It was fifteen years ago that a parent first asked me, "Do you test for ADD?", and I remember that I had the same reaction. "How odd," I thought. A parent had never been so direct in asking about a diagnosis. I wondered, where had she gotten the idea to inquire about a test for a specific condition?
Now, looking back, I know. In 1991 the Individuals with Disabilities Education Act (IDEA) was amended to include ADHD as one of the diagnoses that makes a child eligible for special services and accommodations in public school. Once word spread among parents that an ADHD diagnosis opened the door to special help for their children, an "epidemic" of newly diagnosed ADHD spread throughout our country. Now parents "knew" what was ailing their child---or at least they knew the magic words that could make a public school system change the way it dealt with their child.
These "disorders" were ostensibly based on collection of symptom behaviors that were assumed to have a biological basis in brain chemistry and heredity. But it really wasn't until 1991 and the change in the IDEA laws that the label took on pragmatic significance.
The diagnosis of ADHD and the use of drugs like Ritalin rose at rates never before seen in this country---or anywhere else, for that matter. The year 1991 marked a veritable sea change---a social movement began that changed the way our society views children's misbehavior and underperformance. Doctors started a public-education campaign directed at parents and teachers, and the latter group began to have an even greater impact on who was seen for an ADHD evaluation. Teachers were instructed to view any underperformance or unruly behavior as a possible symptom of ADHD.
Finally, in 2004, an amendment to the IDEA reauthorization plainly stated that school districts could not prevent a child from attending school based upon parents' refusal to give psychiatric medication to their child. However, by then, the pharmaceutical industry had picked up the ADHD diagnosis/medication football and begun running with it.
In the late 1990s, in print ads and television commercials, the drug companies began relentlessly promoting the concept of underperformance and certain forms of childhood misbehavior as symptomatic of ADHD. Ads showed pictures of perfect-looking children behaving perfectly. Slogans such as "Reach for the stars" or "Make your child's hidden potential known" were regular components of these slick and not-so-subtle campaigns.
Drug-industry advertising had its effects. First, it propelled Adderall, a not particularly unique amphetamine combination, ahead of Ritalin as the most commonly prescribed trade stimulant drug. Second, it made the acronyms ADD and ADHD common everyday phrases in every U.S. household with children. It was not so surprising then that about four years ago, the first teenagers began asking me directly for a drug to "help them concentrate."
The effects of stimulant medication on children's behavior in the classroom can be dramatic. I've never been against Ritalin. I've prescribed stimulants to children (and some adults) for a quarter-century. But this new group of teens requesting medication troubled me. I had little doubt that the medication could improve their performance. A few even met my criteria for ADHD. But many seemed very unhappy, alienated from their parents and other adults, and quite unmotivated to do much schoolwork. The request for medication seemed like a further extension of their decision to opt out---to take the easy route---which was, in part, the source of their problems.
To fully understand our heavy use of psychiatric medication, we have to go beyond capitalism and our own shores and understand a cultural phenomenon that has taken hold in most of the Western world. It has been dubbed the "therapy culture" by a British sociologist, Frank Furedi, who posits that as belief in traditional values (exemplified by organized religion and a politics of meaning) has declined, a new, higher valuation on feelings has risen. How we feel, how we feel about ourselves, whether we feel good, and the level of our self-image and self-esteem have become much more important over the last fifty years.
We dwell on our feelings. We believe them to be very important and think we should feel good, at least most of the time. An industry has developed around professionally assessing our feelings and keeping us feeling good. This is the therapy industry, which is part of the therapy culture. The therapy culture has designated "feeling bad"---which heretofore would have been considered a normal variant of human coping---as deviant, pathological, and "disordered," to be treated or cured.
As a nation we will feel sicker and sicker until we move away from the medical model and therapy culture and begin to view most of our major health issues (mental and otherwise) as manifestations of inequitable economic and social factors.
Still, regarding children in my office, I'll keep working with them, their families, and their schools. I will appreciate their weaknesses, but concentrate on their strengths, their families' strengths, and the positive power of their communities in order to improve their lives. Outside the office, I'll continue to alert parents, teachers, doctors, and the public at large to the insidious effects of promoting the disease model of behavior and its consequent disempowerment of children in our community and across our nation.This blog is excerpted from “Pathologizing for Dollars." Read the full article here. >>Want to read more articles like this? Subscribe to Psychotherapy Networker Today!