She sat across from me in that first session, confident in her self-assessment. “I’ve been reading about ADHD,” she said, “and I’m pretty sure that’s what I have. I think I need CBT to help with it.” There was a finality in her voice, as if the work was already done: diagnosis made, treatment prescribed, just needed someone to rubber-stamp it and deliver the goods.
I see this more and more. People arrive at therapy with their conclusions already drawn, armed with information from TikTok, Instagram, or online quizzes. And I’m not dismissive of their struggles, far from it. What concerns me is what happens when the diagnosis becomes the destination rather than the beginning of a conversation. What gets lost when we foreclose exploration before it’s even started?
After eight years as a counsellor in the North East, I’m watching something unfold that troubles me deeply. It’s not about ADHD itself. I’m not here to deny that ADHD exists or that people struggle genuinely with attention, focus, and impulse control. What I’m grappling with is how ADHD has become, for many, a way to avoid deeper, more uncomfortable questions about what it means to be human in 2026.
The Easy Answer to Hard Questions
There’s a pattern I’m noticing: when life feels overwhelming, when focus seems impossible, when restlessness becomes unbearable, we’re increasingly reaching for a pathological explanation. It’s easier, isn’t it? “I have ADHD” provides clarity, community, and absolution in one neat package. It says: this is what I am, not something I’m choosing or avoiding or struggling with.
But what if that clarity comes at a cost?
The client I mentioned, let’s call her Sarah, spent our first few sessions circling back to her ADHD self-diagnosis whenever we started exploring anything uncomfortable. It became a shield. Every time we approached something difficult about her relationships, her choices, her patterns of avoidance, she’d retreat: “Well, that’s just my ADHD.”
It took a few sessions before something shifted. I wasn’t dismissive, but I was curious. “What if,” I offered, “we explored what’s actually happening in those moments when you can’t focus? Not what label to put on it, but what you’re feeling, what you might be avoiding, what would become possible if you could?”
She paused. “I’ve never thought about it that way before.”
That pause, that moment of genuine curiosity about herself, was where the real work began. Not because ADHD wasn’t real for her, but because the label had been functioning as a full stop when what she needed was a question mark
The Medical Model vs. The Human Condition
Here’s where I need to be honest about my own position. I practice from an existential perspective, and that lens shapes how I see this ADHD phenomenon. Existential therapy is fundamentally about personal responsibility, freedom, choice, and the anxiety that comes with all of that. It’s about confronting the reality that we’re thrown into existence and have to make meaning despite uncertainty, absurdity, and our eventual death.
From that perspective, diagnosis can become what Sartre called “bad faith”: a way of treating yourself as an object with fixed properties rather than as a free being who must continually choose. “I am ADHD” versus “I am a person who struggles with focus and must grapple with why and what to do about it.”
But there’s more to it than just existential philosophy. The medical model, the one the NHS has fully embraced, tells us ADHD is a neurobiological condition requiring medical intervention. And yes, that model helps some people enormously. But there are other perspectives worth considering.
Gabor Maté, for instance, approaches ADHD differently. He sees symptoms not as purely biological but as responses to developmental trauma, attachment disruptions, and adverse childhood experiences. His work asks: what happened to you that made your nervous system respond this way? That’s a fundamentally different question than “what’s wrong with your brain?”
Johann Hari’s research on depression and anxiety points in a similar direction: that many symptoms we medicalise are actually healthy responses to unhealthy circumstances. Social disconnection, lack of meaningful work, childhood trauma, poverty. These create real suffering that looks an awful lot like mental disorder.
You aren't a machine with broken parts. You are an animal whose needs are not being met.
The Research That Makes Me Pause
When I look at the research, certain findings jump out. Cross-cultural studies show wildly different ADHD diagnosis rates between countries. The US has rates 5-10 times higher than some European nations. France, which prioritises different parenting approaches and has stricter boundaries around work-life balance, has significantly lower rates. If ADHD were purely neurobiological, we wouldn’t see these massive cultural variations.
Peter Gray’s research documents the dramatic decline in free play since the 1950s and its correlation with increases in anxiety, depression, and attention problems in children. Richard Louv’s work on “nature deficit disorder” shows similar patterns: children disconnected from natural environments displaying ADHD-like symptoms that often improve with time outdoors.
Bruce Alexander’s famous Rat Park experiments challenged how we think about addiction by showing that environmental enrichment matters more than individual brain chemistry. Rats in stimulating, social environments didn’t compulsively use drugs, while isolated rats in barren cages did. It wasn’t about the rat. It was about the cage.
What if we’re medicalising normal human responses to increasingly inhuman conditions? I’ll explore this question more deeply in Part 2 of this series, looking at the systems that create the symptoms we’re so quick to diagnose.
The Hidden Narrative
I know this might sound conspiratorial, but bear with me. We’ve seen this pattern before. When I started practising, the NHS was heavily pushing CBT as the answer to mental health problems. It was brief, standardised, measurable, cost-effective. (Some existential therapists joke that CBT stands for “Crap Before Therapy.”) Before that, it was antidepressants and the chemical imbalance narrative, now largely debunked, that positioned depression as purely biological.
Each time, there’s a rush to medicalise human struggle, to locate problems in individual brains rather than in the conditions we’re living in. And each time, this serves certain interests. Pharmaceutical companies profit. Healthcare systems manage demand efficiently. Society avoids asking harder questions about work, education, poverty, disconnection, and what we’re actually doing to people.
I’m not saying there’s a grand conspiracy. I’m saying there are incentives, economic, political, institutional, that favour medicalising the human condition over addressing systemic problems. It’s easier to diagnose and medicate individuals than to redesign schools, restructure work, address poverty, or question whether modern life is fundamentally incompatible with human wellbeing.
The Professional Tightrope
Here’s what makes this difficult: I can’t say these things without professional risk. Questioning ADHD diagnoses has become socially and professionally dangerous. The climate right now says that to question whether someone has ADHD, or to suggest they might be using it to avoid responsibility, is discriminatory. Full stop.
But I’m not dismissing ADHD or the people who identify with it. I’m asking: even if you have ADHD, even if your brain works differently, you still have agency, don’t you? You’re still choosing how to relate to that difference. The diagnosis doesn’t exempt you from the fundamental human condition of having to choose and being responsible for those choices.
That’s not dismissive. But it’s definitely threatening to a culture that increasingly wants to locate all struggle in biology and remove questions of choice and responsibility.
I worry that even our own professional bodies, would be more interested in protecting clients from my questions than in supporting practitioners doing honest, challenging work. That creates a climate of fear where therapists practise defensively, avoid anything controversial, and conform to dominant narratives not because we believe in them but because we’re afraid of complaints.
And I’m tired. The system grinds you down when you’re constantly swimming against the current, working without institutional backing, feeling professionally isolated precisely when you most need support.
Coming Full Circle
Remember Sarah? After a few sessions of genuine exploration, beneath the label, into what was actually happening for her, she started to grow. Not because I convinced her she didn’t have ADHD, but because she stopped using it as a shield against deeper questions about her life, her choices, her patterns.
We worked together in a way that honoured her experience while still inviting her to take responsibility for how she engaged with it. And that’s what I keep coming back to: relational depth, real connection between therapist and client, only happens when both people are being authentic. I can’t invite clients to explore honestly if I’m performing a version of therapy I don’t believe in.
Mick Cooper writes about those moments of profound meeting in therapy, where both people are fully present and real. But you can’t be fully present if you’re internally disconnected from your own truth. That’s why this matters to me, not just philosophically, but practically. I need to work with integrity to do meaningful work.
The deeper we can be with ourselves, the deeper we can be with others.
My Own Reckoning
Here’s the irony I’m sitting with: I’ve wrote about the poverty of experience in modern life, how we’ve stripped away play, adventure, unstructured time, genuine connection. I’ve argued that many mental health symptoms are responses to being deprived of what humans fundamentally need. (I’ll explore this more fully in Part 3 of this series.)
And yet I look at my own life and realise I’m exhausted. Fatigued. Ground down by the very system I’m critiquing. I’m so focused on meaning, integrity, responsibility, fighting for honest therapeutic work, that I’ve neglected the fundamental human needs I write about.
I need to practise what I preach. I need play. Adventure. Rest. The unstructured time to let my nervous system recover from constantly working against the grain.
This isn’t weakness or failure, it’s acknowledgement. I’m human too. Subject to the same conditions, the same struggles, the same need to choose again and again how to live with integrity in a world that often makes that difficult.
So this is me taking responsibility: for my work, for my perspective, for my own wellbeing. I’m choosing to keep doing therapy that has meaning, even when it’s risky. And I’m choosing to give myself what I’ve been neglecting, time to play, to adventure, to be something other than a professional fighting an uphill battle.
Because maybe that’s the real lesson here: we’re all navigating the tension between who we are and what the world demands of us. Labels can help us understand ourselves, but they can also become ways to avoid the harder work of actually living, choosing, struggling, taking responsibility, and finding meaning in the mess.
The work continues. For my clients. And for me.
This is Part 1 of a three-part series exploring ADHD, medicalisation, and the human condition. Part 2 will examine the research and systemic forces shaping how we understand mental health. Part 3 will explore what we’ve lost in modern life and what reclaiming it might look like.
4 responses
Mark, this was such a powerful and thought-provoking read. What really stood out to me was your point about diagnosis becoming a full stop rather than a question mark. That idea alone made me pause and reflect.
We live in a world where quick answers are everywhere, and it’s easy to see how labels can bring relief and clarity. But I love how you’ve highlighted the importance of curiosity, exploration, and personal responsibility alongside that. Not dismissing people’s experiences, but inviting deeper understanding of them.
Your honesty about the professional tightrope and your own humanity was equally impactful. It takes courage to speak openly about the tension between systems, expectations, and integrity.
Thank you for sharing this and for continuing to encourage deeper conversations, not just about ADHD, but about what it means to be human in the world we’re living in today. I’m really looking forward to Parts 2 and 3.
Fantastically well written and a lot of thought provoking points. Therapy needs an element of challenge and question. Looking forward to the next 2 parts
What an amazing read. Beautifully written, considerate and clear. I hope more people ponder this, I worry that people mistakenly (without agenda or malice) see ADHD as a way to excuse behaviour and hide from their responsibilities. I’d like to consider personal challenges, trauma, mental illnesses as “reasons” rather than “excuses”. Reasons give us compassion and understanding of ourselves, but no one has an excuse that absorbs them of their own poor behaviour.
Fantastically written and thoughtfully put. As someone who has had EMDR therapy for CPTSD and having the toolkit to live a life less stressful, I have people telling me to go and get a diagnosis for autism and ADHD. I know with absolute certainty that I don’t have these conditions, it’s just the speed in which people mention it. Looking forward to reading more.