Kill the meaning. Keep the name.

Introduction

This was one of the first blog posts I originally wrote in February of 2023, at Nightingale. It is a critical one in the development of my thinking around the thing we call ADHD. The basic premise is this: there is a phenomenon—a thing—in the world that has come to be known as Attention Deficit Hyperactivity Disorder (ADHD). Prior to that, in the early 1960s, this thing that we now call ADHD was called Minimal Brain Dysfunction. As a person with this condition, I've gotta say... I don't care for that moniker.

Towards the end of the 1960s, that name changed to Hyperkinetic Disorder of Childhood. That title is less harsh, but gets wrong both the key descriptor—hyperkinetic—and the population—children. Apart from that... pretty spot on. Hyperkinetic is an inappropriate descriptor, because there are many people with ADHD, who could in no way be described as hyperkinetic. And we now know that this is a condition that extends to whole of peoples' lives. If this were an at-bat in a baseball game, the folks who are responsible for coming up with diagnostic names—called nosologists—would have two strikes against them.

In the 1980s, the diagnostic names Attention Deficit Disorder (ADD) and Attention Deficit Hyperactivity Disorder (ADHD) became the names to describe the condition. Three pitches... three strikes... the batter goes back to the dugout in shame.

Like the names that came before them, ADD and ADHD do not just do a bad job at describing the phenomenon but have actively confused things for generations of people who might have gotten some support, assistance, and relief but instead got diagnosed with some other condition or sent home with nothing. In this respect, the wrong names have caused poorer and nonexistent care for countless millions of people around the world for the past 65 years. This is shameful.

Nietzsche enters the conversation

Shakespeare was completely wrong when he wrote,

What's in a name? That which we call a rose
By any other name would smell as sweet;

Romeo and Juliet

His point here is that it doesn't matter what we call a thing. But imagine the following: instead of calling the flower from that sonnet a rose, we called it a steaming pile of sheep shit. If we called it a steaming pile of sheep shit, we might not be inclined to give it to our loved ones on anniversaries and Valentine's day.

And so it is with ADHD. All the names we have come up with for ADHD to date are no better than calling a rose a steaming pile of sheep shit.

Against the realism or nominal realism of Shakespeare, let me counter with everyone's favourite moustachioed German, Friedrich Nietzsche. I don't know if Nietzsche had ADHD, but man... he made a career out of being oppositional to just about every aspect of received wisdom of his era—the last quarter of the 19th century.

The following meaty quotation speaks directly to the fundamental importance of naming things. He writes:

What he says here is profound: what things are called is incomparably more important than what they are. The names that have been created over the past 65 years to represent this condition we now call ADHD are the dresses that have been thrown over the thing itself and are, in fact, foreign to the nature of the thing itself. And over time—from generation to generation—this name that is foreign to the nature becomes something like fact, "merely because people believe in it."

This is where we are today with ADHD. It is so ingrained in the public that ADHD is fundamentally about hyperactivity and attention, because... the god damned name says as much! In 2025, I still regularly see new clients who have been to therapy, some for many decades, and when I suggest to them that they might have ADHD, they think I've got a screw lose. They say things like, "No one's ever said that to me before." I have recently helped a client get their diagnosis at the age of 51. This client had seen Doctors, Psychiatrists, Psychologists, and Counsellors over a 30 year span, and not a single one had every brought up ADHD. Not a single one had ever brought it up, because the name ADHD is foreign to the nature of the condition itself. And because the name is wrong, the diagnostic criteria are wrong. And because the name and diagnostic criteria are wrong, people are not getting the treatment they deserve. This client is now doing wildly better now that they have gotten a prescription for a medication that is effective for their condition—after 30 years of telling their story to professionals who might of helped. But as a result of their experience, they have forever turned their back on and cursed the therapeutic community for their inability/unwillingness to treat her very treatable condition.

Nietzsche tells us how to proceed here: we must use our creative energies to make new things. So... this post and my practice are not just about simply renaming this thing that we've know for the past four decades as ADHD. What I am after is destruction: to chuck the names Attention Deficit Hyperactivity Disorder and ADHD into a historical garbage bin "in order to create in the long run new "things."" My deepest hope is to create a new thing.

Identifying what is foreign to the nature of adhd

It is my contention that Attention Deficit Hyperactivity Disorder (ADHD) is a corrupt phrase and name. It is a collection of prejudices. Its very existence has prevented scores of people from understanding the truth about themselves, namely that they have adhd.

But wait a minute... what is the distinction between ADHD and adhd? The first ADHD is the acronym. It stands for Attention Deficit Hyperactivity Disorder. The second is adhd, and it doesn’t stand for anything. I will give a full explanation below, but for the time being, ADHD is the old name, and adhd is the new one.

But let me return to the idea of corruption. What does it mean that this name is corrupt? Why use this inflammatory language? I use it because I am angry about it. As I noted above, it is my contention that the name ADHD has prevented people—the number of which can never be known—from understanding themselves as people with adhd. In my experience particularly true for women. Studies on the epidemiology of ADHD would have us believe that the gender ration of males to females is anywhere between 2:1 to 10:1. (Slobodin and Davidovitch, 2019).

Now... I don’t have data sets the size of the studies discussed in the paper above.

And... the people who come in to my office may be self selected in a ways that skews the results.

But... I can say without a moment’s hesitation that I have seen no evidence of any ratio between my male and female clients. What I have seen is countless women who have come into my office with diagnoses of generalized anxiety disorder (GAD), borderline personality disorder (BPD), and even bipolar disorder (BP), only to ultimately realize that though they may struggle with anxiety and emotional dysregulation, the trouble generator is adhd. The proper language here is critically important, because the medications and therapies that are effective for GAD and BPD and BD are not effective for adhd. So hearing stories of women who have been taking anxiolytics—the class of medications given for people who struggle with anxiety—and going to therapy for as many as 40 years is not uncommon.

If the above is the product of a corrupt name and conceptualization of what adhd is, then let’s dig a little deeper into the name itself. Let us first disaggregate the name into its component parts:

• attention deficit
• hyperactivity
• disorder

Before starting, it is worth noting that the idea of “attention” itself requires a full unpacking, but I will leave that for a later post.

Attention Deficit

The idea that something called an “attention deficit” exists is... silly. It’s silly, because the concept floats freely without reference to a context or an environment. Everyone has less or more attention for things that they like or dislike, for things that they trust or are fearful of, for things that they love or hate, and ultimately for things about which they care for or about or do not. To say that there is an amount of attention that someone should have globally is to imagine that there is an normatively appropriate amount of attention to have in all situations. This is, on the face of it, simply absurd.

Let us simply take what we know about people with adhd to begin. Everyone who has adhd and anyone who has spent even a little time reading or talking about it knows that one of the characteristics of people with the condition is hyperfocus: in other words... an attention surplus. So, one of the best known features of people with the diagnostic name whose principal descriptor is “attention deficit” are well known to experience something that we might call a surplus or abundance of attention. This is exactly what Nietzsche was talking about when he wrote that names are "thrown over things like a dress and altogether foreign to their nature and even to their skin."

Leaving aside for the moment the fact that “attention deficit” might also include the experience of hyper-attention (which demonstrates an inconsistency or paradox in the name itself), let me return to some imagined sense of what normal attention might refer to.

Now... let me think...
(fingers drumming on my desk)...
What might the normative sense of attention refer to?
Maybe... school and work?

Yes. School and work. But not just any school and work. People have participated in organized learning and have worked since the dawn of time. It must be something about school and work as it exists in contemporary society. What the “attention deficit” in ADHD actually stands in for is attention deficit in a society that prizes work completed in a very particular way: that is, structured around the clock time of routinized contemporary life.

I don’t think we need to spend too much time defining what routinized contemporary life describes: in its broadest definition it is the manner in which all people in modern developed nations—leaving aside the obvious prejudices in “modern” and “developed”—participate in productive activities. In other words, it doesn’t really matter whether you are a preschooler, a trades-person, or a white collar worker. Your days all start at roughly the same time, you have a juice box or a coffee at 10:30, etc. We live in a particularly clock-bound world.

Under these rules of productive work, attention—and the deficit thereof—are measured against one’s capacity to remain focused on one’s work, whatever that work might be, in lockstep with routinized clock time. Those of us with adhd struggle with routinized clock time. But routinized clock time of the contemporary industrialized “developed” world is not the obvious or natural or sole way of conceptualizing the organization of a person’s or a people’s productive capacity. It is generally the way we who live in these nations understand the organization of productive capacities. But it isn’t the case that this is the natural state of things. And, as a result, if there are people who do not conform to said standards, it is not reasonable to say that those people are in deficit of attention.

Hyperactivity

As with “attention deficit,” so with “hyperactivity.” At least in this case there is some truth to the descriptor “hyperactive,” but here the corruption is in the narrowness of the definition and those who are left out as a result. For those who have some experience with young, male children with a diagnosis of adhd, we know what hyperactivity looks like. The DSM contains the following in its description of hyperactivity:

• Fidget
• Squirm
• Often leaves seat
• Runs
• Climbs
• Restless
• “On the go”
• “Driven by a motor”
• Excessive talking
• Blurts
• Interrupts
• Intrudes on others

Fair enough. These are all characteristics of some with adhd. The DSM divides adhd diagnoses into three categories: hyperactive, inattentive, and combined. By that definition, those who are described as inattentive are, definitionally, not hyperactive. In more colloquial language, those who are hyperactive are tearing around and those who are inattentive are often called spacey.

But this typology—a typology is a way of categorizing or dividing things and people up—is wrongheaded, because hyperactivity, as we saw above, is only understood in relation to a person’s bodily movement. They sure as shit can be. And this is precisely why people who are described as inattentive behave in a way that looks like they are not being attentive:

Apologies for shouting, but this is the reason, as I reported above, that women in particular are not properly assessed for adhd and are rather diagnosed as having anxiety disorders. And it is not only women who receive a misappraisal as a result of their lack of outward hyperactivity. I have countless male clients, who also were not properly assessed because they do not exhibit the outward signs of a surplus of activity. It is simply the lack of curiosity and imagination of the community of people who have developed such diagnoses and typologies that the only kind of hyperactivity of which they can conceive is an 11-year-old boy who raises his hand 30 times in a 45 minute span at school.

All people with adhd deal with hyperactivity in some form. All. It is a corrupt practice to say that boys and men who exhibit a surplus of movement have adhd and girls and women who exhibit a surplus of psychic activity—worry, indecisiveness, nervousness, fearfulness, and perseveration—have an anxiety disorder. This is the very definition of prejudice. In some previous writing, I offered the definition of openness/undefendeness as a fundamental way of understanding adhd. One of the ways of understanding those descriptors is through the lens of inhibition or lack thereof. I will leave the discussion of inhibition for a later post, but suffice to say that one of the ways that I hope to reconceptualize ADHD as adhd is by defining those of us with adhd as having a different experience of inhibitory bodily processes—physiological and psychological (if such a distinction is even worth making).

Disorder

And finally... “disorder:” is adhd a disorder? No it is not. And neither is it a mental illness, a mental disease, or any other pathological state. The DSM classifies adhd as a “neurodevelopmental disorder.” The “neuro” part of neurodevelopmental is appropriate. I will discuss the meaning of neurology vis a vis adhd in a later post. And the “developmental” part is simply a descriptor that notes when the “disorder” arises. It is true that adhd is a condition that arises in childhood, i.e. in “the developmental period" (DSM, 2013, p 31). But two things are true about the use of this descriptive language: first, classifying things on when they start is... not very interesting or revealing. Second, by focusing on the “the developmental period” in a person’s life—which definitionally seems to suggest that development then doesn’t occur in other periods of life?—neglects the fact that adhd is part and parcel of a person’s entire life. And again, the use of prejudicial language makes it difficult for adults who were not diagnosed as children to get a diagnosis later in life. I have heard countless clients tell me that their doctors refuse to entertain a diagnosis of adhd, because if they really had adhd, they would have been screened and diagnosed as a child. You can see how this perverse and prejudicial system operates. Joseph Heller coined the phrase for this in the title of his 1961 classic: it's a Catch-22.

Back to the question as to whether adhd is a disorder. A medical dictionary defines disorder in the following ways:

1. A derangement or abnormality of function; a morbid physical or mental state.
2. A disturbance of function or structure, resulting from a genetic or embryologic failure in development or from exogenous factors such as poison, trauma, or disease.

It may seem that the use of “disorder” creates some distance from the pathology of a disease state. But not so. In both the definitions above, “disease” is front and centre. The first definition includes “morbid,” whose chief definition is “disease or pathological.” The second definition suggests that a disorder is the result of a disease state. By this definition, ADHD is a state of diseased attentional status. This to me brings up the the old saw, “6 of one... half dozen of the other.”

To destroy as creators

Let's take Nietzsche's advice: let's destroy the thing known as ADHD.

Others have attempted this nosological feat—nosology is the discipline that names diseases. In fact, as I mentioned above, ADHD was devised as a way of overcoming prior linguistic prejudices. Examples of previous names for the phenomena we now call ADHD are the following (Lange et al., 2010; Nielsen, 2019):

• Mental derangement (late 18th century)
• Johnny Look-in-the-air and Fidgety Phillip (mid-19th century children’s story figures, Heinrich Hoffmann)
• Defect of moral control as a morbid manifestation, without general impairment of intellect and without physical disease (early 20th century)
• Mental restlessness (early 20th century)
• Hyperkinetic impulse disorder (mid-20th century)
• Minimal brain dysfunction (mid-20 century)
• Hyperkinetic reaction of childhood (DSM-II, 1968)
• Attention deficit disorder, with and without hyperactivity (DSM-III, 1980)

Please don’t misunderstand my mood here: as a person with adhd, I am not outraged at the history of the names of this phenomenon. I am—as I've now mentioned multiple times—outraged that we are currently doing a piss-poor job of offering people the assistance they require to recognize and understand themselves as they people they truly are. This is what is ultimately at stake in this conversation about the ways in which we talk about—and name—phenomena such as adhd: offering people the opportunity to get to understand and know and accept and maybe even... love the people they are. This is what can be achieved by calling a thing an appropriate name rather than the inverse of what that thing is.

My purpose in this post is to demonstrate that what things are called is incomparably more important than what they are. In other words, what things are called brings them into being. If it is claimed that ADHD is a neurodevelopmental disorder, then it follows that those practitioners who live under those linguistic rules will be more focused on children—i.e. at the stage of development when the disorder manifests. The corollary of that—and we don’t have to go back into history to recognize this—is that adults get overlooked as a result of the Catch-22 outlined above. It is still claimed to this very day that some substantial percentage of the people who were diagnosed with ADHD as children do not have ADHD as adults. Apologies, but i’m going to shout what follows:

My solution to the problem of determining what to call the condition here under discussion is devilishly simple and completely oppositional: keep the acronym and kill the meaning, hence adhd. I have spent years trying to put a satisfying name to the phenomena that we have called a defect of moral control and attention deficit hyperactivity disorder. As I deepened my understanding of the condition, I tried to translate that into a name that would be appropriately representative. Who knows... maybe a name will be developed that is appropriately descriptive and that rather than excluding whole populations of people—e.g. adults, women, and, in particular, adult women—it will be a name that is open, like the condition itself.

Kill the meaning and keep the name.

But I’ve gotten tired of searching for the right name, and there is something pleasing about using the name that was foisted upon one’s group as the way to describe oneself. My solution is to kill the meaning and the keep the name. ADHD is an acronym that calls forth the meaning contained in the words, “attention” and “deficit” and “hyperactivity” and “disorder.” But those words, as I hope I have demonstrated, are prejudices that endanger the freedom of both those of us who are named by it and them and, by extension, society at large.

There is nothing original about the written notation that I use. It is a well known technique that is generally referred to as sous rature; in English it often translated as “under erasure.” It signifies that the name contains a weakness or an inadequacy but that there is something important about the word itself. So it is with ADHD. The acronym ADHD, the words it calls forth, and the histories contained therein are the history of misunderstandings and misapprehensions about the population of people for whom I would offer the name, adhd.

Bibliography

American Psychiatric Association, & American Psychiatric Association (Eds.). (2013). Diagnostic and statistical manual of mental disorders: DSM-5 (5th ed). American Psychiatric Association.

Lange, K. W., Reichl, S., Lange, K. M., Tucha, L., & Tucha, O. (2010). The history of attention deficit hyperactivity disorder. Attention Deficit and Hyperactivity Disorders, 2(4), 241–255. https://doi.org/10.1007/s12402-010-0045-8

Nielsen, M. (2019). Experiences and Explanations of ADHD: An Ethnography of Adults Living with a Diagnosis. Routledge. https://doi.org/10.4324/9781315142197

Nietzsche, F. (1974). The Gay Science: With a Prelude in Rhymes and an Appendix of Songs (W. Kaufmann, Trans.). Vintage Books.

Sous rature. (2022). In Wikipedia. https://en.wikipedia.org/w/index.php?title=Sous_rature&oldid=1128935518#cite_note-6

Slobodin, O., & Davidovitch, M. (2019). Gender Differences in Objective and Subjective Measures of ADHD Among Clinic-Referred Children. Frontiers in Human Neuroscience, 13. https://www.frontiersin.org/articles/10.3389/fnhum.2019.00441