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March
21, 2001
Type of
Attention Deficit Disorder is All in the
Head
by Ilana
Mercer
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,
but 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
6 to 7 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 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 Institute 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"? 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, 2001 by Ilana Mercer
previously in the Calgary Herald
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