather, is the number of cultural ills and personality types the Adderall epidemic seems to intersect with.

There are the people who want to get high, using Adderall recreationally with the certain knowledge that that’s what they want. There are the people who are so inured to the feel of Adderall that it’s tantamount to a cigarette or cup of coffee to them: It’s not a high—it’s a chemical dependency. Then there are people who treat it as a performance-enhancing drug, like Bay Area software engineers who use it to accomplish high volumes of rote tasks or writers who need to pump out thousands of words a week. There are people who are using it as a sort of off-label antidepressant. There are even those who use Adderall as an anesthetic, who experience an emotional blunting effect from it and long for that. They are hyper-focused, but they aren’t too happy, not too sad; their lives continue in a steady hum of fixation. They crash, then go to bed.

And then there are the TikTok types, who don’t understand why they aren’t operating at the same level anymore—people who seemingly think an Adderall high is a reasonable baseline for their mood.

Their Adderall escapism is about unfettered positivity. These women don’t want to be automatons with a machine-like capacity to work, or at least that isn’t what they describe. They want to live their lives with a vibrancy that only the next best thing to methamphetamine can provide. For most people, before you hit your tolerance wall, Adderall feels like any other stimulant does: unending possibility. There is a reason why MDMA’s street name is “ecstasy.”

It feels silly to speculate why any of this might appeal to someone, or if there is a meaningful difference between that and just wanting to get high. The simple answer is that stimulants feel good. No one needs a think piece about why cocaine feels good—it’s cocaine. But our Adderall obsession comes on the heels of a subsection of the population being fixated on what’s been called “toxic positivity,” an excessive preoccupation with maintaining optimism no matter the situation.

Adderall prescriptions are (or were) booming alongside New Age practices like “manifestation,” which teach that you can will your desired life into reality. If some portion of Millennials and Zoomers are using an ADHD diagnosis to play the victim, then maybe another portion is using it to hack reality in the style of people who, 15 years ago, subscribed to The Secret.

It’s uncharitable to call this emotional or intellectual entitlement. My sense is that people just don’t know better. They are not only at sea, but there is no one and nothing to guide them back to the shores of the good life. Some conclude that life is a never-ending quest to “feel good.” And if a pill can offer that—why not?”

I can't read the full article. Is there a way to get past the paywall without paying?

 

[sloh]

I can't read the full article. Is there a way to get past the paywall without paying?

Not that I know of I've tried. But don't despair! I got you. I ended up paying for the subscription bc I enjoy a lot of their takes. Quite politically neutral compared to WSJ (more conservative) and NYTimes (more liberal).

"In my experience with Circle Medical, no great acting chops were required: The two providers just wanted to make sure I finished the survey. Say “Yes” the magic number of times, and you will get an Adderall prescription. Or, if you prefer and have the gumption to ask, a prescription for Vyvanse or Ritalin."

Full article below:

“In 2021, some 41 million prescriptions were dispensed in the United States for Adderall (and its generic varieties), an amphetamine used to treat Attention Deficit Hyperactive Disorder, symptoms of which include inattention, hyperactivity, and impulsivity. During the Covid era, pharma-startups began using social-media platforms to advertise their wares, while online pharmacies made it much easier to access the drugs. But lately, the legal party seems to be crashing.

Countless young white women on TikTok have recently reported that their Adderall is “working differently.” Their videos exude an air of conspiracy and anxiety. Adderall is already in short supply, with many struggling to fill their prescriptions. And then, once they do get their medication, it seems, well, different.

“Has anyone figured out what they’re doing to our Adderall yet?” a 20-something under the handle @adderalladventures asks, staring into her camera, perturbed. She is fatigued and doesn’t understand why. She offers a laundry list of energy aids she has consumed that day: 20 milligrams of Adderall, a Diet Coke, 5 milligrams of Adderall, another 5 milligrams of Adderall. “I’m fighting sleep right now,” she says, refocusing the camera to show that she is in bed.

The complaints multiplied feverishly: that Adderall “wasn’t working,” with young people urging their viewers to “think critically” about whether the government was allowing or even forcing pharmaceutical companies to water down the drug and its derivatives. Eventually, The New York Times weighed in. The paper found what you would expect. Despite TikTokers telling their viewers to “submit complaints to the Food and Drug Administration about what they believe is ‘new’ Adderall being distributed,” the Times couldn’t find evidence that the formula had changed—at least, taking the agency’s word for it.

Rather, the complaints stem from five contributing factors, according to the Times: tolerance buildup; the impact of starting and stopping medication; cognitive bias; contraindications with other medications, as well as potential comorbidities of an ADHD diagnosis; and then, finally, the most obvious problem, one that many users unwittingly revealed in their videos—young people had switched to generics due to the shortage and didn’t realize the impact that might have.

Even if they are the same drug, generic and brand-name medications will have minor ingredient differences. Unfortunately for some people, a difference in, for example, filler material will change how they metabolize the medication. Add the fact that different pharmacies will use generics from different manufacturers—and that the shortage has also pushed people to get their prescriptions filled at multiple pharmacies—it’s no wonder they feel like their medication isn’t quite the same. You might get the jitters on CVS’s amphetamine salts, but not Walgreens’. Maybe you didn’t experience any emotional side effects from Adderall, but whatever you are getting at the HEB, Publix, or Jewel-Osco pharmacy makes you crash and crash hard.

According to Dani Potter, who goes by @thedandan on TikTok, differences in generics are more significant than variations in how individual people metabolize them. She claims her doctor told her many of his patients were experiencing problems with their generic from Teva. In a video posted March 7, she says she switched manufacturers to Sandoz, and all was good. (Interestingly, her description of Adderall’s impact on her was “butterflies” and, well, basically a stimulant high.)

Even though many malcontented TikTokers claim that they have been using ADHD medication “their whole lives,” just as many have only recently embraced the label of “neurodivergent.” There had been clues for a while, they claim: chronic fatigue, poor executive functioning, an inability to focus on basic tasks. Many of them, too, have self-diagnosed with checklists they have found online. The rationale is that health-care providers are either too expensive to see, or tend to gatekeep, leaving people unable to get the help they desperately need.

While the mainstream accounts of ADHD self-diagnosis suggest that this is a phenomenon unique to TikTok, or perhaps simply downstream of pill mills that advertise on TikTok, it’s been a recurring problem online since at least the 1990s.

Dissociative identity disorder was self-diagnosed on Usenet newsgroups and personal home pages; self-harm, depression, psychopathy, and anorexia (to name only a few chronic conditions) were popularized in forums, on LiveJournal and Xanga, MySpace, and later, Tumblr; the “extremely online” have long self-identified as autistic.

In all cases, a small but vocal group of skeptics emerges, for example, in spaces for anorexics. The term “wannarexia,” for example, emerged in reference to people who feign having an eating disorder to be included in virtual communities for people suffering the real thing. In the case of autism, the trend of self-diagnosis happened concurrently with it becoming a news and entertainment trope.

While stories about anti-vaxxers who reported that their kids had autism due to vaccine injuries boomed, movies and TV shows like Adam, The Good Doctor, and The Big Bang Theory depicted successful—or at least, entertaining—autistic men and women. Online, teenagers started self-identifying as autistic. They oversaturated social media so much that some autistic people and their family members started using the hashtag #ActuallyAutistic to differentiate themselves from newcomers.

Of course, there is a key difference between the stories detailed above and an ADHD diagnosis. Where autism or anorexia may come with a prefab identity, ADHD comes with a prescription for legal stimulants.

It’s no secret that, for a time, an ADHD diagnosis was as easy to get as a flu shot. According to The Washington Post, prescriptions for ADHD medications rose 19 percent on average between 2018 and 2022. Adderall specifically increased by 35 percent over that time. Services like Cerebral and Done came under fire for making the process as easy as clicking “add to cart,” galvanized by now-controversial TikTok advertisements. But they weren’t the only companies engaging in questionable practices: Telehealth providers like Circle Medical, a “comprehensive primary care provider,” which has received less media attention than Cerebral and Done, offer only a thin veneer of legitimacy to their ADHD diagnoses.

Appointments for ADHD treatment sit alongside consultations for “gender-affirming” hormone therapy, anxiety and depression treatment, and sleep studies. Users schedule an appointment, usually with a family nurse practitioner or physician’s assistant, and they run through a modest list of questions about symptoms together. In my experience with Circle Medical, no great acting chops were required: The two providers just wanted to make sure I finished the survey. Say “Yes” the magic number of times, and you will get an Adderall prescription. Or, if you prefer and have the gumption to ask, a prescription for Vyvanse or Ritalin.

What’s remarkable about all of this isn’t that telehealth took pill mills online, making them accessible to anyone with a smartphone. It isn’t remarkable that people are trying to game them, either—that has been happening for a long time. What’s remarkable, rather, is the number of cultural ills and personality types the Adderall epidemic seems to intersect with.

There are the people who want to get high, using Adderall recreationally with the certain knowledge that that’s what they want. There are the people who are so inured to the feel of Adderall that it’s tantamount to a cigarette or cup of coffee to them: It’s not a high—it’s a chemical dependency. Then there are people who treat it as a performance-enhancing drug, like Bay Area software engineers who use it to accomplish high volumes of rote tasks or writers who need to pump out thousands of words a week. There are people who are using it as a sort of off-label antidepressant. There are even those who use Adderall as an anesthetic, who experience an emotional blunting effect from it and long for that. They are hyper-focused, but they aren’t too happy, not too sad; their lives continue in a steady hum of fixation. They crash, then go to bed.


And then there are the TikTok types, who don’t understand why they aren’t operating at the same level anymore—people who seemingly think an Adderall high is a reasonable baseline for their mood.

Their Adderall escapism is about unfettered positivity. These women don’t want to be automatons with a machine-like capacity to work, or at least that isn’t what they describe. They want to live their lives with a vibrancy that only the next best thing to methamphetamine can provide. For most people, before you hit your tolerance wall, Adderall feels like any other stimulant does: unending possibility. There is a reason why MDMA’s street name is “ecstasy.”

It feels silly to speculate why any of this might appeal to someone, or if there is a meaningful difference between that and just wanting to get high. The simple answer is that stimulants feel good. No one needs a think piece about why cocaine feels good—it’s cocaine. But our Adderall obsession comes on the heels of a subsection of the population being fixated on what’s been called “toxic positivity,” an excessive preoccupation with maintaining optimism no matter the situation.

Adderall prescriptions are (or were) booming alongside New Age practices like “manifestation,” which teach that you can will your desired life into reality. If some portion of Millennials and Zoomers are using an ADHD diagnosis to play the victim, then maybe another portion is using it to hack reality in the style of people who, 15 years ago, subscribed to The Secret.

It’s uncharitable to call this emotional or intellectual entitlement. My sense is that people just don’t know better. They are not only at sea, but there is no one and nothing to guide them back to the shores of the good life. Some conclude that life is a never-ending quest to “feel good.” And if a pill can offer that—why not?”

 

[randomdoc1]

I'll take that as a compliment.

If you look at the ADHD reddit, it's like a horoscope where any kind of vague life problem is chalked up to "my ADHD acting up again." Someone needs to give them a reality check - either they learn the truth or they are left with the eyebrow-raising "I know more than my psychiatrist about psychiatry."

Well obviously we know nothing. They know their bodies. We only learn from books and that research mumbo jumbo and not life experiences. That’s literally what my dad said to his oncologist the other day while demanding an antibiotic. He later found some old antibiotics, took them, and currently has the runs.

My response: “actually you are completely right. Congratulations 🎉!”

 

[shoomer]

It’s hopeless

The White-Girl Speed Party Crashes

In 2021, some 41 million prescriptions were dispensed in the United States for Adderall (and its generic varieties), an amphetamine used to treat Attention Deficit Hyperactive Disorder, symptoms of which include inattention, hyperactivity, and impulsivity. During the Covid era, pharma-startups...

compactmag.com

“What’s remarkable about all of this isn’t that telehealth took pill mills online, making them accessible to anyone with a smartphone. It isn’t remarkable that people are trying to game them, either—that has been happening for a long time. What’s remarkable, rather, is the number of cultural ills and personality types the Adderall epidemic seems to intersect with.

There are the people who want to get high, using Adderall recreationally with the certain knowledge that that’s what they want. There are the people who are so inured to the feel of Adderall that it’s tantamount to a cigarette or cup of coffee to them: It’s not a high—it’s a chemical dependency. Then there are people who treat it as a performance-enhancing drug, like Bay Area software engineers who use it to accomplish high volumes of rote tasks or writers who need to pump out thousands of words a week. There are people who are using it as a sort of off-label antidepressant. There are even those who use Adderall as an anesthetic, who experience an emotional blunting effect from it and long for that. They are hyper-focused, but they aren’t too happy, not too sad; their lives continue in a steady hum of fixation. They crash, then go to bed.

And then there are the TikTok types, who don’t understand why they aren’t operating at the same level anymore—people who seemingly think an Adderall high is a reasonable baseline for their mood.

Their Adderall escapism is about unfettered positivity. These women don’t want to be automatons with a machine-like capacity to work, or at least that isn’t what they describe. They want to live their lives with a vibrancy that only the next best thing to methamphetamine can provide. For most people, before you hit your tolerance wall, Adderall feels like any other stimulant does: unending possibility. There is a reason why MDMA’s street name is “ecstasy.”

It feels silly to speculate why any of this might appeal to someone, or if there is a meaningful difference between that and just wanting to get high. The simple answer is that stimulants feel good. No one needs a think piece about why cocaine feels good—it’s cocaine. But our Adderall obsession comes on the heels of a subsection of the population being fixated on what’s been called “toxic positivity,” an excessive preoccupation with maintaining optimism no matter the situation.

Adderall prescriptions are (or were) booming alongside New Age practices like “manifestation,” which teach that you can will your desired life into reality. If some portion of Millennials and Zoomers are using an ADHD diagnosis to play the victim, then maybe another portion is using it to hack reality in the style of people who, 15 years ago, subscribed to The Secret.

It’s uncharitable to call this emotional or intellectual entitlement. My sense is that people just don’t know better. They are not only at sea, but there is no one and nothing to guide them back to the shores of the good life. Some conclude that life is a never-ending quest to “feel good.” And if a pill can offer that—why not?”

A Brave New World becomes more and more relevant every day.

 

[sloh]

A Brave New World becomes more and more relevant every day.

Indeed.

"Listening to Soma

Then, too, our age also offers more literal varieties of the lotus plant. Those well-behaved young people are the most medicated generation in history, from the drugs prescribed to ADHD-diagnosed boys to the antidepressants prescribed to anxious teens. Most of the medications are designed to be calming, relaxing, offering a smoothed-out experience rather than a spiky high. The increasingly legal drug of choice for adults is marijuana, which its advocates argue doesn’t inspire as much dangerous behavior as alcohol and hard drugs, making the prototypical stoner a far more harmless figure than the prototypical drunk. This argument is contested, as is the evidence to date on legal pot’s effect on crime and mental illness. Even the evidence that it sometimes encourages aggression, though, might mean that the drug resembles the Internet in making a small minority more violent but tranquilizing the majority—so that for most people, a stoned society is more likely to be a dreamily contented society than an unstable or angry one, and the spread of pot will make an age of stagnation seem mostly like a chill good time.

Then there is the opioid epidemic, which swept across the unhappiest parts of white America without anyone noticing because the drug itself quiets rather than inflames, supplying a gentle euphoria that lets its users simply slip away, day by day and bit by bit, without causing anyone any trouble. It’s not that there aren’t bursts of violence associated with the opioid trade, or addicts willing to commit murder for a fix. But, generally, Americans have ended up dying in record numbers from opioids without the kind of crime wave or murder spike, without the turbulence and chaos, that accompanied the crack epidemic. As the essayist Andrew Sullivan wrote for New York magazine in 2018, “The drugs now conquering America are downers: they are not the means to engage in life more vividly but to seek a respite from its ordeals.” And unlike pot, opioids are antisocial drugs, offering bliss that’s best experienced in solitude. Instead of the munchies, they make you indifferent to food; instead of supercharging the libido, they make you indifferent to sex. “Once the high hits,” writes Sullivan, “your head begins to nod and your eyelids close.” The best book on the epidemic, by the journalist Sam Quinones, is called Dreamland for a reason.

None of the commercial marijuana products or illegal fentanyls can yet match the qualities of Aldous Huxley’s “soma” in Brave New World—the “perfect drug,” one of his dystopia’s boosters says cheerfully, offering “all the advantages of Christianity and alcohol” without religious guilt or hangovers. Soma is manufactured and distributed precisely in order to maintain social stability, but our own somas aren’t so consciously designed; they’re more dangerous, more unevenly distributed, and less universally desired. But they have some clear Huxleyan effects, insofar as they offer a temporary exit from ordinary discontents for precisely the kind of people who might otherwise be inclined to rebel or smash things up, to join a cult or start a revolution, or to opt out like the early Christians in some radical, society-altering way. They wreck lives, but they may also stabilize society; they cull unhappy people, via suicide or overdose or just a numb unhealthiness, but it’s all a personal choice (or, at least, a “choice”) rather than the kind of imposed-from-above social Darwinism that might provoke resistance. They don’t solve social problems; indeed, they worsen them—just ask the babies born to opioid addicts, the small towns ravaged by drug overdoses—but at the same time, they prevent those problems from having the broader consequences that a society without so many drugs and distractions would expect to experience.

And the drugs pair with the virtual entertainments in the same way that soma pairs naturally with other features of the Brave New World World State. Huxley’s perfectly stabilized society had the “feelies”—essentially VR sex. We are not so far away from something similar, at the place where sex robots and Oculus Rift converge. Our society doesn’t repress youthful lust and aggression so much as it stimulates them safely through video games and smut; his dystopia had the mandatory Violent Passion Surrogate, administered “regularly once a month. We flood the whole system with adrenin. It’s the complete physiological equivalent of fear and rage. All the tonic effects of murdering Desdemona and being murdered by Othello, without any of the inconveniences.

Our own versions are not so far advanced and our society is not, of course, so stable. But under decadence, the Western social order has taken a decidedly Huxleyan turn, with social trends that simultaneously vindicate one cultural-conservative premise—that choice alone doesn’t make people happy, that the unbound individual is likely to become a slave to entertainments and a refugee in his own mind, that pot and circuses inevitably succeed family and religion—while proving a different conservative expectation wrong. From the 1960s onward, conservative critics of a triumphant boomer liberalism predicted that rampant individualism would make society itself dissolve; that fewer fathers and weaker churches and a general hedonistic ethos would mean more crime, more violence, more overt social breakdown. And Western trends from about 1965 through about 1990 seemed to vindicate that premise. But then something changed, and without the social fabric obviously reknitting—without the revival of civic or religious life or the strengthening of community attachments and family bonds that people on both sides of the culture war earnestly desired—crime rates fell, and teenage delinquency diminished, and the pattern of everyday life became more stable and law abiding and simply safe.

The social revolutions of fifty years ago led to a certain kind of chaos, in other words. But thanks to virtual escapism, the one great technological achievement of an otherwise stagnant age, the decadence that came in afterward looks surprisingly sustainable."

 

[Shikima]

I don't understand anything you wrote at all. Are you working or not?

I am working. Many hats, many baskets with eggs. And I just need to remember to show up here.

 

[Shikima]

MSN