The Medicalization of Human Variety

Laurie and Debbie say:

We’ve been thinking about social and political effects of psychoactive drugs for a long time and these two articles by Marc Bousquet seemed like a good reason to talk about that now.

In 2003, six million American schoolchildren—about 15 percent—took methylphenidate (Ritalin) alone. Methylphenidate has replaced Prozac as the drug defining an entire cohort.

Before we start: We know that there are people who take Ritalin, and other psychoactive drugs, and experience a serious improvement in their lives. We always support people making whatever choices make their lives better.

That being said, 15% of schoolchildren represents not an occasional disorder but an epidemic, and the drugs are apparently going to a lot more people than just the children (and adults) for whom they are prescribed:

Students themselves actively seek the ADHD diagnosis. The pills have many uses related to the spectacularized culture of testing, overwork, stress, and body-consciousness—they aid in concentration, provide wakefulness, suppress appetite, assuage certain emotions, and improve athletic performance. They can be crushed and snorted or smoked recreationally in ways similar to methamphetamines. The diagnosis itself directly addresses high-stakes testing: medicated or not, ADD and ADHD-diagnosed students can request additional time in many testing circumstances.

Many more students than diagnosed use the medication: There is an active black market in Ritalin in every educational environment from primary school through graduate degrees. Students pay up to $10 a dose for “vitamin R.”

Just as thematized in the mass culture of the professional-managerial class (in TV shows like Desperate Housewives), there are widespread reports of parents using Ritalin prescribed to their children to meet the demands of their own “standards-based” existences. In families trapped in low-wage jobs, parents may also take Ritalin to meet the demands of their own working lives in the service economy or, sometimes, illegally sell it to make ends meet.

While student respondents acknowledge [recreational] use, overwhelmingly the main use is to keep up with work or performance pressure in a high-stakes culture. “I don’t think I could keep a 3.9 average without this stuff,” said one high-achieving college student (Jacobs, NYT). Another report shows that continuous assessment of scholarship recipients leads to usage: “I don’t know what I would do without it,” said another. “There’s no way I could have kept my scholarship if I didn’t use it” .

When we look at over-riding social trends, rather than individual choices, there’s lots to be nervous about here. As we see it, widespread application of drugs to common social experiences has at least two consequences for the society. One is the tendency to try to solve a social problem with an individual medical response: if 15% of American schoolchildren really need drugs to keep up in the classroom, could something be wrong with the classroom? We know that there’s an amazing amount “wrong” with our classrooms and our school systems–are we using Ritalin and other drugs to keep us from having to tackle those issues?

Second, drugs are prescribed for “disorders.” ADD, ADHD, and many other diagnoses are often about an inability to fit in to an increasingly high-pressured, single-track, one-solution culture, just as bariatric surgery is about an inability to fit in to a culture trying to be “all fit one size.” We were both simultaneously reminded of the wonderful Oliver Sacks story of the man who took his Tourette’s medication during the week, but stopped taking it on the weekends so he could keep the joy he got from drumming. Many of these drugs blunt other responses, minimize other reactions, take away an ability to see/hear/feel/experience. When given to young children, it seems very likely to us that the drugs may have a permanent blunting effect, or cause other permanent changes in how these children learn to see/hear/feel/experience the world.

The whole picture gets a little more menacing when you add in “Oppositional Defiant Disorder,” about which the same author wrote an earlier short piece on “Oppositional Defiant Disorder,” also in the Chronicle.

A diagnosis of ODD can result in medication with powerful tranquilizers like Risperdal and Zyprexa.

A massive therapeutic industry of behavior modification, including pharmaceutical companies, now targets parents, promising cures for “defiant children.”

One of the most pervasive ad campaigns draws on the rhetoric of homeland security to label youth defiance “The War at Home,” urging a corrections mentality on the family: “The focus of treatment should be on compliance and coping skills, not on self-esteem or personality. ODD is not a self-esteem issue; it’s a problem-solving issue.”

[Clinical psychologist Bruce] Levine suggests that in many cases the symptoms of ODD are rational resistance to authoritarian abuses and “rebellion against an oppressive environment,” explanations rarely considered by educators or mental health professionals.

This is not so new; in the 1950s, defiant kids (especially girls) were psychiatrically diagnosed and prescribed electroshock therapy (which is also coming back into medical fashion, sadly enough). While ADD/ADHD is primarily a diagnosis of the high-achieving middle class, ODD is a label easily used to subdue working-class and underclass students, and medicalize their completely justified rage at their treatment by society.

We are in the very very early days of brain science; once you get through the maze of “serotonin uptake,” “receptor binding,” and “protein affinity,” you invariably get to “the mechanism is not well understood.” This means that we often don’t know what these drugs actually do. (Ritalin was developed to treat Mohr’s syndrome, a rare disfigurement syndrome which affects the mouth, nose, and fingers.)

What we do know is that when brain medications are the first line of defense with young children and early teens, they often grow up believing that drugs are the answer to everything. And the pharmaceutical industry is more than happy to keep cranking out expensive, poorly understood “answers” as the problems multiply.

Day-dreaming, fascination, high energy, excitement, willfulness: these things enrich the human experience. They are important to kids, important to adults, important to living together in society. So far, we don’t have the science or the capability to medicate them out of existence, but we do seem to be trying to minimize them, in the name of promoting competiive success and minimizing anger, frustration, pain, and despair. If we aren’t judicious in our decisions about what are disorders and what is us, we stand to lose a great deal more than we gain.

Thanks to Arthur D. Hlavaty for the pointer.

14 thoughts on “The Medicalization of Human Variety

  1. Just curious: why is it “sad” that electroshock therapy is coming back into use? Not that I’m a booster for it, but it sounds like you’re saying that it’s obviously bad. From what I’ve read, the current practice uses much lower “doses” than were once used, which minimizes the risk of memory loss and other complications, and it can be a effective treatment for intractable depression in some people.

    Or is it just that you’re concerned that there’s a fashion for it; e.g. it could be useful in some circumstances, but is being overused or overpromoted? Because my impression is that it’s only used after other therapy options have been exhausted, at least in part because it has such a bad reputation due to the way it’s been portrayed in fiction. Sure, it can be (and has been) misued; but is this fundamentally different or worse than misuse of psychoactive drugs, which you accept can be useful for some people?

  2. Seems to me we’re headed to medicinal lobotomies if this trend continues. Do we really want a society with no diversity? If there’s no diversity, there’s no room for genius, because drugs have blunted the ability to make leaps of intuition that lead to innovation. If we medicate our genius away, where is our country headed? Not anywhere that I want to be, that’s for sure.

  3. As one of those with loved ones who take these drugs, I’m deeply divided on the subject. I have seen the positive effects that appropriate medication can offer. They can be life-changing. That said, we do give our daughter a “medication break” in the summer as much as possible, letting her just run around and be a kid. Also, I find that her meds wear off much earlier in the day that they are advertised to do, often before school is even over. So she’s getting something of a “break” every day, even when she’s taking it almost every day.

    All of that said, I’m totally with you that perhaps there is something wrong with SOCIETY, that we feel a need to do this on such a massive scale. I’m particularly fond of the slim book published quite a while ago, with the subtitle “A Hunter In a Farmer’s World.” It makes the point that ADHD folks do not have a “deficiency” as much as they have a different way of thinking and viewing the world.

    For me as the wife and parent of AD(H)D people, as well as the sister of one, and with my own psych issues (mostly depression and anxiety) dogging me all my life, I have found the process of living in our society to be one of tightrope walking. It seems that it’s always a compromise, trying to get my kid through school, and keep my husband working steadily to provide for my family. Because whether or not I think our society is screwed up–it’s still the society we live in. I have to live in this every day; I can’t easily choose to live in a different society–and neither can my daughter and husband. They need to learn skills and coping mechanisms to help them interface with a world that doesn’t move at their pace. So far, it’s my experience that the medication is helpful in doing that, and that proper dosage does not leave my child, for instance, unable to be creative. Quite the contrary, I have found that rather than “medicating our genius away” as Vesta44 fears, that my husband’s “genius” is *revealed* with proper medication. A lack of it means he fritters away his time and energy; a presence of it means he can stay on track to manifest his own dreams.

    Does this mean I think it’s the answer for everyone? Most emphatically not. I do believe it’s overdiagnosed, and that the medications are overused–gone, perhaps, to people who are just unable to cope with our fast-paced, frenetic society. I worry about how the drugs might affect my child’s growth, and I make sure to keep up with her doctor’s med-checks. But we are fortunate, “privileged” even; I am able to stay home, working from home and therefore flexible enough to monitor and advocate for both child and husband. Many people are not so lucky.

  4. I think the bind you describe of using drugs to cope with the stresses and strains of today meaning that you do not develop coping mechanisms over and above reaching for more drugs; is the typical drug addict dilemma.

    It also means that those stresses and strains become more pressing as they are allowed to continue due to being relieved by drugs.

    I don’t know if it’s so much that there is something wrong with society, there is no such thing as a perfect society, all societal groupings have to break people at least a little, in order for them to fit in.
    The issue for me is one of development, evolution in a sense, an increasing amount of societies have (again?) reached a point where mere subsistence is something we can see beyond. This seems to have altered the way our bodies, specifically our minds function, it’s as if there’s more going on upstairs, I don’t mean intelligence, I mean more energy transfering itself to the brain (and nervous system?).
    We are still being brought up largely with a mindset that was formed before this and we have yet to fully adapt to this.

    A lot of it is need for respite and calm, more than ever we need to employ the techniques of mental and physical meditation and contemplation. And train ourselves and our children in them.

  5. @wriggles:
    I disagree with your position. You seem to assume that people like my husband and my daughter have never tried mental and physical meditation and contemplation. You would be incorrect. My daughter knew how to calm herself at about age 2, by “being a tree.” Those techniques were helpful, but simply not *enough*. I find it rather insulting that you essentially label them both as “addicts” without any personal knowledge.

    Societies have used chemicals to change brain chemistry for millennia, though psychoactive compounds found in plants, mostly. It’s just that we now have the ability to extract and synthesize to a degree never before known. It is true that this new form is something our society has not fully adjusted to. But to presume that all brain differences can be brought into harmony with the rest of society by simple contemplation is to reduce an extremely complex issue beyond the point of usefulness. As with bodies, no brain is the same, and no solution fits all.

  6. Sorry if this is too long, BP, you can cut it if you like, but I had to answer much of what Dawn said.

    Dawn- meditation etc, is not something you try, it’s something you just do, like having a bath, it’s for everyone at any time, regardless of what else is going on, we all need some form of it. I wasn’t claiming it as a panacea-the comments you quoted referred to the fact that a larger and larger minority of young people are taking drugs, motivated and engaged youngsters at that, to cope with everyday life. Do not confuse that with people who have a genuine issue of brain function.

    You say you are insulted by the term addict, don’t be, first off I mentioned the addicts dilemma, it could just as easily have been the dilemma of any adaptive coping mechanism that doesn’t deal with the cause of an issue. And secondly, it is not an insult contrary to your views to be an addict, it is something to be looked at and addressed, but it is not an insult because the powers that be have decided to play a dirty game of demonisation.

    Again the adjustment I’m talking about is not an adjustment to drugs, I don’t agree by the way with your comment that synthesising chemicals is anything new or produces a new paradigm of effects. I’m talking about adjusting to the change from most of our energies being taken up with survival to more imperceptible and possibily cerebral age, we haven’t fully adjusted to that.

    But to presume that all brain differences can be brought into harmony with the rest of society by simple contemplation is to reduce an extremely complex issue beyond the point of usefulness. As with bodies, no brain is the same, and no solution fits all.

    That is exactly what I persume, because I cannot believe that the brain has become so flawed that it suddenly can’t work without drugs. Techniques of meditation are not just things or drugs substitutes, they allow the mind to heal itself and right itself. They are not a destination but a journey, where you stop is where you decide to stop, they are as simple or as complex as the workings of the mind as they are the workings of the mind.
    It is drugging the brain that is simplistic and reductive, a mind has a problem, so you bludgeon it with some chemical ignoring the fact that it is a whole orgran, the whole body actually. That to me is absurd.
    People are hurting and taking drugs because of it the biggest insult of all is to just keep doleing out the pills regradless.

  7. wriggles says the comments you quoted referred to the fact that a larger and larger minority of young people are taking drugs, motivated and engaged youngsters at that, to cope with everyday life. Do not confuse that with people who have a genuine issue of brain function. Fine. But you seem to be assuming that DawnD’s husband and daughter are not among those who “have a genuine issue with brain function.” How do you know? And how does that square with It is drugging the brain that is simplistic and reductive, a mind has a problem, so you bludgeon it with some chemical.

    You also say I cannot believe that the brain has become so flawed that it suddenly can’t work without drugs.

    What exactly do you mean by “the brain”? Your brain? Mine? DawnD’s daughter’s?

    What if it were I cannot believe that the body has become so flawed that it suddenly can’t work without drugs. That may be true in general, but some people’s bodies do need drug treatment. For example, my pancreas pooped out about 10 years ago, and as a result, I can’t live without exogenous insulin. No, this is not the way the human body is designed to work, but sometimes things go wrong. I agree that psychogenic drugs are being overused; that doesn’t mean they’re never appropriate.

  8. There are studies suggesting that people who are taking appropriate medication are less likely to self-medicate with alcohol, opiates, etc.

    I’m curious if anyone has read the harrowing story in last week’s NY Times Magazine about kids diagnosed as bipolar. It is here.

  9. Janet, when I spoke of the ‘bind you describe………….’ I see it looks as if I was talking to Dawn, I wasn’t, I was addressing the post itself, sorry if that was unclear.

    What exactly do you mean by “the brain”? Your brain? Mine? DawnD’s daughter’s?

    The human brain, as in:

    15% of schoolchildren represents not an occasional disorder but an epidemic, and the drugs are apparently going to a lot more people than just the children (and adults) for whom they are

    What you refer to here is an inexplicable rise in people taking drugs for what is supposed to be an innate difference of brain chemistry/ structure.

    That may be true in general, but some people’s bodies do need drug treatment.

    Did I say they didn’t? What I said was regardless of brain status, we should be teaching all our children techniques of how to allow the brain to achieve it’s optimum rest and healing state, whether they have ADHD or not, how does that manage to be an attack on drug therapy?
    As for your pancreas, you cannot really compare it to your brain, which is of a different order of complexity altogether, and don’t forget that if you are taking medication for this, what if you needed medication for your brain, how can you be sure they wouldn’t clash or nullify it? It makes sense to minimize medication.

    What I’m saying is that we learn to make the most of the brain’s capacity to right itself when we work more with it, I believe that this may well be why the brain shows signs of distress, when it cannot adequately de-stress (excuse the pun). Whatever is problematic after that is what should be treated.

  10. @wriggles

    I imagine if you look at historical levels, you’d find an “inexplicable rise” in the use of penicillin sometime after its discovery, too. Does it get overprescribed? Sure. Does that mean we should stop using it for the large numbers of people for whom it works to save their lives? Less clear, IMO, but we probably won’t until and unless there are other, equally good or better treatments to replace it with.

    @Lisa Hirsch

    My personal anecdotal information (and my reading) supports your assertion, yes. Unmedicated or improperly medicated ADD folks are at particular risk from various forms of speed, cocaine, meth, etc. Anything that works, as the medication does, to help focus the overwhelming inputs that they receive all the time.

    re: The original post, and most of the comments–
    [I had a nice pithy post that seems to have disappeared into the ether. Ah well.] My view is that medication is a TOOL. Meditation, CBT, and other approaches are also tools. I personally prefer more tools in my toolbox, not fewer.

    And yes, it’s still worth asking the question of whether we *as a society* have created an untenable situation, one where we are increasingly *forced* to rely upon certain tools over others, just to exist. Medication should be one of several approaches considered when each child (or adult’s) needs are evaluated. To medicate in a vacuum is, IMO, inappropriate.

    OTOH, presuming that all children can be taught* to effectively meditate and therefore become “normal” at completing their schoolwork, is IMO rather like hitting a nail with a banana because it’s roughly the same shape as a hammer, and it’s “all natural!” Bananas are a good tool for making sure one is not hungry, but not so great for driving nails into wood, IME. Perhaps the appropriate societal response *IS* to simplify, and to return to a state in which most problems could be solved by banana–but I’m not convinced this is practical for the vast majority of our current population.

    *And let’s not forget that this is a group of people who have often been labeled “unteachable” by the time they even hit school. I find it laughable in the extreme that anyone could even think that “teaching them to meditate” might be a useful tack for the vast majority of these kids. For me, I react to this notion very similarly to “well, if you would JUST LOSE WEIGHT, everything would be better! It’s just that simple!”

  11. Wriggles, it’s hard for me to tell what you’re saying, because you seem to be defining “addict,” “meditation” and other key words very idiosyncratically and expecting your readers to know what you mean by them.

    But yes, it does sound to me like you’re attacking drug therapy, not simply the issue of giving drugs to people who don’t need them, which I think we all agree is a very bad idea.

  12. I understand the concern in terms of conformity, social control, how medication works for children in particular, and large trends. And I don’t mean this to be a slight on people here, at all, because you all grok the privilege thing and are talking about other issues. Still, the assumptions behind this whole conversation can be somewhat vexing, too. For a different perspective, here’s a post to consider, about meds and privilege:

    A quote:

    “What is so awful about people taking medicine?

    “…. I encounter this sort of foreboding in quite a lot of writing, to begin with. People pull out the Scary Statistics about drug use, for this or that medical condition or this or that group of drugs, using those numbers to make a point about Big Pharma or to insist that the people taking that drug could just do some yoga and be like, totally cured of their debilitating depression!

    “As a society, we have a complex about this whole drug thing. We have no problem with modifying our brain’s regulation of certain chemicals streaming through our blood with the intent of altering this or that function when the thing doing the modifying is, say, food, or physical activity, or orgasm, or incense, or sun exposure, or, hey, sleep! But when you cut out the middle man people start getting all jumpy.

    “Really, though, that’s not it. It’s not the drugs that make people nervous. The drug panic is just the superficial manifestation of a much, much more deeply-rooted fear.

    “The fear of disability.”

    And one for wriggles on how to consider talking about this stuff sensitively:

    a quote:

    “I have encountered these well-meaning people many, many times. They suggest this diet, or that exercise program, or this doctor, or that web site. But what they are doing in actuality is acting on the assumption that I have not put effort into learning about my condition, what causes it and how it works, and spent a significant amount of time looking into all of the treatment options, and continually trying new ones in an attempt to find something that works in my life.

    “And I know, I know you are trying to be nice. But having to confront people over and over again, especially people who are only trying to be nice!, with the facts about my condition and how it has affected my life, gets tiring after awhile, and makes me feel like a rotten jerk.

    “And I can tell you from experience, having talked with other folks with a variety of conditions, that I’m not the only one who feels that way.

    “So, again: Stop. And Think. Disability in particular, but illness in general, are subjects that are never really examined on a deeper level in mainstream society. This means that you have most likely been taught mechanisms to deal with the subjects that are very broad and superficial. But if you are serious about facing up to your own privilege and being a friend to those people without it, you will put a little more thought into the assumptions you rely upon when approaching these issues. Trust me, it will be appreciated.”

  13. There was a card on PostSecret a couple of weeks ago that sort of summed up this issue. It said something like, “I started taking Ritalin to lose weight. And I felt better–my grades went from Ds to As. But I didn’t lose any weight.”

    To contribute my own perspective, speaking to the issue of psych meds– it’s definitely a conundrum, I think. On the one hand, 15% is a big number, and the increase is relatively sudden, and the psychological profession has equated nonconformity with mental illness plenty of times which should make us suspicious. The pressures of achievement and conformity of all kinds are huge, and, from all we read, just getting worse.

    On the other hand, I can certainly second DawnD, with my own experience– my dad’s side of the family includes a huge, huge number of people with mental illness (especially depression), and has done so for a much longer time than such illness has necessarily been recognized/treated by medicine. Those people self-medicated, most often with alcohol; or they were institutionalized/imprisoned; or they were considered failures or otherwise held morally culpable for their distress; or they were just “that way” and everyone knew that X person should never be left alone.

    Even so, and granted that it’s a large family (11 kids each have 5+ kids each have 5+ kids etc), just in the generational cohort of my dad’s age (he’s in his 60s now), 6 relatives committed suicide *that we know of*. So sure, a whole lot of these people would now likely be medicated (and many are, a seemingly-huge and -sudden increase from when SSRIs and other meds were not widely available), but would that be a bad thing?

    Certainly the condition itself has been going on longer than postwar US culture, so it’s not all attributable to that.

    I know for myself, I first started thinking about suicide when I was 5, and began to be agoraphobic when I was 8 or 9. I finally got diagnosed and started meds after my own hospitalization, at age 25. The idea that I could have had a much less difficult childhood if there had been medication does appeal on some level, even though I also do agree that there’s a lot of risk with kids’ brain chemistry and that it is a fast-evolving field that we’re just starting to decipher.

    However, I think what would have been most useful for me would have been to know that what was problematic for me was not just due to an intrinsically flawed character– not just weakness or laziness or cowardice or what have you. Meds or not, discovering that there was a physical component to how things are for me was transformational, and it would have been nice to know much earlier on. I have talked with people who have Asperger’s or AD(H)D or bipolar disorder who say similar things– knowing that it was *not just them* was really important.

    IOW, it’s good, IMHO, to recognize also that human variety can and does, innately, include configurations that are challenging to live with, and that those configurations maybe had to be endured in the past; but if they don’t have to be as difficult any more, enabling that is also intrinsically good. And that line is blurry for a number of reasons– 15% seems high, but how do we know what level is too low?

    Also, I can speak to ECT (electro-convulsive therapy), too, having had it. As it existed in the mid-1990s, at least, it is definitely not the horror that it used to be– you’re put under for the process, they do use much lower “doses,” it’s more monitored. Aside from some wicked headaches from where the electrodes were placed, and some muscle cramps, I was not in any pain from it. And it’s especially useful, apparently, for people who cannot tolerate psych medication for whatever reason (side effects, their other meds contraindicate it, etc).

    For me, it was a disaster. I still have no memory of most of that summer, I did it for all the wrong reasons, and the disorientation and memory loss made the agoraphobia much much worse. But I also know people who have had it work extremely well for them. Like anything, it’s not a panacea and shouldn’t be prescribed willy-nilly, and certainly in the circumstances you describe where it was used to “treat” women whose only “illness” was to be unconventional, it’s oppressive and horrible; but the fact that it’s being used therapeutically now is not *necessarily* a nightmare, either.

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