Sami Timimi and the Morning After Society

What Remains When We Remove Every Social Construct?

Before We Remove Society

In recent months, amplified by Channel 4’s broadcast of The Great ADHD Myth?, X has once again produced its customary procession of critics declaring that “ADHD does not exist.”

Not that ADHD may be overdiagnosed in some populations and underdiagnosed in others. Not that its diagnostic boundaries are imperfect, culturally influenced or sometimes applied carelessly. Not that medication, medical authority and commercial interests deserve scrutiny. Those positions would require evidence, qualification and—most dangerously—nuance.

“ADHD does not exist” is much easier.

It resembles the rhetorical manoeuvre used by some opponents of the so-called climate-change “agenda.” The Earth’s climate plainly changes; the serious scientific question concerns the extent, causes and consequences of the current change, including the substantial role of human activity. Denying the phenomenon altogether avoids having to engage with the more difficult questions. Absolutism does not resolve the debate. It merely replaces it with a slogan.

The same happens with ADHD. Concerns about overdiagnosis do not establish that underdiagnosis is impossible. Criticising the diagnostic model does not make the recurring patterns it describes disappear. Questioning whether ADHD is always identified or treated appropriately is not the same as demonstrating that nobody experiences it.

There is also something rather remarkable about professionals declaring ADHD fictitious while charging as much as £235 per session to help people troubled by the fictitious condition. Apparently, ADHD exists just long enough to generate an invoice.

One of the central arguments offered for its invalidity is that ADHD is a “social construct.” This sounds devastating until the same reasoning is applied consistently. Language, race, employment, medicine, human rights, scientific evidence and money are also socially constructed. Social construction tells us something important about how humans classify reality, attach meaning to it and organise institutions around it. It does not establish that the realities being classified are imaginary or inconsequential.

This thought experiment grew from a conversation with ChatGPT about what would happen if Sami Timimi—one of the more prominent advocates of the cultural-construction account of ADHD—woke in a world from which every social construct had genuinely disappeared.

What would remain? What would vanish? And how would his own argument be received in a world without language, literature, psychiatry, professional authority or the shared concept of evidence?

You are welcome to call the result AI slop. My thoughts are often considerably sloppier before I invite the machine into the room.

The satire is not intended to prove that every feature of the ADHD diagnosis is biologically fixed, clinically valid or beyond criticism. It asks a narrower question: if a category is socially constructed, does that mean the phenomena it attempts to describe cannot be real?

Sami is about to have a rather inconvenient morning.

Sami Timimi woke with the distinct impression that something was missing.

It was not his alarm clock. The alarm clock was missing too, but this was only the beginning of the problem.

He opened his eyes and found himself lying beneath a tree. There was no bed, no bedroom and, as far as he could tell, no house. The sun hung some distance above the horizon, although he could not say what time it was. Time still passed, apparently, but nobody had divided it into hours. The morning had been liberated from the oppressive medicalisation of lateness.

He stood, brushed the grass from his clothes and looked around.

The landscape was pleasant enough. There were trees, birds, insects and a small river. What there were not were roads, fences, signs, buildings or any other evidence that somebody had decided one part of the world should be used differently from another.

Sami was relieved.

At last, he thought, a world without social constructs.

Then he wondered where the bathroom was.

After resolving this matter in a manner that would have concerned the General Medical Council, he set off towards what he hoped was civilisation. He soon realised that civilisation might itself have been included in the purge.

A person was approaching from the opposite direction.

The stranger was tall, dark-skinned and carrying several pieces of fruit. Sami smiled. The stranger watched him carefully.

“Good morning,” Sami said.

The stranger did not reply.

“I’m Sami.”

Nothing.

Sami pointed to himself. “Sami.”

The stranger looked towards the trees, perhaps checking whether anyone else had witnessed this behaviour.

It occurred to Sami that language was socially constructed. Words had no natural relationship with the things they described. There was nothing inherently tree-like about the sound “tree.” It worked only because generations of people had agreed to keep making the same noise whenever one appeared.

This was inconvenient.

He tried smiling again. The stranger took one step backwards.

Sami had hoped to ask about diversity, equity and inclusion. It seemed an ideal opportunity. The person standing before him would have been classified as Black in the world Sami had left behind, although here there was no racial classification and therefore no Blackness in its political or historical sense.

There was dark skin. That was plainly visible. But there had been no empire, slave trade, apartheid, census category, racial segregation or inherited distribution of power through which pigmentation had been turned into race.

The stranger had never experienced racial exclusion. They had also never experienced racial inclusion, representation or empowerment. Nobody had included them in an institution because no institutions existed. Nobody had denied them equal employment because there was no employment. Nobody had questioned whether they belonged in a particular neighbourhood because there were no neighbourhoods and, more fundamentally, no property.

Diversity was present everywhere. Equity and inclusion had nowhere to operate.

Sami tried saying “DEI” anyway.

“Dee. Ee. Eye.”

The stranger handed him a piece of fruit, presumably out of concern.

It was a generous gesture, although generosity had not yet been constructed as a virtue. It might simply have been an attempt to stop him making noises.

Sami accepted the fruit and continued walking.

He had not gone far before he began thinking about work. He was expected at the clinic, although “expected” was perhaps optimistic. There were no calendars, appointments or contracts. Even if his colleagues existed somewhere in this world, they had no socially agreed reason to be standing in a particular place waiting for him.

Still, professional habit was difficult to shake.

He reached into his pocket for his car keys.

The keys were there.

This raised his spirits until he remembered that the car was not.

A vehicle, he reflected, was not merely a physical object. It was the accumulated result of metallurgy, engineering, measurement, industrial organisation, intellectual property, wage labour and a broad social agreement that thousands of strangers should manufacture separate components which would eventually be assembled into something owned by a person who had contributed none of them.

There was no petrol either. Petroleum presumably remained beneath the ground, enjoying its natural condition as chemically interesting sludge.

Even if a car had appeared, there were no roads. Even if there had been roads, there were no traffic laws. Nobody had socially constructed a correct side on which to drive, a maximum speed or a shared understanding that red meant stop.

Sami put the keys back into his pocket. They had become small pieces of shaped metal commemorating the vanished concept of ownership.

He walked on.

By midday—or by the point at which the sun made “morning” increasingly difficult to defend—he came upon a group of people working near the river.

One was collecting fruit. Another was arranging branches into a rough shelter. A third was attempting to carry water in folded leaves.

A young man moved rapidly between them.

He began helping with the branches but abandoned them when he noticed the fruit. On the way to the fruit, he became interested in a brightly coloured insect. He followed it towards the river, remembered the water, collected some in a leaf and then put the leaf down somewhere while returning to the shelter.

Nobody called him inattentive.

Nobody called him hyperactive.

Nobody called him neurodivergent.

The young man nevertheless appeared unable to complete any of the tasks he had begun.

An older woman retrieved the abandoned leaf and handed it back to him. He stared at it with the expression of someone who had no memory of having placed it on the ground.

Sami watched closely.

Nearby, another person remained absorbed in stripping bark from a branch. Several members of the group moved away, but she did not notice. When someone touched her shoulder, she reacted with visible alarm. She then returned immediately to the bark, as if the rest of the world had been temporarily switched off.

A third person seemed unable to tolerate the noise of stones being struck together. He covered his ears, retreated from the group and remained apart long after the sound had stopped.

There were no diagnostic labels here.

The patterns had neglected to disappear.

Sami approached the young man and gestured towards the unfinished shelter, the scattered fruit and the forgotten water. The young man smiled, picked up a branch and immediately became distracted by Sami’s shoelaces.

This, Sami thought, could be entirely cultural.

Then he looked around at the absence of schools, examinations, offices, performance reviews, smartphones, pharmaceutical advertising and Western expectations of childhood.

The young man had still lost the water.

The environment had altered the consequences of his behaviour, certainly. Nobody would deduct marks, issue a warning or diagnose him for failing to complete the shelter. But night would arrive whether or not time was socially constructed, and exposure to cold appeared stubbornly material.

Sami sat beneath a tree to consider the matter.

From his satchel, which had inexplicably crossed with him, he removed several pages of his work. One bore the title ADHD Is Best Understood as a Cultural Construct. Another examined the social construction of ADHD through psychiatric history, Western family life, medical discourse and the pharmaceutical industry.

He felt a reassuring return of intellectual footing.

The group gathered around him.

Sami pointed to the title. He pointed towards the young man. He pointed back to the title.

The group studied the pages.

Writing, unfortunately, was another social construct. The marks meant nothing to them. There were no journals, universities, publishers, citations, professional reputations or peer-review systems through which Sami’s argument could acquire authority.

There was not even an author. Authorship required a socially recognised relationship between a person and a text, normally protected through another construct called copyright.

An older man took one of the pages and folded it carefully.

Sami smiled. At last, an interested reader.

The man used it to carry berries.

A woman took another page and placed it beneath the uneven corner of a wooden platform. His critique of Western psychiatry achieved immediate practical application.

The final pages were added to a small fire.

Sami protested, but protest depended heavily upon language and recognised ownership. The flames moved briskly through the literature, showing no respect for its citation count.

That evening, the group sat beside the fire. Sami watched the young man abandon his food twice, interrupt several activities and then become so absorbed in shaping a stone that he failed to notice everyone else preparing to sleep.

The young man was not experiencing ADHD because ADHD did not exist here as a diagnostic category. He was, however, experiencing something.

Sami began sorting his observations:

Persistent difficulty maintaining an intended sequence of action.

Attention captured by novel stimuli.

Unreliable recall of immediate intentions.

Intense absorption under particular conditions.

Uneven consequences depending upon the surrounding environment.

He stopped.

He had begun constructing a category.

The following morning, Sami encountered a woman whose behaviour resembled the young man’s in several important respects but differed in others. He adjusted his category.

Later he met a child who displayed some of the same characteristics without obvious impairment. Sami wondered where the threshold should be drawn.

By afternoon, he was comparing individuals, distinguishing patterns and considering whether some variations clustered together more reliably than others.

Within two days he had invented observational psychiatry.

Within three, he had concerns about overdiagnosis.

The central difficulty was becoming apparent. A category could be socially constructed without the phenomena grouped beneath it being socially manufactured. “River” was a human word and rivers did not divide themselves into formally agreed classes, but drowning remained possible. “Hunger” was a linguistic category, yet the stomach seemed unimpressed by philosophy.

Social construction explained how people named differences, decided which ones mattered and organised responses around them. It did not establish that the differences appeared only after the naming.

Sami considered neurodiversity.

The neurodiversity movement was clearly constructed. It contained values, political claims and ideas about how people ought to treat cognitive difference. There could be no concept of accommodation without shared environments, no disability rights without law and no demand for inclusion without institutions capable of excluding.

But neurological diversity was not waiting for permission from sociology.

The people around him differed in sensory processing, attention, memory, emotional responsiveness and behavioural regulation. No political movement had produced those differences. The movement merely offered one way of understanding and responding to them.

Sami began to see the trap.

If neurodiversity was invalid because its language and political framework were socially constructed, then dignity was invalid for the same reason. So were autonomy, consent, justice and protection from harm. None could be found as a discrete biological object. None existed without human agreement.

The argument could abolish ADHD.

It could also abolish every ethical principle required to object to ADHD diagnosis.

Late in the afternoon, Sami saw the dark-skinned stranger again. He wanted to explain what he had learned.

Race was constructed, but racism had been real.

Money was constructed, but poverty had been real.

Employment was constructed, but exploitation had been real.

Psychiatric diagnoses were constructed, but human suffering had been real.

Neurodiversity was constructed as a political framework, but cognitive variation had been real.

The stranger listened to the series of meaningless sounds and offered him another piece of fruit.

Sami sat beside the river.

He had found a world without social constructs. It contained no stigma, no coercive diagnosis, no pharmaceutical industry and no medical authority imposing definitions of normality.

It also contained no rights, no medicine, no education, no collective knowledge and no language through which suffering could be communicated.

The sun descended.

Night, showing its customary disregard for theoretical disputes, arrived.

Across the clearing, the young man who did not have ADHD was searching for the water he had misplaced again.

Afterword: The Map Is Made; the Terrain Is Not

The purpose of this thought experiment is not to suggest that Sami Timimi’s broader criticism of psychiatric diagnosis has no value. ADHD is unavoidably shaped by culture. Its name, diagnostic criteria, thresholds and institutional meaning were created by people. What a society expects from children and adults influences which differences become visible, which become disabling and which attract clinical attention.

A classroom requiring prolonged stillness will expose certain difficulties more readily than an open environment. A workplace built around uninterrupted concentration, punctuality and administrative consistency will penalise some cognitive patterns more heavily than others. Race, gender, class and access to healthcare will also affect who receives a diagnosis, who is overlooked and whose behaviour is interpreted as a medical problem rather than a moral failure.

These are important criticisms of how ADHD is recognised and managed. They justify scrutiny of diagnostic practice, pharmaceutical influence, cultural bias and the risk of turning a heterogeneous group of people into a single medical story.

They do not establish that the underlying differences are imaginary.

The central error arises when three separate propositions are treated as though they mean the same thing:

1. ADHD is a socially constructed diagnostic category.

2. The meaning and consequences of ADHD depend partly upon the environment.

3. The cognitive and behavioural patterns grouped under ADHD have no validity beyond social expectations.

The first proposition is almost certainly true. The second is well supported by both disability theory and ordinary observation. The third does not logically follow from either.

All diagnostic categories are constructed because nature does not write classification manuals. Humans decide where to draw boundaries, which features belong together and when variation becomes clinically significant. This applies beyond psychiatry: blood-pressure thresholds, pain scales and many definitions of disease involve human judgement. The presence of judgement does not make the phenomena being judged unreal.

Nor does the absence of a single ADHD biomarker settle the question. ADHD may not represent one uniform biological entity. It may prove to be an umbrella category covering several developmental pathways and cognitive profiles. Its boundaries may overlap with autism, trauma, sleep disorders, learning differences and other sources of difficulty. That uncertainty should make the model more modest, not make the people described by it disappear.

Timimi’s critique is strongest when it asks whether diagnosis is being treated as a complete explanation. It is weaker when social construction becomes a solvent poured over any evidence that an identifiable pattern exists. A label can be historically contingent, culturally mediated and imperfect while still pointing towards something recurring and consequential.

The same distinction applies to neurodiversity. Neurodiversity as a political movement is socially constructed. It contains values about identity, dignity, accommodation and the distribution of power. Neurological diversity, however, is an observable feature of the human population. The political framework did not create cognitive variation; it changed the language through which that variation could be understood.

This is why removing social constructs from Sami’s imaginary world does not remove differences in attention, activation, memory, sensory processing or behavioural regulation. It removes the shared vocabulary used to recognise them. It also removes the institutions that can either disable or support the people experiencing them.

A responsible account of ADHD must therefore hold two ideas at once.

The diagnosis is not a biological object waiting to be discovered in the brain. It is a human model: provisional, culturally situated and open to revision.

But a model being human-made does not mean it refers only to itself.

The map is constructed. It may contain disputed borders, inherited distortions and places that have been given the wrong names. We should revise it where necessary.

We should not conclude that there is no terrain.