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Accommodation

or Making Excuses?

Self-Knowledge

and Responsibility

Shame

Clergy

and Community Support

Prayer

and Ritual as Structure and Focus

Christianity

Judaism

Islam

Some commentators

have linked the increased awareness of ADHD to a decline in personal

responsibility and traditional morals. They feel that the medical

community, in bestowing the diagnosis of ADHD or other mental illness, is

giving the affected individual permission

to continue objectionable behavior. The patient seeks medical absolution

in the therapy room, abandoning the traditional values of church or

temple. Some individuals who seek special accommodations in school or in

the workplace are held up to public ridicule. Such individuals are said to

be lazy or are trying to style themselves as victims. Some will point to

themselves as good examples. They were impulsive “bad boys” in school.

Once they got out of school and met the realities of having to make a

living, they “straightened up” and overcame their moral shortcomings.     

While

these charges may make one’s blood start to boil, we need to take such

criticisms seriously. Often a little self-examination can be useful. This

raises several important questions. What is the meaning of

“being diagnosed”? Are you still the same person? If one has

a neurobiological condition that predisposes one to impulsivity, where

does personal responsibility fit in? Where does reasonable accommodation

end and “making excuses or being prickly” begin?

I feel

that there is no conflict between the need for personal responsibility and

the need to understand one’s diagnosis. Most moral systems value the

concept of self-knowledge. Understanding one’s strengths and weaknesses is

necessary for one to function as a moral being. Once one becomes aware

that one has ADHD, it becomes a responsibility to learn more about the

condition. Then, one can try, through increased self-knowledge, to avoid

impulsive acts that might offend or injure others. The same principle

holds for parents of a child with ADHD. When to punish, when to

accommodate and when to try to gradually shape behavior?

When

dealing with individuals with long-standing, severe ADHD, I sometimes

encounter those who have become so used to their own impulsivity and

failure that they have ceased to care about the rights of others. They

have learned to associate with impulsive, antisocial peers. At their

worst, they can function as predators. Such an individual might use his or

her diagnosis as an “excuse” but this is usually part of an

over-all antisocial pattern. I have treated a number of such individuals.

For them, the road to recovery is longer and more agonizing. Some regain

their self-esteem, and with extensive academic, medical and social help,

achieve successful lives. Others end up in the juvenile or adult penal

system.

There

are some individuals who seek a specific psychiatric diagnosis to try to

explain long-term life problems. Whether or not they actually have the

ADHD, the diagnostic and process does not satisfy them. Each professional

who does not deliver the expected miracle is eventually devalued. Such an

individual might be one of the rare people who will ask for unreasonable

accommodations. This person might swing from the pole of extreme guilt to

the pole of feeling of constantly victimized. Such an individual would

benefit from long term individual psychotherapy with a therapist who can

tolerate being both idealized and devalued.

In my

experience, the majority of those diagnosed with ADHD do not misuse their

diagnoses to get undeserved accommodations. Indeed, the individual may be

wracked with shame and anxiety about their inability to contain their

disorganization and impulsivity. This sense of

shame

and secrecy can paralyze an individual and make him or her unable to

ask for reasonable assistance. This person, hearing public criticism of

ADHD, may retreat further into shame and secrecy. In particular, I have

found that deeply religious individuals can be much harder on themselves

than their elders or clergy.

Since

the increasing diagnosis of ADHD has been criticized as a move away from

traditional morality, it might be interesting to consider various

religious perspectives on the subject of psychiatric diagnosis, religious

communities, and personal responsibility. (For this discussion, I will be

excluding the tiny minority of mentally ill individuals who truly cannot

understand the nature of their actions).

Over

the years, I have worked with many deeply religious people from a variety

of faiths. They have often been gracious enough to bring in literature to

educate me about their beliefs. When appropriate, I have

involved

their clergy or religious community in the treatment. This

collaboration between clergy and psychiatry has almost always been

positive. Once there is a climate of mutual trust and respect, a

particular religious community can be an invaluable source of structure

and support. In my experience, most clergy are more accepting of the

diagnosis of ADHD than their more conservative parishioners. A few clergy

needed education about ADHD, but almost all were eventually supportive.

For

certain individuals with ADHD, daily prayers and other

religious

rituals provide a good way to handle transitions, and to frame the

experiences of the day. The church, temple or mosque is a source of

interpersonal support and a ready place for structured social activities.

Religious communities can have all of the same foibles as can individuals.

Like other social institutions, they can be prone to cliques, and petty

prejudices. However, good clergy and lay leaders function to remind the

community to look beyond prejudices and to constantly strive to imitate

God.

Some

Christians

have used Jesus’ dealings with the Apostle Peter as a model for how one

might deal with a child or an adult with ADHD. Some have wondered whether

Peter himself had some of the characteristics of ADHD. He loved Jesus and

desperately wanted to be more like him. However, on several occasions, he

acted impulsively and was unable to follow through. For example, on the

night Jesus was betrayed, Peter cut off a soldier’s ear. He also promised

to stick with Jesus no matter what happened. However, by the morning

cockcrow, he had betrayed Jesus three times. In other situations, Jesus

called Peter by name, gently pointed out the mistake and suggested a

correction. In the case of the three denials, a piercing look was enough

to remind Peter of his error. The later books of the Christian scriptures,

written about the time after Jesus, give hope in that they show a more

mature, confident man who has clearly learned from Jesus’ encouragement

and gentle setting of limits.

Some

contemporary Christian ministers suggest that faith can relate to

individuals with psychiatric diagnoses. Once one becomes aware of a

psychiatric diagnosis, it becomes one’s responsibility to learn more about

the condition. Through knowledge, one might be able to minimize impulsive

acts that might offend or injure others. Prayer can lead to a sense of

forgiveness and freedom from shame. Even if one feels forgiven, there is

still the obligation to attempt to make amends to other people who might

have been hurt by one’s impulsive acts. When one is freed from shame and

secrecy, it is often easier to make meaningful amends to others. Prayer or

meditation can be a source of quieting and centering. Some distractible

individuals may not be able to sustain a lengthy, focused prayer. However,

in the Screwtape Letters, C.S. Lewis indicates that the most

powerful prayer is a simple brief prayer for the grace to manage the daily

challenges.

The

Jewish

celebration of Pesach, (Passover) commemorates the deliverance out of

bondage in Egypt. It is one of the earliest examples of interactive

learning. The participants should experience the deliverance from slavery

as if it were happening to them that evening. There is particular

attention to teaching the children. There are stories, breath-holding

contests, hunting for a hidden object and songs to keep children and other

distractible folk involved. The Haggadah, (order of service), describes

four types of children and commands the adults to teach each type of child

in a way that he will learn best. The four sons are the wise son, the

simple son, the wicked son and the son who is too young to ask questions.

The Haggadah describes specific teaching techniques for each son so that

each will understand the experience of the Exodus.

At one

Seder meal it suddenly struck me that these commandments were the Divine

blueprint for the special education laws; 94-142 and subsequently IDEA.

Over two millennia ago, there was a commandment to give each individual

instruction that he or she could understand and apply! Particularly

interesting is the instruction for dealing with the wicked son. One might

see him as the distractible, impulsive defiant child. He says, “What

mean ye by these commandments?” The teachings command one to

point out that he has, by his language and attitude, excluded himself.

This gentle rebuke is interpreted as pointing out his self-exclusion. The

eventual goal of this is to encourage him to rejoin the family group and

participate in the miraculous deliverance. Much of the subsequent games

and playful contests also function to draw in such an individual.

The

Jewish rituals cover a wide variety of every day and unusual events. These

prayers and rituals can be very centering and can help structure the day.

The Bar and Bat Mitzvah, coming of age ceremonies, welcome young people

into the community. The preparation can be academically intense. The

Jewish community recognizes this and there a number of tutorials and other

accommodations so that a broader range of individuals are able to join the

Jewish community.

The

Suni Moslem believes that at birth, one is assigned

two angels who record all of one’s good and bad deeds. However the

“pen is lifted” in three circumstances. These are youth, sleep

and insanity. Individuals with mental illness who can distinguish right

from wrong are not exempt from the recording of their deeds. However,

Islam tends to be understanding about an individual’s limitations, and

will accept a sincere effort to obey the laws of Islam. If one Moslem does

something offensive to another Moslem, the recipient may shun the

offending individual for only three days. After that one must forgive.

If an

individual commits an impulsive negative act, he or she must make a

sincere prayer of repentance to Allah, and then ask the offended

individual for forgiveness. Muhammad said that one must then follow the

offensive action with a good deed. Islam is often quite specific about

expected behaviors and responses. For instance, if one is unable to fast

during Rammadan because of one’s psychiatric medications, one could

instead feed a hungry person each day during the fast.

Most

often, I find that individual believers of many faiths are harder on

themselves than would be their clergy. For example, several religious

groups have special fast days. Certain medications and medical conditions

make fasting impractical or actually dangerous. Most clergy feel that it

would be a sin to endanger one’s health for the sake of a fast day.

Frequently, the patient needs to hear this directly from the clergy or lay

elders. In the case of most medications for ADHD, one can stop them for a

day or rearrange the dosing to facilitate a one-day religious fast. The

month long, dawn-to-dusk Moslem observance of Rammadan is more

challenging. However, I have managed, with community help and some

pharmacological maneuvering, to see patients through this important

religious observance.

Individuals

who have the diagnosis of ADHD are often relieved that there is an

explanation for their fogginess, fidgetiness, and impulsivity. However,

when they attempt to get accommodations, they are often accused of

laziness or making excuses. Some commentators have seen the diagnosis of

ADHD as the medicalization of morality. However it is appropriate to

consider psychiatric treatment as responsible stewardship of one’s body

and mind. Those with ADHD, like everyone else, should always try to take

responsibility for their actions, and make amends for any offenses.

However, those who condemn this diagnosis are not representative of most

liberal or conservative religious leaders.

 


Read Our

Collection of Original Articles on Adult and Pediatric AD/HD

ADHD

and Medication: the Basics  

When

a Grandchild Has ADHD

Adult

Attention Deficit Disorder: Diagnosis, Accommodation and Mastery

Helping

Your Child Succeed in School

Coping

Styles in ADD Adults

Practical

Hints for Raising and Educating an ADHD Child

Neurobiological

Diagnosis and Personal Responsibility: How Does Morality Fit in with ADD?

How

Computers Can Help Individuals with ADD

Book

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