Ep 857 ｜ Is ADHD Real？ ｜ Guest： Dr. Roger McFillin (Part One)
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Summary
In this episode, Dr. Roger McFillan joins us to discuss ADD and ADHD. Dr. Mcfillan is a clinical psychologist, coach, and speaker who has been on the show before to talk about depression and why they don't actually work. In this episode we talk about ADHD, what it is, how it is diagnosed, and why it is often harmfully treated.
Transcript
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Dr. Roger McFillan is a clinical psychologist. He's a consultant, coach, and speaker as well.
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We've had him on the show before to talk about depression medications and why they don't actually
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work. And today we are talking about another controversial topic, which is ADD and ADHD
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and how these diagnoses are not necessarily, according to Dr. McFillan, based in real science
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and therefore the treatments that are often given for them are also not scientific and in many cases
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extremely unproductive, unhelpful, and even harmful. This is a two-part conversation. Today is part one
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where we get into ADD, what it is, how it's diagnosed, and how it is often harmfully treated.
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And then you'll have to stay tuned for part two for the rest of it, even more apparently very
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controversial things that we are going to discuss. This episode is brought to you by our friends at
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Good Ranchers. Go to GoodRanchers.com. Use code Allie at checkout. That's GoodRanchers.com. Code Allie.
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Dr. McFillan, thanks so much for joining us again. I have to say there was quite a reaction,
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a positive reaction overwhelmingly to the conversation that we had, but of course,
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plenty of pushback, which I'm sure that you're used to when you say things like there's no such
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thing as a chemical imbalance. It's not just something that people disagree with. I realize
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it's almost a part of people's worldview. They really want to cling to that for some reason when
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it comes to depression and anxiety. So before we get into what we're talking about today,
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is that something that you've experienced that it's really difficult for people to
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hear what you said, that the chemical imbalance theory is not something that's rooted in good
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science? Yes. Well, first, thank you for having me back. I did read a lot of the comments from our
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last interview, and I found them fascinating and interesting. And some of that I think is really
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important to address up front, because we're definitely going to walk down a similar path as
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last time, where we're discussing this condition and how it really has become a person's own
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individual identity. And from what they've learned in popular culture, it really does drive a lot of
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their behaviors and their reactions. So let me just first say a couple of things. I think in American
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culture, we're in this unique period of time where it is a lot easier to criticize the person versus
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the actual argument. So I do think I have to defend some of my credentials here as a clinical
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psychologist, because there was a portion of people who responded to the last interview said
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that I did not have the credentials to be able to speak out on this. So first,
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I am a clinical psychologist and not a medical doctor. So they are accurate there. But what are
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clinical psychologists? We are researchers and clinicians. So I have a doctoral degree in clinical
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psychology. I've published research. Where my strength is, is being able to understand medical research and
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then being able to communicate that as best available evidence. So when you're an active clinician, you
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have to act and make decisions that are based on this evidence. And so I think by last time that I was
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here, I was communicating that scientific literature. And so it's also important for people to know my
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concerns or the things that I'm going to discuss today or discussed last time are certainly not
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limited to non-medical professionals. There are many medical professionals who are speaking out
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against this. In fact, one of the blessings of being on your show is I've been able to connect
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to a lot of people, especially pediatricians in the medical system who are forced to intervene in
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ways that they don't feel are scientifically sound or follow guidelines that have problems. And we'll get
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into this today. So your question is a good one about like personal identity, especially when we get into
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the conversations about ADHD. It is so prominent now in American culture that people take on these
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identities as if they define who they are. And so when you start to be critical of the science or you
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provide alternative views, it's different than other diagnoses. You would think that if somebody learned
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that there were safer or more effective ways to understand the treatment of cancer, for example, they would be
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thrilled to be able to understand that and see what works. But when it comes to like your mental health,
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it gets confused where people feel like there is actually a personal attack and you're invalidating
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them. Right. That's those are definitely some of the comments that I got and something that I
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that I saw repeatedly, which I've heard before, so I'm not sure where it originated, but I've heard I've
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heard doctors say this to people, not to me, but to people I know saying, you know, we have to take
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medication for all different kinds of illnesses, physical ailments. And the illness in our brain is
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no different, just like we have imbalances. If you have diabetes or if you have some other kind of
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chronic disease, you may have to take medicine to manage, which maybe even that's debatable to some
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people. But their point is that there are physical ailments that you have to take medicine for,
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and we shouldn't treat a mental illness, they would say any differently. And I think it's an
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attempt to say there should be no shame or no embarrassment around this. This is just what you
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have to do. But that didn't really engage with the arguments that you made about the fact that
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actually those medications are not doing what these people think that they are or say that they are
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when it comes to, quote unquote, fixing depression and anxiety.
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Yeah, let's first start with depression and anxiety are real conditions. They're painful,
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and they can be really impairing. Comparing it to a medical condition is disingenuous. I can go to my
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primary care doctor if I have strep throat, you can detect that with a test, identifying that bacteria,
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and then targeting it with a drug that kills that bacteria. When it comes to the complexity of the
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human experience and mental health, there are no tests. We are not doing brain scans. We are not
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doing blood tests. We are not identifying any form of biological abnormality. And my point in the last
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meeting with you was we were prescribing drugs that perturb normal functioning. So we are altering what
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is normal. There is no identifiable chemical deficiency in the brain that is being treated.
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So anyone who is promoting that idea is promoting only marketing, advertising rhetoric. It's not science.
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And anyone who is an expert in this area is aware of the multitude of scientific studies over decades
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are going to agree with me on that one. And that's not that's not unique to a psychologist perspective
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or somebody who's not a medical degree. Experts in this area are very clear about that.
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Well, I hope that you got a lot of encouraging messages because you were able to see the comments,
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but you weren't able to see all of the direct messages that I received on Instagram from people
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affirming the message that you gave and also just getting a lot of comfort from what you said.
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So on the one end, yes, there are people who are going to be defensive and understandably so maybe
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if they've been told that or if they feel that and maybe we'll talk about this, that the medicine has
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changed their life. It's saved their life. That's something that I heard from some of your
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detractors. But really, the majority of feedback I got from people who really feel that they've suffered
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from bouts of intense depression more than just your standard sad mood or bouts of intense anxiety,
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whether it's postpartum or whatever season of their life, or they have loved ones who did.
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They reiterated your message that, yes, when I went on these medications, sure, it made me numb,
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so I wasn't feeling what I was before. But in some cases, it made me feel paranoid. I couldn't sleep at
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night. I became an insomniac. I became almost psychotic. I became some people saying a different
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person. And then the most tragic tales, which we talked a little bit about last time,
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are the messages that I received of people who said, yeah, my dad, my husband, my uncle actually,
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you know, killed themselves, died by suicide after taking these medications. A lot of messages from
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wives of veterans, or from kids of veterans who were put on these medications because of PTSD.
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And they believe that these medications actually made their symptoms far worse. So much more than
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the criticism and the detractors, I got a lot of gratitude. A lot of people saying, wow, I didn't
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know this, this changed my mind. Someone who initially actually, she responded very negatively to the post
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that I posted on Instagram, very angry about this. And then she came back and she said, you know what,
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I listened. And I just didn't know, I just didn't know. So I wanted to, I know you already get a lot
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of encouragement, but I just wanted to affirm you in that, that the vast majority of the messages and
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the feedback that I got were from people saying, oh my goodness, thank you so much for having him on.
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Um, so you can respond to that, but maybe if you want to also respond to some of the criticism of
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people saying, how can you say this when these medications saved my life? Yeah, I do speak out
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on behalf of those people. I've been in this field for 20 years. So I am observing it firsthand as a
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clinician. The harms are significant. When I say that there is at least a double risk of suicide and
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self-harm compared to a placebo, those are identifiable statistics. There is a large global
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community of harmed patients that I am speaking out on their behalf. We know that these symptoms of
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these drugs have been underestimated. The problems related to drugs are underestimated. And that's part
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of being in the allopathic medical system here in the Western world that is really controlled by the
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pharmaceutical industry. As far as those who have identified that these drugs save their life,
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I'm skeptical, but I also want to speak to that. I actually was inspired to develop a YouTube video
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to respond to that. There are reasons why people might attribute that drug to saving their life. And
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remember, I think it's important to understand that we are creators of our reality. So how we make sense
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of our world is powerful. Whether you say a drug saved your life, or you say Jesus saved your life,
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or love saved your life, or exercise saved your life, that becomes your reality. But as a scientist
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and who supports informed consent, giving people accurate information, I think saying the drugs save
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lives, it's hyperbolic. And that's why we have randomized control clinical trials. Now, the things that we do
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know about the drugs is there is a high placebo response. In pain and mental health, the placebo
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response can range from 40 to 60%. So we know that people are getting better just from the placebo
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itself. And one of the things I mentioned last time, and I think it's really critically important,
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is that we have not yet really tapped into the power of the mind-body. And we don't utilize that in
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the way that we can in medical treatments. So there's also a psychoactive response on the body.
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There's a numbness. So there's a possibility that exists for a very small portion of people
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that if they're intense emotional pain, that feeling of detachment or numbness can feel like
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a relief. And we don't want to deny that. I think my point in the last interview with you was that is
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not anti-depressant. That's not going to lead to a recovery from an episode. It could potentially
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provide that relief. But most people are going to view that numbing and that detachment as aversive,
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because you're also numbing other emotions. There's decreased empathy. There's decrease in
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libido, severe sexual functioning, unable to experience joy and happiness in the same way.
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Right. And so in that sense, would you say, though, that someone whose emotions were so intensely dark,
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that the numbing brought on by the SSRI is preferable? Like, is it possible that the SSRI
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like brought them back from the brink of suicide or acting out in a violent way because of their
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intense depression or whatever it is? Or would you still say, uh, we still need to look at other
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factors? I wouldn't credit the medication for that.
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I wouldn't credit the medication on that. So even when we look at the data, there might be a small
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percentage of people who react more positively outside the placebo response. That's really
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debatable. But, um, my concern is the longterm. So if we don't have evidence that the drugs decrease
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suicide and we haven't, we have plenty of evidence that say they increase that risk. I don't want to in
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any way communicate that this drug can bring somebody back from the brink. There's other drugs
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that are available that can also create a sedative reaction temporarily. So it, to me, it's the concern
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with the widely prescribed drugs that we call antidepressants that are being used for depression
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or anxiety. Ultimately, I do believe experiencing our emotions to serve us is necessary for emotion
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regulation. So I don't want to turn a temporary or episodic condition into something longterm. I want
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people to be able to understand that their emotions serve them and they're communicating important
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messages that there's something in their life that needs to be changed. Now that might be something
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medical. That might be something physical as well. We can think about depressive symptoms or anxiety,
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almost like a fever and sit same thing. When we talk about focus or irritability or hyperactivity,
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it's, it's a symptom. So similar to a fever, but we don't know what the underlying cause is. It could
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be anything from a, a cold or it could be cancer. So it doesn't solve the problems, but I'm a reasonable
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person. And I know that people have a right to choose the drugs or medic, uh, medications that are
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available in our system. It's about providing them accurate information. So if somebody believes that
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that emotional numbing, even though there could be permanent side effects is preferable to the life
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that they're, they're living, then they should have the freedom to take that drug.
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Okay. Let's move into the conversation about ADD and ADHD, because a lot of the messages that I
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received asked me, can you please have him on to talk about ADD, ADHD? I've got a ton of moms in my
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audience. And if they're like my mom, uh, they may have been told at some point in their child's
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adolescence that, Hey, your child definitely has ADD. And because they can't sit still,
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they talk too much in class. That was my issue growing up. I think every teacher from, I don't know,
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maybe kindergarten, uh, to fourth grade, uh, told my parents that I had ADD and they should look on,
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look at putting me on ADD medication. But thankfully, thankfully my parents knew that
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wasn't true because I actually had a really, really good attention span, good reading comprehension.
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I couldn't stop talking in class. I'm not saying that's a good thing, but that's just what it was.
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I just couldn't stop myself from talking to my neighbor. And it probably was just more frustrating
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to my teachers than anything else. But whether it be that, whether it be, uh, antsiness or they have
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a son who just is rambunctious, wants to play around. A lot of parents are told, you know what,
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your kid really needs ADD to be able to focus, to excel in school, even to fit in with friends.
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And when you hear that as a parent, it can be really hard to resist that because you're like,
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well, I don't, I don't want my kid to not do well. I don't want to set my kid up for failure.
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And so they prescribe these medications. Um, and so I just want to, I want to hear your thoughts
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first about the phenomenon, and then we can get into the medication that's actually being prescribed
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for it. So Allie, I'm going to say things that are controversial today. I'm ready. I want your,
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I want your listening audience to hear me out. So listen to everything that I'm saying. Don't
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selectively choose things that I'm saying because I have gotten killed on social media for saying the
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things I'm going to say today. First, there is no such thing as ADHD. First controversial statement.
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Now let me explain. Okay. That does not mean that someone might struggle with focus or concentration,
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and it doesn't mean that someone might deviate from the norm on hyperactivity. But ADHD is not a
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discrete medical illness. It's a social construction. It is a constellation of symptoms
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that we have used to try to describe certain behavior in certain contexts. And my opinion
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is extremely problematic. So it's a social construction, meaning that ADHD first was identified
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in the DSM in 1980. And as you might expect, it is highly, highly influenced by the pharmaceutical
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companies. And the drugs to treat this are amphetamines for the most part, psychoactive
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stimulants on the central nervous system. We can get into that. But my problem with the ADHD diagnosis
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is similar to what I was talking about with fever. You might have somebody in a classroom or a specific
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context that deviates from the norm in terms of hyperactivity or being able to focus on certain tasks.
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The questions that we have to ask ethically in society and parents have to ask, is this a
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disorder? So when we take naturally inclined people like yourself to be talkative, who have a difficult
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time focusing on what they would consider to be boring tasks, maybe they're more physically active,
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maybe their mind works in the same way. The creative, the daydreamer, the artist, the kid who needs to be
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outside running and investigating, hunting or fishing or things of that nature. And we put them in a
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restricted environment like an American classroom. And think about the American classroom. Now still to
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this day, we're going to have bells like factory bells. We have lined up in a rows, a teacher in front.
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It's really kind of training obedience. And so the ethical question is, are people who do not fit
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into that restricted environment and their talents and their skills are outside of what is normative
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in that environment? Should we be identifying that as a disorder? And then what are the implications for
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that down the line? So when it's a socially constructed disorder, many people are getting
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that label from school systems. And that's where teachers have been incredibly brazen in acting outside
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their own boundaries of competence and trying to find ways to drug obedience and compliance in the
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Hmm. Now that's a good point. I didn't think about that, that it's really not teachers role
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to diagnose your kid or even suggest a diagnosis of your kid and suggest medication. Honestly,
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I hadn't thought about that because this is a story that I've heard so often that it comes from the
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teacher. It doesn't come from a doctor. I remember having to go to a doctor one time for, it was actually
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for migraines. And one of the things that they test, I was in middle school. They have you read a
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page and then you have to tell them what you just read. That's how they test your attention span. Is
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your mind working? And he was like, you know, it was good reading comprehension, whatever. I remembered
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everything. And it was just affirmation, I think, for my parents that she doesn't have an attention
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problem. As you said, maybe she doesn't fit into standard schooling or whatever, which ended up being
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fine. I guess I learned how to not talk as much or whatever it was. But it, so the
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doctor didn't have any concerns. It was the teachers. And I never thought about it like that,
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that in some cases, I don't want to say every teacher, but in some cases, these teachers are
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trying to medicate students into compliance. Gosh, that's problematic for a lot of reasons.
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It is. And let me go over like actually how these diagnoses are made. So it is a wide range of
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availability that we have in the healthcare system to try to determine if focus and attention is
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problematic. Now this is, we would all agree, even if you want to bring on an expert who says,
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well, ADHD is real and these symptoms impair somebody. We'll all agree that it is significantly
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overdiagnosed and very easy to achieve the diagnosis. So there's some good research out there
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that suggests that a large percentage of parents never thought their kid's behavior to be problematic
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until they went into the school system and heard it from a teacher. Now you go into your pediatrician
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and the way your pediatrician makes a diagnosis is not through brain scans or advanced neuropsych
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testing that is looking at all the complex cognitive skills that are required to function well in
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American society. It tends to be a checklist, which I can be happy to read some of the items on the
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checklist today because with any form of checklist, you know, that's used as a screener, which is now
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being used to diagnosis. You're going to overdiagnose a significant portion of the people and ADHD is
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not a very reliable diagnosis. So you go to your pediatrician, the pediatrician assumes, well, if the
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teacher is observing them every single day and the parent is stressed out because of the academic
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problems, well, then I'm going to assign the label. And what is the intervention for ADHD? It's primarily a
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psychostimulant drug, even though other interventions have been proven to be as or if not more effective. The
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easy thing to do is to try to take the drug and we can get into the drug because it's very, very effective for a
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period of time. But the way you can get a diagnosis is simply just by identifying with it. Nowadays with
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diagnostic expansion and trying to sell more stimulants, you can go on any website, you can take
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a quick checklist, they'll even score it for you. There's other companies that are popping up everywhere
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where you can take the checklist and get the drug sent to your home, where you have a significant abuse
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problem of Adderall, which is an amphetamine used to treat ADHD. And there's a lot of experimentation.
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There's things that I think parents just have to know when it comes to both the diagnosis, it's not
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very reliable. And two, the drugs that we use to treat them have really significant problems related
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to dependence, side effects. A number of the issues that I said with other psychiatric drugs
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are just as concerning with stimulant drugs. So stimulant drugs are scheduled to narcotics.
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And what that means, it's defined as having a high potential for abuse and physical and psychological
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dependence. So in the United States, the pediatricians aren't going to recommend kids
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drinking caffeine every day because of the concerns with caffeine for young developing brains.
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But they're going to prescribe a potent stimulant for kids as young as two or three years old
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on a developing brain. So it's much more potent stimulant with much more wide range of adverse
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negative effects. So a lot of the recommendations don't make a lot of sense medically.
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And how we're told, or at least how I remember being told from friends who are on Adderall or even
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Ritalin, which I think was used for ADHD. I actually remember a girl that I grew up with that I went to
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school with. She, you know, was diagnosed with ADHD. She took Ritalin and she developed all these kinds of
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like very debilitating tics because of that. And again, I don't remember anyone questioning like,
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maybe this isn't, I don't know, cost benefit analysis here doesn't seem to be working out.
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I knew so many of my friends on ADD medication. And they typically were diagnosed with that because
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they couldn't, they just couldn't keep up with schoolwork or whatever, or they weren't making
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great grades. I went to a private Christian school. And so there were kind of hot, you know,
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pretty high academic standards. And so it was just assumed if you weren't doing well, it's because you had
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some kind of like diagnosable illness. But how it was explained to me was that
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these stimulants for the normal brain, they would make you more hyperactive. But for the already
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hyperactive brain, someone who has ADHD, it actually does the opposite. It actually calms them down.
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That's kind of how it was explained, kind of in the same way that SSRIs are explained to us from the
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pharmaceutical companies that the chemical imbalance thing, this just balances the chemicals in your
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brain so that you can feel happy again. So tell us why that explanation that the stimulants actually
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Yes, those are lies. So what these stimulants do is they increase the availability of dopamine
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and norepinephrine. So these are two neurotransmitters that are implicated in focus,
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attention, elevated mood, motivation. Taking Adderall is powerful. It's a performance enhancing
00:27:00.740
drug. It's why it's a banned substance for most of the professional sports leagues. Because if you take
00:27:06.320
it, you're going to have enhanced cognitive functioning for a period of time. The idea that
00:27:11.240
there is differences in brain is just poor science that is communicated in ways that people don't
00:27:17.960
understand. So I probably mentioned biological reductionism. This is what they do. They reduce
00:27:23.280
very complex interacting neurological systems. Like the brain is as complex of an organ as we can
00:27:34.180
imagine. And that's taking away other things like personality, the soul, when we talk about the entire
00:27:40.820
human experience. But let's just say we were going to reduce everything to the brain and everything is
00:27:47.120
just our entire experience of being a human is just related to our brain functioning.
00:27:52.840
Even then, the science isn't sound. So it's not like somebody who has attention problems
00:27:58.400
experiences a decrease or not enough norepinephrine or dopamine. It's just any single person who would
00:28:07.960
take that drug is going to have enhanced cognitive focus for a period of time. It almost like quiets the
00:28:15.460
noise. It brings somebody. Their inner energy can be calmed. It does affect the entire body. That's why
00:28:21.840
these drugs are abused on college campuses. They'll take the drugs in order to study. And there is a
00:28:28.780
euphoric response. It doesn't prove mood, which is why you'll see psychiatrists providing these drugs
00:28:34.160
for depression. So the drugs are powerful. And as I said last time, if we could just give them for a
00:28:42.260
short period of time and it would have no adverse effect, well then, great. I think these drugs would
00:28:47.140
be widely sought after as performance enhancers across the world. But the problem exists with any
00:28:53.060
drug is tolerance. So I was reading a study before I came on to your show that about 25% of people are
00:28:59.120
going to have tolerance to the drug within days or first couple of weeks. And we don't even know the
00:29:05.020
long-term implications of these drugs, but we do know this is what happens. The brain seeks homeostasis.
00:29:10.900
So you need more and more of the drug in order to have the same desired response.
00:29:17.620
What is problematic is this becomes a gateway diagnosis. ADHD is a gateway diagnosis into the
00:29:23.700
mental health system because you're going to prescribe these drugs to young children developing
00:29:27.940
brains. We don't know the long-term consequences. We know they act on the reward system of the brain
00:29:32.860
similar to other stimulants like cocaine. So they are highly addictive. And at some point,
00:29:38.560
the brain is going to adapt to them. And so then you're going to add another drug or an increased
00:29:46.000
dose, which increases the likelihood of an adverse drug reaction. And now they get misdiagnosed as
00:29:51.440
depression or anxiety because the withdrawal reactions to these drugs include both those symptoms,
00:29:57.520
including drug-seeking behavior. So it's this paradoxical effect of the long-term use of these drugs
00:30:02.480
drugs has a negative effect. Now I hear so many things coming out of the medical literature and
00:30:10.000
from medical professionals that just are simply not true. In fact, I love the Huberman lab and I think
00:30:15.040
he's got a great podcast and I listen to it frequently, but when he goes outside his area of expertise,
00:30:20.880
he just repeats the drug narrative and overestimates benefits and underestimates the risks to the drug.
00:30:30.560
And this drug culture is problematic. So there's two things that have been communicated in the
00:30:36.240
literature about ADHD. And again, they're marketing propaganda. They're not science. That if you
00:30:41.820
identify it as ADHD and you're untreated, you increase the likelihood of later substance abuse.
00:30:47.180
That is not true. And it doesn't even make reasonable or logical sense. And that's the
00:30:53.420
thing about, I hope your listeners, I think a lot of your listeners are very reasonable and logical
00:30:59.260
people who rely on common sense. So think about it. If you're at a young age and you're taught that
00:31:06.620
you need a drug to change the way you feel or the way you behave, do you think that is going to
00:31:11.820
increase the likelihood you turn to a substance later on in life or decrease the likelihood?
00:31:15.660
So it's certainly going to increase the likelihood of turning to drugs because you've almost been
00:31:20.940
conditioned to view your life that way. The other thing that is certainly not true is that being on
00:31:28.120
stimulant medication enhances learning long-term. I was just reading a recent meta-analysis that showed
00:31:34.740
that those who are non-medicated and diagnosed with ADHD outperformed academically those who are on the
00:31:43.660
drug. So that's two of the major selling points for why you need to put your kid on an amphetamine
00:31:51.480
early in life is to enhance academic outcomes long-term. Now, short-term, you can create a study
00:31:57.960
to do that, right? Because I did mention that the drug, at least short-term, is a very powerful
00:32:03.440
enhancer of cognitive abilities. So it might be able to get kids for a period of time to complete work,
00:32:11.600
but it doesn't increase intelligence, doesn't enhance learning. It's also very difficult to
00:32:15.880
get accurate data from those studies because you're comparing a person who's on the drug to
00:32:21.740
essentially, you know, who would they be as far as academic growth if they were not on the drug?
00:32:28.120
But it's very clear when I talk to other experts, and I've done podcasts on this,
00:32:32.440
that we don't have the evidence that they prevent later substance abuse. We don't have the evidence
00:32:37.100
that they enhance learning and improve academic functioning long-term.
00:32:53.940
So why do we treat children and people diagnosed with ADD and ADHD with the medications that we do,
00:33:02.160
knowing what we know about them and not knowing what we don't know about them? What's the history of this?
00:33:09.600
And also, what do we do with this information? Like, how do we help kids and adults with attention issues,
00:33:17.560
with behavior issues? What are some practical solutions? That's what we're going to talk about
00:33:22.420
in part two of this episode, which will come out tomorrow. So stay tuned for that.