Though many have been tempted to interpret Trump in terms of some secret masterplan for good or ill, according to the authors of a new book, Regime Change, the project is pointless: “Trump will often do simply whatever he feels like in the moment, frequently giving in to shockingly impulsive behavior.” His preferred stimulants seem to be cable news, late-night social media rants, and taking risks with global stability. When he was formulating his tariff plan, he is said to have forgotten to include China, before improvising on the spot, to the horror of economic advisors: “Put them in for ten.”

We live in the age of ADHD, and Trump seems a perfect symbol of our distracted, hyperadrenalized time — his own lack of an official diagnosis notwithstanding. It is estimated that around 3-4% of adults and 5% of children globally have the condition, which seems a rather conservative estimate in relation to the numbers of students, celebrities, and middle-aged women who think they have it. According to NHS figures, among young people who are classified as NEET — ie not in education, employment, or training —“20–34% are likely to have ADHD, most of whom will not be diagnosed”. Rising prevalence is costing the British taxpayer a fortune; but at a less dramatic level, it seems we are all a bit ADHD now. Interactive screens are moving the cultural baseline for excitement, making things formerly experienced in technicolor appear boringly black and white. Like the American President, we now only respond to fabulous tributes, thrilling conflicts, and bizarre sights — which is presumably why Westminster is currently obsessed with a man dressed as a bin. Meanwhile in the US, placing a bet is apparently now more common than reading a book.

Seemingly unable to countenance the influence of fast-moving culture upon our plastic brains, many medics and therapists continue to talk as if ADHD were as objectively determinable in a human breast as the presence of cancer or heart disease. But the fact remains that the concept is a collection of symptoms, in search of a distinctive neurobiological cause. Even allowing for the possibility of hardwired, lifelong cases, there is no established way to rule out false positives largely created by more ephemeral social conditions — as local councils know to their cost. And certainly, the therapeutic and pharmaceutical industries have no financial incentive to separate the sheep from the goats.

One under-explored tool in this area is phenomenology — though admittedly, the methodology I propose is unlikely to be immediately useful to PIP assessors. With some who exhibit the full set of DSM-approved symptoms, there is often not so much a deficit of attention, as a paralyzing surfeit. The stream of consciousness is hijacked by insistent details: intriguing sounds or sights that interrupt the flow of a thought or an action, demanding they too be noticed and properly contemplated. There is also the phenomenon of hyperfocus — zooming in deeply for ages, often upon relatively eccentric or niche topics — meaning that the capacity to take in mundane information or carry out plans is reduced. If you are the mother of someone like this, be prepared to repeat every instruction twice. (Don’t ask me how I know this.)

Indeed, ADHD is frequently described as involving a sensation of powerlessness; an inability to direct the beam of attention, so that it feels like your mind is being yanked around involuntarily. A common metaphor is of someone else switching the channels for you. Whether or not this inability to take charge of the inner remote control counts as an impairment worthy of special dispensations from the state is a different question (I think not); but I am in no doubt that it describes a genuine psychological type.

An accompanying idiot’s guide says that this sort of brain is extra hungry for stimulation, due to a dopamine imbalance — though not, unfortunately, in a way that provides an easy test for the condition overall. The brain ranks the inner to-do list in terms of the jolt to the system that particular tasks will immediately provide — or not — rather than their importance in relation to the person’s longer-term goals. Activities involving a cheeky hit of adrenaline shoot straight to the top of the list, but this ranking is not based on rational decision-making. The unconscious brain has already set its priorities, well before awareness ever reaches the conscious mind.

If true, this hypothesis seems to explain the feeling of relative powerlessness over the direction of the mental spotlight quite well. Whenever you find yourself doing something, but with no idea why, it is tempting to disavow the action as not really something you “did” at all. Indeed, the philosopher Elizabeth Anscombe partly defined intentional actions as the very ones to which “why?” questions are applicable — as in, “towards what ultimate aim of yours is this particular action, here, now, supposed to act as a useful bridge?”.

For instance: why are you scribbling in that book? An intelligible answer would be that you are making notes, in order to remember certain points, in order to ace an interview, in order to get a particular job; a paradigm of a smoothly-related chain of reasons. Equally, although most people are capable of letting their minds wander, they can also move their attention around in order to fit with prior plans or intelligible purposes. You listen to the teacher, not because she is intrinsically fascinating, but in order to avoid punishment, or pass a test; you pay attention to the mess your house is in, not because you like staring at it, but in order to clean it up, so that you can then avoid disapproval from visitors.

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It is this capacity to use background aims to control the flow of concentration, and so help produce efficient behavior, that appears relatively lacking in some lifelong ADHD-ers. They have an “executive function disorder”, as the jargon goes. Marooned thoughts and perceptions crowd in as if from nowhere, without fitting into a discernible higher plan. It must be a bit like being Keir Starmer, but more interesting.

This framing fits with several philosophical accounts of attention itself. On one view, the role of the capacity for attention is, precisely, to select certain sense impressions and thoughts for their relevance to fruitful action. On a slightly different view, attention enables you to structure the contents of consciousness into foreground and background, important and trivial, in a way that fits with your prior beliefs, desires, intentions, and values. Either way, the power of attention is closely related to purposes and goals. People who find no clear demarcation in their minds between the central and the peripheral can still get utterly absorbed in a particular thought or sensation, and they often are; but they lack a kind of interior sorting hat for personal salience.

If this is roughly right, then it indicates some important differences with more culturally-induced forms of attentional deficit. In the latter case — say, with the kind of rapid onset ADHD that students get during the second year of university, or women sometimes acquire in middle-age — there is rarely any accompanying involuntary hyperfocus. Concentration cannot settle on anything at all for long. Equally, unlike in the involuntary case, there is often an intelligible rationale available for staying in this highly distractible, jittery mental state, and an associated set of social rewards and benefits, no matter how primitive and ultimately self-defeating they prove to be. For instance: I have no idea if Trump’s attentional issues are lifelong or acquired, but it seems clear that his frequent unpredictable switching of positions usefully unnerves his opponents.

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Meanwhile, for those of us who are not world leaders, a different set of benefits attach to the restless magpie mindset. One of these is that you are always on a state of high alert, ready to pounce on the latest new popular thing, and reap any social rewards accordingly. Your mind has been suitably molded to a virtual environment of endless novelty and outrage. You are primed for the emergence of high-status new trends or talking points, including — ironically — the ongoing trend of female influencers claiming they have ADHD. And thanks to fantasies encouraged by the virtual world, you can also cycle through gratifyingly shallow versions of intimacy, rage, sorrow, and love, before moving seamlessly onto the next sensation. You can ignore all the real difficulties in your life, lost in a trance.

But because in this case, being intensely distractible fits within a coherent means-end pattern of decision-making, it also follows that you could choose to do things differently, in theory anyway. Over time, you could train yourself to focus on what is genuinely important in your life rather than trivial, and to wrest control of the mental spotlight back towards more profitable ends. This is probably also true of the first set of ADHD-ers, to some extent — the ones who feel like they have lost the remote — but it will be a lot more difficult and stressful.

And there is a final intriguing aspect of this framing to think about. If the capacity for sustained mental attention really does require a background sense of purpose to guide it, then people who don’t feel much direction in life will surely be more likely to count as horribly distracted: NEETs, say, in receipt of government benefits, telling themselves they are too radically impaired to get a job. For young people in this unenviable position, there is presumably not much in life that seems worth focusing on for very long; so it is scarcely surprising if they feel aimless and mentally scattered as a result. One might even wonder which came first: the PIP or the ADHD.

Operating separately to incapacity benefits, it’s the system of Personal Independence Payments (Pips) now attracting most attention, largely thanks to the Government’s crass attempts to reform it before U-turning earlier this week. Pip is intended to aid people aged 16 or over with medium- or long-term disabilities who “have difficulties doing certain everyday tasks or getting around”, with corresponding money available for “daily living” and “mobility”. It isn’t means-tested, is compatible with being in work — although most who receive it are not — and there is no requirement you spend the money on particular forms of assistance. (As Hertfordshire County Council helpfully points out, it “can be spent on whatever you wish, such as outings, special interests or holidays, or put away into a savings account”.) Pips for anxiety and depression now account for 16% of spending, and 1.4 million are claiming for “psychiatric disorders” including autism and ADHD.

One obviously significant factor here is that mental disorders are now full-blown cultural identities for many, with impressively technical-sounding labels for human suffering being collected like Pokémon cards. Encouraged by GPs and therapists, millions of people treat lists of psychological symptoms almost mystically, as if they were a kind of science-backed cipher for the enigmas of the human soul. Given the speed at which proliferating diagnoses become “disabilities”, the Government’s decision to tackle welfare reform would have been a good time to do some joined-up thinking about what happens when therapy culture meets benefits street.

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Instead, the DWP attempted to deal with the trend covertly, proposing complicated and overly generalized reforms that would have unfairly taken from physically disabled people too. And I understand why they were underhand about it. Talking honestly about the explosion of mental health conditions is intimidating, not least because of the numbers of outraged people steaming in to protest about imagined accusations of hypochondria or malingering. Yet, the observation that psychological conditions can ripple across populations like wind through wheat, being especially susceptible to social influences, is compatible with debilitating dysfunction and awful suffering happening at the individual level. There’s no split between “real” mental health disorders and culturally porous ones. The latter — which includes the vast majority of them — are as real as any other. And the suffering they bring feels the same from the inside, no matter what the source.

To acknowledge that genuine suffering is involved is one thing; to know what to do about it quite another. One of the many bizarre things about the current Pip situation is how counterproductive it looks for the anxious and depressed, in particular: keeping ruminating, avoidant, socially isolated people stuck in limbo, paid to stay away from the situations they fear most. The problem becomes yet more apparent when you compare two hypothetical claimants, each stuck at home: one with severe anxiety, and one with (say) cerebral palsy. Both may have trouble getting out of bed, dressing, doing housework, and going shopping, but for different reasons. Unlike for cerebral palsy, there are relatively cheap scenarios close to hand in which severe anxiety is controlled and eventually abates. Therapeutic buzzwords such as “behavioral activation” and “exposure therapy” underline the basic point. Yet, still we have a benefits system that incentivizes some unhappy, world-avoidant people to stay that way.

The DWP crudely tried to kick away the crutch, but a better approach would be to acknowledge the complex interaction between macro and micro. As philosopher Ian Hacking noted decades ago, most mental health disorders exhibit “looping effects”, meaning that official diagnostic criteria shift over time in response to social pressures coming from below — including from the political activities of patients and the real-world classifications of mental health professionals. And equally, the concepts we collectively have for these disorders tend to “creep” vertically as they simultaneously “loop”: that is, they become targeted at less and less extreme kinds of experience and behavior. We end up with unhelpfully broad concepts, at least in popular guises: “autistic spectrum disorder” which includes both profound non-verbal limitation and high-functioning quirkiness; OCD which comes in a “mild” flavor, raising the reasonable question of how this could count as an obsession or a compulsion at all.

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None of this happens on purpose. It’s just the way that patterns of mental dysfunction tend to go, when they don’t have an easily-identifiable biological basis and are indexed to prevailing social norms. Meanwhile, back at the micro-level, once an individual gets a new diagnosis — even for relatively mild symptoms — a very 21st-century response is to make it a core part of his personal identity. As this narrative embeds, modifying his incoming experiences in the light of it, suffering can easily worsen, symptoms get exacerbated, and lassitude and defeatism set in. Again, this is just how pattern-recognizing, habit-forming brains tend to work.

Loopers-in-chief include affluent tastemakers, always on the lookout for a freshly interesting story to tell about the self. Get diagnosed with arthritis (or indeed, schizophrenia) and nobody really cares; get diagnosed with ADHD plus depression, and immediately become an object of touchingly relatable fascination for lifestyle editors. Middle-class parents are also complicit in shifting diagnostic criteria through pressure — albeit inadvertently and from understandable motives — anxiously monitoring their offspring’s behavior in terms of currently fashionable disorders, and translating their worries into entreaties to teachers and doctors.

But school is nothing compared to what comes next on the typical “mental health journey” — otherwise known as the place where personal resilience goes to die. In universities, mental health classifications do not so much slowly shift over time as rapidly collapse into meaninglessness, occasionally nuzzled back into a vague semblance of coherence by a passing support alpaca.

Many young people arrive already primed with letters from GPs or therapists, attesting to conditions like autism, anxiety, or depression; and if they don’t have a diagnosis yet, they can get one soon enough. No matter what their circumstances, these all now count as disabled students, for which reasonable adjustments must be made according to the terms of the Equality Act. Underfunded and desperate for good publicity, swamped with miserable customers, and tyrannized by the awful prospect of student suicide, university managers often take the path of least resistance and try to just give students whatever it is they say they want — on the condition that it doesn’t cost too much money. Removing anxious students because they are unfit to study is bad, because their fees go with them; putting trigger warnings on books is good, mostly because it is cheap.

My knowledge here is not just abstract. When I worked in universities, at least a quarter of the students in each class had a mental health diagnosis, emblazoned in colored lettering on the register so I wouldn’t forget. There weren’t enough individual exam rooms or scribes for all those who requested one. Non-attendance was easy to get away with, as long as you said the right things. Sometimes absentee names on registers were only connected to faces at the final degree ceremony, where their mysterious owners rose again Lazarus-like, teetering across the stage on vertiginous heels.

At the beginning of each term, I would be sent details of particular students who did not want to be asked questions in class. By the time I left my job, many exams were being phased out altogether in the name of the anxiety-ridden and attention-depleted — just in time for ChatGPT to sweep in and win all the prizes, quite literally. None of this was specific to my institution; from what I hear of other places, it was absolutely typical, though perhaps things have improved since.

It’s hard to inspire students to become less frightened of life, when their lecturers also seem frightened of them. Scale up this attitude to society at large and we definitely have a problem. Yet it remains difficult to make an obvious point in response: that mental disorders/disabilities, although limiting and distressing, are significantly unlike bodily disorders/disabilities in at least one important respect. This is: on average, they are much more responsive to good habit-formation, in terms of the thought patterns you foster and the behavioral routines you adopt. Indeed, this very point is presupposed by the existence of the therapy industry, whose raison d’être is, precisely, to change thought and behavior patterns for the better. In contrast, when you go to your GP with a broken leg or a gallstone, she is unlikely to suggest CBT as a first resort.

Articulating this basic point, so blindingly obvious to laypeople, is difficult partly because academia makes it so. Thousands of sophisticated-sounding articles tell us that mental disorders are brain-based, and so “physical” too; that mental illness often accompanies physical illness, and vice versa; that anxiety and depression can exacerbate bodily pain as well as stem from it; that the mental and physical realms deserve “parity of esteem”; and so on.

All of these things may be true; but they only show that bodily disorders and mental disorders are interrelated in complex ways. They do not establish that they are exactly the same thing; and nor that they should be treated identically, whether by the NHS or the DWP. As the campaigning slogan goes, it is indeed time to talk about mental health — but not in the sense of yet more pointless navel-gazing or individual soul-searching. As Rachel Reeves probably said to herself on Thursday morning: when it comes to turning the page on old, sad stories, every day is a new day.