Tag Archives: education

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.