[BM] There is a crucial difference, though, between a broken leg and these mental conditions or constitutions. In the case of a broken leg, you can demonstrate the objective existence of a physical pathology, and there are treatments known to be effective in pretty much every individual case. For ADD and the like, no-one has demonstrated either an objective pathology, or an objectively effective treatment based on an understanding of the pathology. All we have is descriptions of symptoms that cluster together (although no individual need show all of them), vague genetic correlations, and supposed treatments of very variable effect. There may indeed be a definite thing wrong with the brains of OCD sufferers, and there may be possible treatments as effective as setting a broken bone and applying a cast, but currently, very little is actually known.

(simulposted by a much more succinct post from Raak, but...)
[BM] Well... yes and no. I'll take ADD as my example, since that is obviously what I know best.

It is clear that ADD behaviours can be severe enough to cause problems, and that there are a lot of people who carry these behaviours around with them, but it is not certain that ADD is an objectively definable disease. For instance, ADD has been described and recognised by the US psychiatric establishment for more than 30 years (although its name has been changed a few even times over that time), but the UK establishment only officially recognised ADD in the 1990s - this despite the first published work on ADD being in the UK a hundred years before. Even in the US, ADD has only recently (ie in the last ten years or so) been widely recognised as occurring in adults - it was considered a childhood affliction which was obliterated by adolescence.

Part of the problem is that labelled conditions such as ADD, OCD, etc are note discrete: a bone is broken or it is not broken, but ADD has more degrees than there are labels, and even then it is not clear that even someone whose collection of symptoms is technically pathological enough to be so labelled is actually displaying anything more than just a strong personality trait. There has been work to scan brains under ADD-expressing conditions, and there are apparently common factors to those scans, but ADD is at best a collection of possibly related symptoms. But then is personality just an expression of brain chemistry?

As I say, my belief is that those who are actually disadvantaged by their ADD behaviours are those who have been trying to use their brains in ways which don't mesh with their brain chemistry or personality, where "one size fits all" education systems teach the same learning mechanisms to everyone regardless of how they really learn best. This is one of the reasons that I talk about my having ADD behaviours; Idon't consider myself to be diseased¹.

[1] this is going in a footnote because it's not part of the core point, but one of the things which concerns me about statements that ADD is underdiagnosed is that it is then treated as a disease. At this point the children (and this is where I become most concerned - it is almost always children) are dosed up with psychostimulants in order to make them fit in rather than training them to use their brains to their best advantage: the problem is not solved, it is avoided.

Absol-bloodly-lutely. Extremely well put. It extends beyond education and learning mechanisms too, in my view.

[Dunx and Raak] Hear hear. Nicely expressed.

As Raak says, a leg is generally broken or not broken, and the difference is pretty clear and agreed upon, but you get members of any minority group into a room (ADD sufferers, autists, gays, black people) into a room and ask them to define "ADD", "autism" or, heaven help you, "gayness" or "blackness" and you will soon have a heated debate on your hands.

...just witness the endless controversies in the last few decades over the definition and meaning of "disabled".

I agree with Dunx that the problem is really one of society not being able to handle people who are different. It's terrible that children, in particular, who have a different way of learning, get straitjacketed into the traditional methods and classed as having a problem if they don't fit in. It's especially ridiculous given how much society actually prizes ADD traits in many ways - such as creativity and spontaneity - which is how people like Billy Connolly, Robin Williams, and Ozzy Osbourne got to where they are today. Bill Clinton, of course, is the classic ADD kid made good. But at the same time, I do think that there is good evidence that ADD, in particular, is a discrete and specific disorder, with specific physiological causes, rather than a handy name for a bunch of sometimes associated phenomena. Raak is wrong to say that the genetic correlations of ADD are vague: they are not vague at all, and there is very good evidence for a strictly physiological basis, although of course how that basis manifests itself will vary according to conditions. Certainly ADD behaviours do vary from person to person in type and degree, which is one of the things that make it hard to diagnose, but it doesn't follow that the underlying cause varies - at least where ADD is the correct diagnosis. We have a rather skewed view of it in the UK because, as he says, it hasn't been officially recognised here for very long, compared to the US; in fact, some of the newer treatments for it, such as Concerta (essentially slow-release Ritalin) are unheard of to many supposed experts in this country. Plus, of course, the media like to fixate on issues of medication and horror stories about it. By the same token, it would be better if society could change to accommodate those of us who are different, but given that it can't, medication is a whole lot better than nothing. I have known people whose lives have been utterly ruined by ADD as well as by OCD. If they had been diagnosed earlier and given the help they needed - medication as well as proper counselling and behavioural therapy - who knows how things might have been different.