The love and concern for our children is one of the most powerful things in the lives of parents. We want them to succeed in what is an increasingly competitive world. Attention Deficit Hyperactivity Disorder (ADHD) touches on our fears and aspirations for our children. It also puts to the test the manner in which we accept their imperfections and the effect of those imperfections on us. This is why understandably the topic of ADHD causes such distress to parents.

When I queried this catch-all diagnosis, giving voice, incidentally, to a robust and ongoing debate underway in the scientific community, readers objected. I was accused of neglecting to do “research,” although talking to ADHD stakeholders was usually how readers defined research. Let me say that while the human story is emotionally powerful and makes for good copy, in isolation, it is an anecdote with little research validity beyond that of a case study. I would hope, however, that people use their critical faculties to question orthodoxy. Arguments must ultimately be judged on their merit, not by the authority or the qualifications of those who make them.

In 1997, Robert Sternberg, a prominent Yale professor of psychology told The New Republic magazine there was no medical evidence to support the view that children who are labeled learning-disabled have an immutable neurological disability in learning. A year later the flagship American National Institutes of Health (NIH), confirmed his pronouncement. In a Consensus Statement on the Diagnosis and Treatment of ADHD, prepared by a non-advocate, non-Federal panel of experts, the NIH cautioned that there exists “no independent valid test” for ADHD, adding that “further research is necessary to establish ADHD as a brain disorder”. This paper offers a distillation of the relevant research to date in the field.

There are persistent concerns in the research and clinical communities regarding the psychiatric Diagnostic and Statistical Manual of Mental Disorders (DSM) from which the ADHD and many other fashionable diagnoses are culled. The latest critical examination of the manual is entitled Making Us Crazy DSM: The Psychiatric Bible and the Creation of Mental Disorder.

Written by two American academics, it received a nod from no less than the august British Times Literary Supplement (TLS), whose reviewer ventured that the DSM is an American invention, unique to that culture. The DSM, wrote American reviewer and social psychologist Carol Tavris, represents a “brilliant orchestration of pseudo-science, marketing and promotion,” which has “succeeded in transforming the normal difficulties of life into mental disorders.”

The book points not only to the shabbiness of scientific evidence inherent in the DSM, but to the hundreds of diagnoses created which are vulnerable to misuse. Conditions like “Oppositional Defiant Disorder,” or “Conduct Disorder” harbor Orwellian possibilities. Such diagnoses were likely the bailiwick of the mental health professionals in the former Soviet Union, when they needed to dispose of dissidents.

For real double-bind value, look no further than a DSM condition called “Non-Compliance with Treatment.” Disagree with the medical demiurge, and he slaps you with a diagnosis. Safer not to risk that second opinion. Not only are “most of the DSM labels circular,” avers the TLS reviewer, but they “confuse labels with explanations”. Ultimately, they aim to give the public a psychiatric explanation for the pain in their lives, and hope that a pill can eradicate it.

There are now approximately 5-6 million children on Ritalin in North America, up from 1 million in 1990. Most of the children being medicated are boys, with minority boys 11 times more likely to be on this stimulant. Ninety percent of Ritalin, which is supposed to help children focus, is marketed in the US. One can’t help but wonder why American and Canadian children don’t score very well on international scholastic tests. Maybe there isn’t enough Ritalin going around? On the other hand, maybe the schools are failing children. Either way, it doesn’t really matter: As long as Ritalin is making kids happier, who cares? Certainly not the pharmaceutical companies who are making merry with between $30 to $60 a month per medicated child.

By masking the pain of living with a pill, mental health professionals are abnegating their responsibility and traditional mandate to explore and improve the many psycho-social factors that influence a life. In the process, vital interventions are overlooked, and we whittle down control over and responsibility for our lives to the inaction and resignation inherent in a biological determinism.

Finally, by allowing emotional life to be homogenized through pharmacology, we are passing up on what it means to be human.

©2000 Ilana Mercer
The Calgary Herald
January 13

Disease labels are now being slapped on an ever-wider range of behavior. Members of the psychiatric and medical professions and their patients have all taken to the idiom of disease like ducks to water. The twin evils of reductionism and the pathologizing of everyday behavior are at work here. Complex behavior, once considered the function of morals, choices and yes, character, is now routinely reduced to the basic components of genetics and biochemistry and outsourced to the ‘expert’. Thus the thief is a kleptomaniac; the arsonist a pyromaniac; and the promiscuous a sex addict. This is both poor scientific practice as well as morally and intellectually impoverished.

It has not stopped Dr. John Ratey, a Harvard associate professor and a well-respected, prominent psychiatrist from claiming in his 1997 book Shadow Syndromes that quirky behaviors are actually mild mental illnesses resulting from brain dysfunction.

The lout who is appropriately obsequious with the boss because he knows where his bread is buttered, but who is less dainty with the wife, even thumping her occasionally, would be a candidate for compassion. He is after all doing battle with what Dr. Ratey terms “Intermittent Rage Disorder”. And the dad who dotes on his children while they are with him, but fails to mail them child support money as soon as they are out of sight, is simply afflicted with “Environmental Dependency Disorder”: He remembers his kids only when they are around. Is there proof for these sub-rosa disease categories? None whatsoever, although this has not prevented Ratey and many like him from coating their pronouncements with a patina of scientific respectability—and then cashing in.

If Ratey is up the creek without a paddle, then he is up there with the best of company. The Psychiatric Diagnostic and Statistical Manual (DSM-IV), the Rosetta Stone of the profession, has grown since its inception in the 1950s from 60 categories of abnormal behavior to about 410 diagnostic labels today and counting. Many of the disorders described in it are a matter of trend and niche. One of the diagnoses Dr. Ratey is particularly fond of is Attention Deficit Hyperactivity Disorder (ADHD). So fond is he of this chimera that he diagnosed himself with it. The reason this seemingly competent person decided he had a learning disorder is because he was unable to free associate during psychoanalysis!

Indeed, ADHD is the focus of a growing industry. The Canadian ADD Foundation says this learning disorder is likely genetically transmitted, affecting six to seven per-cent of the population. There are pervasive efforts underway to pronounce ADHD a disorder of the brain, although the evidence for this is scant. Driven by advocates and special interests, among them former U.S. Vice President Al Gore’s wife Tipper and a slew of medical professionals and peddlers of pharmaceuticals, U.S. legislation has pronounced ADHD a brain-based disorder. This is most curious because the flagship American National Institutes of Health (NIH), led by a panel of independent scientists, concluded that there is as yet “no independent valid test” for ADHD, and that “further research is necessary to establish ADHD as a brain disorder”.

The treatment protocol for ADHD is another aspect of this controversial diagnosis that gives the NIH pause. Children with ADHD are often given powerful psychostimulants. Yet there are no long-term studies of either stimulants or psychosocial treatments, and certainly “no information on the long-term outcomes of medication-treated ADHD individuals in terms of educational and occupational achievements, involvement with the police, or other areas of social functioning”. But what must surely put the advocates to shame is the NIH’s consistent findings that treatment for ADHD yields little improvement in academic achievement and social skills. Treatment, it seems, doesn’t do what it is supposed to do.

If nothing else, it is an interesting exercise to scrutinize the DSM-IV-based ADHD diagnostic criteria. Who doesn’t know a child who “has difficulty sustaining attention, doesn’t seem to listen when spoken to directly, loses things necessary for tasks, fidgets, or is on the go constantly”? Come to think of it, most adults at some point or another answer to such a description. Couple such subjective diagnostic criteria with the fact boys outnumber girls with the condition by nine to one, and ask yourself whether the ADHD-diagnosis is not inadvertently targeting typical male exuberance.

The ADHD-experts claim that children who take these drugs are better liked by other children and experience less punishment for their actions, which in turn improves their self-image. Considering that the adverse effects from the prolonged use of medications for ADHD can range from cardiac arrhythmia through to seizures and liver damage, this is some price to pay for popularity.

©1999 Ilana Mercer
  The Calgary Herald
  December 28