Having traced the social and cultural spread of ADHD (see part 1 and part 2), we can now ask a deeper question: do we really need the ADHD label to understand what it names?
Before exploring that, let’s briefly recapitulate what makes ADHD appear so pervasive today.
Why Does ADHD Seem So Common?
Because…
- a concise label offers relief, belonging, and direction;
- many modern conditions mimic or amplify its features;
- online culture spreads recognizable narratives quickly;
- a neurobiological frame lowers stigma and grants practical benefits;
- attention today is under chronic strain, making ADHD‑like experiences ordinary.
The Narrative Advantage
ADHD is often framed neurobiologically—“a different brain.” Benefits include:
- reduced stigma, more compassion and understanding (“that’s how my brain is wired”).
- access to adjustments at school or work (flexible deadlines, medication, tutoring support).
- a coherent-seeming explanation for lifelong struggles (difficulty focusing or finishing projects feels “finally explained” or “it all makes sense now”).
- consistency with a broader biomedical culture that values measurable diagnoses and medication-based interventions (brain scans, standardized testing, pharmaceutical treatment).
But this narrative has its limits. While it can be helpful to say, “It’s my brain,” stopping there risks flattening the complexity of attention and behavior. From a psychoanalytic perspective, attention is not just a neurocognitive function—it is deeply shaped by relationships, emotions, and unconscious conflicts and desires.
Vignette:
Geronimo, a 35‑year‑old software developer, sought therapy for chronic procrastination and trouble focusing.
The ADHD lens helped him name certain patterns, but as we explored his story, a more nuanced picture emerged.
A once‑exciting project had devolved into tedious maintenance work. Career stagnation after a company reorganization stirred envy toward colleagues who were advancing.
On days when a teammate shipped a high‑profile feature, Geronimo found himself “losing” hours doom‑scrolling or rewriting code that didn’t need it.
His cognitive symptoms were real. But they made sense even without invoking ADHD — in light of unspoken competitive feelings, blocked ambition, and boredom.
This example illustrates a broader point: while neurobiological explanations can be comforting, they often describe rather than explain. They highlight what someone struggles with but not why those struggles take the shape they do. By focusing only on the brain, we can overlook the emotional and relational context that gives rise to these patterns—and where the real potential for change lies.
Beyond the Label: What We Miss When We Just Call It “ADHD”
While the ADHD diagnosis can offer relief and a sense of direction, it can also obscure deeper questions. From a psychoanalytic perspective, persistent restlessness or inattention are not simply disorders or deficits but expressions that may reflect something else — unacknowledged emotion, conflict, or relational strain — and thus invite exploration. What follows are not definitive readings but brief sketches of what an analytic listening might discern beneath the symptom — not universal explanations, but invitations to think.
- Unspoken emotions: Restlessness can act as a shield: constant motion that defends against a collapse into despair, grief, or inner stillness. Similarly, inattention may not simply be a deficit in focus but a way of avoiding something intolerable—such as the gaze of a demanding or judging Other.
- Relational patterns: Attention is often shaped by early relationships. A child who grows up constantly seeking recognition from a distant or emotionally unavailable parent may learn to scan their environment for subtle signs of approval or disapproval, staying alert to every shift or reaction. In adulthood, this same sensitivity can persist: attention becomes tuned to what others might do or expect, making the person more easily pulled away by external changes and interpersonal cues than by their own inner focus. Thus, attention may reflect unresolved relational patterns rather than neurodevelopmental deficits.
- Fantasies and aggression: Inattention can reflect unconscious resistance to authority or a refusal to engage with something felt as humiliating or threatening. By “forgetting” to complete a task or zoning out, one may assert autonomy in a way that feels safer than confrontation—even if self‑defeating. In such moments, “not doing” functions as disguised rebellion, often alongside a compliant self‑image. Anger: outbursts often surface when old narcissistic wounds are touched—early humiliations reactivated.
What Usually Goes Unseen Behind “ADHD”:
Much that gets grouped under ADHD involves emotional and relational dynamics invisible on the diagnostic surface.
At analytic listening, impulsivity, disorganization, procrastination, anger, defiance, restlessness, intolerance of boredom, and retreat into fantasy share one struggle: to hold together what one feels. Attention and the body become the places where this tension announces itself.
It is a difficulty sustaining attention — not only in the sense of staying with what one feels, but of choosing among the many things one feels or perceives. Attention means being able to follow one thread rather than all of them, to invest in what resonates personally instead of dispersing into everything that calls. The person with so-called ADHD is flooded by raw stimuli—by a world hard to process, to give form to, to organize, to make sense of, and thus to contain. Without inner ordering, one is carried by a current that never stops moving.
When speech falls away—when what is felt cannot be made sayable, thinkable, or representable—the sensory‑affective flow finds no path for elaboration. It remains in the body or in action.
Then one acts instead of speaks:
- moves, distracts, bursts out, or withdraws;
- builds imaginary worlds or gets lost in doing;
- delays or self‑sabotages, seeking relief from an inner overflow.
Such behaviors, often gathered under the ADHD label, can be read as responses to an excess of affects and stimuli not yet made thinkable. The difficulty lies less in “attention” per se than in finding words between body and world—in transforming tension and affect into thought.
Without this mediation, one remains exposed: the outer world sets the tempo; the inner world chases, reacts, defends, disperses.
At root, it’s an impasse of thought in the face of experience—from which the varied forms of doing, agitation, and escape unfold.
None of this denies neurocognitive contributions; it adds layers where reduction obscures.
Do We Really Need the ADHD Label?
The symptoms commonly described under the banner of “ADHD” are real. No one is denying that. Distractibility and inability to sit still may also be responses to our culture of ceaseless productivity and motion.
Yet many of the struggles gathered under “ADHD” are also intelligible, one by one, as expressions of anger, frustration, anxiety, depression, shame, envy, boredom, guilt, or even paranoid anxieties. So how helpful, really, is this new ADHD label?
This diagnosis can reduce shame, provide a shared language, and open doors to support.
And yet, I suggest that in both clinical and cultural discourse, the acronym ADHD often adds less depth than it promises.
There is then a risk in reducing all of these phenomena to ADHD: the label, while illuminating, can also obscure.
Naming is like shining a flashlight—it illuminates one area while casting the rest in shadow. ADHD describes what someone struggles with, but it doesn’t necessarily explain why those struggles take the shape they do. For instance, hyperactivity can reflect unacknowledged anger or a need for recognition. Inattention can reflect unconscious resistance to authority or a refusal to engage with something that feels humiliating or threatening. These dynamics are often rooted in early relationships, where patterns of seeking, avoiding, or defending against connection were first established.
The point isn’t to deny the reality of ADHD symptoms but to refuse reduction. The real work often lies in uncovering the unconscious conflicts and unspoken emotions that organize attention and behavior. This is where analytic work can make a difference — not by managing symptoms, but by helping people find meaning in their particular form of struggle.
If the label provides relief, it can also narrow meaning.
The challenge is to move from labeling to understanding — from “Do I have ADHD?” (a question whose expected answer is, interestingly, a simple yes or no) to “What does my symptom express, and why in this form?”
Next
In the final section (click here), I’ll turn from theory to practice — how to approach the question “Do I have ADHD?” as the beginning of an inquiry rather than its answer.