I am constantly being targeted by ads for telepsychiatry services on social media, and I’ve watched the niche quickly explode over the past year and a half — companies like ADHD Online, Done, Cerebral, and Ahead clutter my Instagram feed now.
The general model of these services goes something like this: you take an assessment online, meet with a psychologist virtually, and get a diagnosis and a prescription for a monthly fee. Most of them don’t take insurance, which can be a good thing for people who don’t have insurance anyway, or a bad thing if you do.
I appreciate improved accessibility in a country where healthcare is hard to get and insurance is a nightmare, and I’ve had good experiences with telemedicine personally. I’m glad it exists as an option and I think it can be helpful, especially for marginalized folks for whom access to healthcare services is even more limited. But despite the positives, I have questions about the message these companies are selling.
A quick look-up of ADHD Online on the Better Business Bureau came back with several eyebrow-raising reviews from discontent service users, many of which claimed they felt cheated or scammed, or that their own doctor did not accept the online diagnosis their $150 bought them.
“They are preying on people with poor impulse control during a time when they are having trouble seeing a doctor in person,” read one complaint written last December.
“The company is a complete scam,” read another on June 17.
The Michigan-based company was founded by business executive Zachariah Booker, who lists himself as “Visionary, Groundbreaker, Leader” on his LinkedIn page, and Dr. Randall Duthler, a physician in Grand Rapids.
ADHD Online seems to have invested heavily in Instagram ads. I am shown several per day, and I’ve also spotted the brand in TikToks by popular ADHD influencer Dani Donovan, who has half a million followers (though without ad disclosure — a big issue on TikTok — it’s unclear whether this was sponsored).
The healthcare industry has caught on to the cash cow that is influencer marketing. A company called WEGO Health, started by a former marketing executive at Yahoo, is capitalizing on this by connecting pharmaceutical companies to influencers they call “patient leaders”.
A post on their Industry blog, subtitled “Three Takeaways for Today’s Pharma Marketer”, explains why:
“Over 80% of respondents say that to navigate and find helpful health information available on social, they specifically watch what patient online community leaders share and discuss. 79% look to social media to answer specific questions about their own personal experiences.”
A different blog for pharma marketers elaborates:
“…small and micro-influencers can be a great choice. In fact, they provide an even greater ROI [Return on Investment]. Their audiences might be smaller but are very loyal and engaged.”
A loophole in advertising law allows pharma companies to pay influencers without disclosing sponsorship — and WEGO’s Terms of Service also include a confidentiality clause for their patient leaders. Instead of direct-to-consumer advertising, which is highly regulated, companies are now using a subtler tactic called disease awareness marketing.
They pay influencers to promote awareness about a condition like ADHD and prompt their followers to seek medical help. You’ve likely seen these posts — they usually follow the format of “Do you do x? You could have y! Talk to your doctor.”
Another TikTok by Connor De Wolfe, one of the most popular ADHD influencers with 2.8 million followers, seems to parody this format while actually just replicating it. In a skit between a kid who relates a bit too much to ADHD content and his mother, Connor explains co-morbidities and the pitfalls of self-diagnosing based on memes, but then suggests the viewer take a self-assessment linked in his bio.
When I clicked the self-assessment, I immediately noticed the massive Shire logo at the bottom. Shire is the company that manufactures Adderall, and it’s no secret that pharma companies have produced their own assessments to steer people toward an ADHD diagnosis for years — even winning awards for how clever this strategy is.
Again, there’s no ad disclosure, so it’s unclear whether this was sponsored or if Connor is just trying to be helpful (I would like to give these influencers the benefit of the doubt) but regardless, the video plays into a very effective marketing strategy for Shire.
Meanwhile, pharma reps market their drugs directly to doctors, often giving them gifts, which has been “associated with more prescriptions per patient, more costly prescriptions, and a higher proportion of branded prescriptions” according to a 2017 study.
So, you see a post from your favorite influencer that makes you think you might have ADHD, you ask your doctor about it, and they prescribe the medication that’s been marketed to them. An easy, effective strategy that skirts all those pesky ad regulations!
It’s Not All About Your Potential
This word, potential, is plastered all over the ADHD industry’s marketing materials.
“I have a unique opportunity to help people achieve their true potential by treating their ADHD,” reads ADHD Online Physician Devang Patel’s job description on LinkedIn.
“Empower everyone to reach their full potential” is the tagline on Done’s About Us page. The paragraph beneath it laments “low work performance” and “strained relationships with coworkers” and finishes with the line:
“There’s even the potential of getting fired from work without knowing they have a mental disorder.”
Job security is not just a personal problem in America, though — almost all states in the US operate under at-will employment, which means an employer can fire an employee at any time without just cause, and the US at large is extremely hostile to worker’s rights campaigns and labor unions that would protect people’s jobs.
Not to mention, no one anywhere in the US can currently pay rent working full-time at the minimum wage! Positioning these issues as solely caused by an undiagnosed mental disorder is grossly oversimplifying the complex social reasons many people struggle to survive in America, and it has a long history.
“Struggling with ADD/ADHD? WE ARE THE SOLUTION,” reads ADHD Online’s homepage.
Advertising is hinged upon locating a problem that someone has — especially a problem that causes someone anxiety and shame — and then presenting your product or service as the solution to that problem.
These companies are wrapping themselves in soft color palettes and progressive language about empowerment and accessibility, but at their core, they’re just businesses using the oldest marketing tactic in the book to sell you something.
In this case, it’s the idea that all your pain and suffering stems from an undiagnosed mental illness that you are just $150 and a 50-minute video chat away from fixing.
But as someone who was diagnosed with ADHD as a teenager, tried 4 different kinds of ADHD meds, and saw so many therapists and psychiatrists over the past decade I can’t even count them anymore, I can tell you that an online diagnosis and a prescription for pills is not the magic solution to all of life’s problems that these companies want you to think it is.
The reasons you’re not “living up to your true potential” are far more complicated than just wonky brain chemistry. You’re probably exhausted, forced to work most of your week making barely enough to pay all your bills, crushed by spending all your time doing something that likely bores you to tears with no energy left over for the things you actually love, in an environment where you have basically no control over your daily activities and no guarantee that you won’t be fired on the spot.
“You have to work hard, a lot is expected of you, and you have minimal control over the process,” Robert Sapolsky writes in his book on the physiology of stress, where he explains in detail how this combination of low control and high demand has been linked to all kinds of illnesses.
Unless you’re an entrepreneur or a CEO or you’re very lucky to work at a company that gives a shit about their employees’ health, this is probably your daily work experience.
I’ve begun to see these marketing tactics as a medicalized re-packaging of the American Dream — the belief that anyone can achieve success in the US if they just work hard enough, except in this case, it’s not your work ethic holding you back from your “true potential”, it’s your broken brain.
“I’m not lazy, I just have ADHD,” is one of the most common themes I see in ADHD diagnosis stories, and while I understand the relief found in this narrative, I don’t like the implications, because the subtext is: some people are lazy, and they do deserve their suffering, but not me, because I have ADHD.
We know by now that meritocracy is a lie and laziness is too, but these are the lies that keep us working, that keep us distracted from the fact that there are plenty of systemic barriers in place that you can’t bootstrap yourself past, and that poverty, like wealth, is inherited.
Inevitably, someone trots out a rags-to-riches story as proof that the American Dream is still alive and well, but these anecdotes are rare and based far more in luck than merit. They don’t represent the majority of experiences in the US at all, but they do give the masses hope that the system works, that nothing about it needs to change, that the only person you have to blame for your failure is yourself.
This can be psychologically devastating, and an ADHD diagnosis offers a welcome respite from this self-blame, much the same way mothers of autistic kids have leaned into medical model narratives to avoid the unfair blame of bad parenting. It’s understandable, but it also takes the focus away from society at large and locates problems solely within the bodies of individuals, a very convenient strategy for capitalism and the state alike.
Tropes that Sell
“I thought I was lazy, I thought I was a failure, I couldn’t keep up, I was overwhelmed — but then I got my ADHD diagnosis, and now it all makes sense.”
This is a recurring theme in diagnosis narratives — a person reaches rock bottom, they turn to doctors for help, and they are diagnosed with something, which becomes a key turning point in their story.
They take this diagnosis and look back at their life, re-narrativizing their past through this new lens. It’s a kind of sense-making, and research shows it can be empowering for some people, but make others feel worse.
Suffering and confusion in particular contribute to someone’s desire for sense-making, which is part of the reason these diagnosis success stories can be so seductive. The book that popularized ADHD in the 90’s, Driven to Distraction, made heavy use of these personal sense-making narratives.
Most of the book is just Drs. Hallowell and Ratey describing case studies of their patients’ struggles and explaining how being diagnosed with ADHD turned their lives around, which proved to be a very effective marketing tactic for ADHD itself, and in turn, doctors and pharmaceutical companies.
“The book ultimately sold more than a million copies and was translated into a dozen languages, making Hallowell and Ratey millionaires,” writes journalist Alan Schwarz in ADHD Nation, “Doctors began approaching Hallowell at psychiatry conferences and saying — in these exact words — “Thank you for filling my waiting room.’”
Hallowell calls ADHD a “good news diagnosis” and a “superpower” — he is constantly talking up the life-changing effects of diagnosis and treatment in a way that makes people feel like it could be an answer to all their problems.
This narrative is particularly effective in American culture, considering our obsession with superheroes, stories that often involve a hidden identity and a journey of self-discovery that allows the hero to become their true self — to reach their full potential.
“At their best, superhero origin stories inspire us and provide models of coping with adversity, finding meaning in loss and trauma, discovering our strengths and using them for good purpose,” writes psychologist Robin Rosenberg.
They’re centered around a main character (“you have to start romanticizing your life!”) finding their inner power through hardship, becoming a virtuous symbol of all that is good in a terrible world.
These stories promote individualism and American exceptionalism, so much that the US military has actually supported several Marvel productions. Three of the top five highest grossing films of all time in the US have been Marvel movies. If films are a mirror of the culture in which they’re created, this is a narrative Americans hold very dear, one that can be used to a marketer’s advantage.
Medicalizing Social Expectations
What I find particularly disordered are the expectations that are placed on us. The American exceptionalism that undergirds our superhero movies teaches kids that they’re special, gifted, destined for greatness, while the standards for academic achievement get higher every year at increasingly younger ages.
In an essay called Canaries in the Coal Mine, Thomas Armstrong proposes that rising rates of ADHD diagnoses should be seen as a form of “biocultural feedback” — early warning signs that how we’ve structured society is hurting us, and it’s affecting the most sensitive people first.
“Younger children these days are increasingly being asked by adults to do things they are not developmentally ready for,” he explains.
Children have homework in kindergarten now, something “unthinkable in the 1950s”, when kindergarten was still just a place for very young kids to play.
In the 1960’s, American education reform pushed the idea of accountability, which refocused classrooms on results in the form of grade point averages and testing.
“American educators besieged the Swiss developmental psychologist Jean Piaget and asked him how his cognitive stages of development could be speeded up, a problem he regarded as ‘the American question’,” Armstrong writes.
He explains how developmental researcher David Elkin coined the term “hurried child syndrome” to describe the effects of this developmental rushing on children, “which included physical symptoms (headaches, nausea, irritability), learning dysfunction, attentional difficulties, and behavioral problems.”
Because we teach them they can be anything they want to be if they work hard enough, that they can save the world like a superhero, kids aren’t prepared at all for the reality of life that awaits them after they graduate — most of which is average, mundane, and pretty fucking hard, even for the straight, middle-class white kids. Add marginalized race, gender, sexuality, and poverty layers to their identities and it only gets exponentially harder.
Many people who get diagnosed with ADHD in adulthood do so because the shift to college, their first job as an adult, or motherhood becomes overwhelming to the point that they seek medical help, another common trope in the narrative.
We are told this is underlying ADHD being triggered to emerge by stress, but hyperactivity, inattention, and fatigue are also pretty common human reactions to overwhelming circumstances (and especially to sleep deprivation, a chronic condition that 1 in 3 Americans have).
All of this distress is legitimate and deserves support, regardless what you label it. You shouldn’t need a doctor to sign off on your pain for it to be real, but unfortunately, that’s the system we live in. We are basically forced to medicalize our distress to get any help.
We are expected to juggle 40 hours of work, a social life, parenthood, hobbies, and self-care while being bombarded everyday with digital information overload, horror stories on the news, and all those broken promises of greatness we grew up believing we were destined to reach.
If we can’t keep up with these inhumane demands, then there must be something wrong with our brains. We’re not reaching our full potential, and that’s where companies like ADHD Online come in, presenting their service as the solution.
I’m not arguing that ADHD isn’t “real” (a silly argument, in my opinion, because “disorders exist insofar as they are recognized as legitimate in discursive practices within social, cultural, and institutional contexts.”), or that you shouldn’t be able to take stimulants if you want them or get a diagnosis online if you need one to access services and accommodations.
I’m arguing that we are being sold a bunch of individualistic bullshit to excuse the complete lack of societal change that would actually make a huge difference in people’s lives.
If you really want people to reach their full potential, you would push for a higher minimum wage, a shorter work week, and better labor laws. You would want to provide paid leave for new parents, tax billionaires (and especially, their inheritances) to invest in public services, or maybe even consider a universal basic income program that would cover the cost of survival so people can focus on thriving, creating, and caring for each other.
But the businessmen that run America don’t actually believe in your potential, not really, not beyond what they can use to generate profit for themselves.
Maybe it’s time we stop believing in the false dream they keep selling us, too.