DN Debate Replicas. "Don't fool 'Lise-Lott' that she has something wrong with her brain"

At the same time that Markus Heilig shows how addiction care can save lives (DN Debatt 10/10), British authorities warn that a focus on diagnosis can stand in the way of support. Diagnoses can also do damage, they write.

Two things can apply at the same time. There is a difference between "Lise-Lott's" story and the perfectly healthy children who now grow up with the idea that somewhere inside them there is a biological error that means they do not "function" as the adult world wants.

The limitation of registry studies that show that adhd drugs reduce various risks is that they cannot fully isolate the drug's effect from other things that affect the patient's life and care, for example the consideration that Heilig mentions. Save "Lise-Lott" with all available means, but do not neglect the health and social service staff, because they save lives every day.

Also, don't fool "Lise-Lott" that she has something wrong with her brain or genes, because that puts the blame on her. The diagnosis of ADHD is "a pragmatic working tool", Heilig wrote recently, not a "brain disease".

Yet some psychiatrists tell their patients that. It's not okay. The words can shape the patient's identity. Believing that one has a biological defect in the brain that causes one's difficulties is a potent explanatory model, and it affects. Believing that the defect is inherited from generation to generation can cause people to avoid having children. Anyone who wants to implant such a model must have proof that it is true in the particular individual in question, and nobody has that when it comes to ADHD. Genetic risks exist for everything - coffee drinking, divorce and dog ownership. Emma Frans has shown why one should not interpret the studies the way Heilig does.

Nevertheless, the money flows to biological research, rather than to housing for "Lise-Lott"

Many have warned of the influence of the pharmaceutical industry on treatment recommendations – the National Audit Office, a UN report, journalists, Swedish and international researchers. A cornerstone of marketing is to highlight researchers whose results the industry likes. It creates a bias, which trickles down into the guidelines. Not a single one of the eight studies that Heilig cites is completely free of conflicts of interest.

The majority of studies on drug effects are also carried out by industry, and there are many mappings of how the results can be influenced. Psychiatry's patients have the right to an unbiased science. The state should build stronger protection. The state of knowledge that Heilig cites is a consensus document. Other researchers have flipped the coin.

If someone tries to concretize Heilig's reflection on overdiagnosis, the reception is cold. But the patients who have great needs, like "Lise-Lott", are crowded out by those with lesser needs. The road ahead has ditches on both sides. Let those of us who actually know something about medicalization and the negative effects of diagnoses contribute what we can.

ADHD is not a myth, but a psychiatric diagnosis. These are labels, but should not be used arbitrarily. They were created with the hope of finding biological causes. It came to shame, but still the money flows to biological research, rather than to housing for "Lise-Lott".

The answer to overdiagnosis is not in the brain. It is the explanatory models that are the problem. The effects of the drugs are powerful, but they do not treat a biological fault. Let's use them judiciously.