Going by how ADHD is sometimes represented in the media, a reasonable person could end up with the impression that people with ADHD simply did not exist until about 1990.
Of course, that’s not the case, and the condition we now call “ADHD” has been around since long before modern medicine, begging the question: what was it like having ADHD in centuries past, and how did society view people with ADHD?
In a fascinating paper, researchers from University of Valencia in Spain have just shed some new light on this question by going through historical literature and medical writings for descriptions of what’s today known as “ADHD.” They found that several physicians as early as the 18th century gave in-depth clinical descriptions of conditions that would now be diagnosed as ADHD and that there are non-medical descriptions of clear ADHD-like symptoms in many sources even earlier.
Here are some of the most interesting things they found.
ADHD in Ancient Greece
Hippocrates was no slouch. He’s considered the father of Western medicine, and the Hippocratic oath that doctors take is named after him.
Well, you can add to his list of accomplishments jotting down the first known description of ADHD. In 493 BCE, he summed up the disorder rather eloquently, noting that he’d observed patients with “… quickened responses to sensory experience, but also less tenaciousness because the soul moves on quickly to the next impression.”
He did go a little off course by concluding that ADHD was caused by an “overbalance of fire over water” in the body, but in all fairness to him, researchers still aren’t totally solid on the underlying causes of ADHD yet.
“Reckless” and “Shallow”
Although not as well-known as Hippocrates now, Melchior Adam Weikard was a celebrity doctor in his day and earned the honor of being Catherine the Great’s personal physician. In the mid 1770s, he published a textbook called The Philosophical Doctor.
Now, personally, if my GP ever chose to self-identify as a “philosophical doctor,” I would be heading for the door faster than you could say “don’t forget to take your IV out.” However, these were different times, and Weikard was actually pretty cutting-edge when it came to ADHD.
In his textbook, he devoted an entire chapter to what he called “Mangel der Aufmerksamkeit” (“lack of attention”) in German and “Attentio Volubilis” (“changeable attention”) in Latin. Per the paper’s authors:
Weikard described adults and children suffering from a lack of attention as being easily distractible by anything, even by his or her own imagination, as well as lacking perseverance and persistence, overactive and impulsive generally characterized as unwary, careless, flighty and bacchanal. Furthermore, he indicated that inattentive individuals “will be shallow everywhere”, they are “mostly reckless”, imprudent, and most inconstant in execution.
Weikard also had some interesting ideas about why these children and adults were acting the way they were. Apparently, he speculated that one cause of the condition he’d observed might be, in the words of the paper’s authors, “dysregulation of cerebral fibers resulting from over- or under stimulation.” This explanation actually fits pretty well with low arousal theory, the modern idea that people with ADHD are chronically understimulated for brain-related reasons.
The DSM in 1748
In 1748, the Scottish physician Sir Alexander Crichton published a widely read text he called “An inquiry into the nature and origin of mental derangement: Comprehending a concise system of the physiology and pathology of the human mind and a history of the passions and their effects.”
The book was noteworthy for two reasons: first, for using the term “concise” in a title that contained 32 words, and more importantly, for including a chapter on attention that talked about attention disorders in a way that is familiar to us today.
Crichton was probably one of the first people to think of distractibility as a spectrum where everyone differs slightly in their capacity for paying attention. He described people at the extreme end of the spectrum as having an ADHD-like disorder that, in the words of the paper’s authors, “was associated with unusual levels of impulsivity, restlessness and emotional reactivity.”
What made Crichton’s description of ADHD downright DSM-like was his note that the attention disorder he described could “be born with a person” or could appear “at a very early period of life.” The DSM-5 requires that ADHD symptoms surface before age 12.
Like Weikard, Crichton thought the disorder he’d seen might be brain-based, describing it as a dysregulation in the “sensibility of the nerves.” He also predicted that it would affect children’s education and even observed that it was often associated with other mental disorders.
“Accidents of External Circumstances”
In the 19th century, the British psychiatrist Sir Henry Maudsley gave a rather poignant description of ADHD. He talked about a child “driven by an impulse of which it can give no account, to a destructive act, the real nature of which it does not appreciate: a natural instinct is exaggerated and perverted by disordered nerve centers, and the character of its morbid manifestation is often determined by accidents of external circumstances.”
Honestly, even though we have the nineteenth century docs beat as far as understanding what ADHD is, we have nothing on them in terms of descriptions of the disorder that are both poetic and clinical at the same time.
Also in the nineteenth century, Scottish psychiatrist Sir Thomas Smith Clouston wrote about what we’d now call hyperactivity, describing a child who “becomes ceaselessly active, but ever-changing in its activity” as a result of “undue brain reactiveness to mental and emotional stimuli.”
So the takeaway is that the nineteenth century was probably a terrible time to have ADHD but a marvellous time to read about it.
The full paper is available online for free, and definitely worth a read if you’re curious how people thought about ADHD before the DSM was around.
As with the study I wrote about on how having ADHD affects how you solve a specific kind of maze, this is a paper you’re not likely to see mentioned in the media. The most interesting ADHD research often gets the least publicity!
Photo credit: Wikipedia/Andrew Lorenzs