Philosophy, Psychiatry, & Psychology

Erler and Hope’s insightful article underlines the significance of authenticity to the experience of mental disorder; in particular of anorexia nervosa and bi-polar disorder, but also of depression and attention deficit/hyperactivity disorder (ADHD). Their analysis draws on personal accounts and empirical evidence to illustrate a range of ways in which psychiatric diagnoses and treatments interact with self-understanding and the negotiation of personal identity. because these concepts—‘self-understanding’ and ‘personal identity’—are both meaningful and vague, particularly when trying to get a handle on ‘authenticity’—another difficult concept—the authors usefully tie the empirical data to the experience of different ‘mindsets’ that represent a ‘substantial inner conflict’ often associated with psychiatric diagnosis (Erler and Hope 2014). From this perspective, a person’s struggle with authenticity is related to wanting to resolve the conflict and to achieve ‘psychological unity and stability.’ After an extended analysis of different contemporary writers’ views of authenticity, the authors claim the ‘true self’ account of authenticity (which they link primarily to Charles Taylor) to be the account that most accurately maps on to psychiatric patients’ struggles to discover an authentic self.

In this commentary, I extend Erler and Hope’s analysis in two ways: first, I consider their ‘true self’ account of authenticity in relation to young people’s experiences of mental disorder diagnosis and treatment—specifically ADHD and stimulant drugs; and second, I consider briefly authenticity in the context of clinical practice.

In families of children with ADHD, something of the ‘inner conflict’ described by Erler and Hope in adult psychiatric patients is represented in parents of child patients; it is especially visible in parents’ dilemmas around stimulant drug dosing. Parents of children taking stimulant medication as treatment for ADHD spontaneously deploy authenticity in reasoning about, and in justifying, dosing decisions (Singh 2005). Their reasoning about the relationship between authenticity and medication is inconsistent, however: on the weekend, withholding medication allows a child to be ‘free to be who he really is’; during the week, providing medication allows a child to ‘know who he really is—a successful learner.’ Parents use reductionist [End Page 237] accounts to advocate on behalf of their children for school resources and services; they say, for example” ‘He doesn’t have a behavioral problem; it’s his brain.” It may seem as though these parents ‘know’ the real child and view ADHD as alien and inauthentic. In practice, however, parents’ responses to ADHD children’s behaviors indicate a far more ambiguous conceptualization of the relationship of the child’s diagnosis to his ‘true self’ and to the child’s responsibility for his behavior (Singh 2004).

Parents’ dilemmas inevitably inform ADHD children’s own concerns about the relationship between stimulant drug treatment and authenticity, but in younger children (ages 9 to 14) at least, authenticity is not a primary mode of understanding the relationship between stimulant drug treatment and the self. This is in part due to the fact that, at this stage of development, children’s sense of self is still deeply relational and embodied. In interviews, children did not engage well with an abstracted discussion of ‘the real self’ and tended to contest accounts that suggested they were somehow less authentic or inauthentic when taking medication. Yet authenticity emerges as significant in children’s embodied experiences of self, most clearly when they experience bad side effects of medication. Here even young children, whose self-concept is just emerging, will say, “I don’t feel myself” in describing side effects (Singh 2013a). Another important way in which a concern about authenticity expresses itself is in children’s experiences of ADHD symptoms. In some cases of highly aggressive children with ADHD, a sense of the ‘true self’ is bound up with very negative self-attributions (‘inside I must be evil’; Singh 2007). More commonly, children report experiences of self-alienation when describing a lack of ability to reason and to make good decisions in face of a negative stimulus, such as a bullying taunt on the playground. Repeated experiences...