The War on Not Taking Drugs

Apparently, taking your kid off Ritalin can get you investigated for child abuse.

Comments

[Jennifer]

In ten to fifteen years, I predict a monstrously huge class-action suit against the pharmaceutical companies, on behalf of all the zombies who were forced to take this garbage in their youth.

[meep]

My brother took Ritalin for years, starting when he was about 10. Later in his teens, he decided on his own that he didn't like being constantly medicated--even though he acknowledged it helped him in school. His doctor didn't "approve" either, but he's been twice as happy since he got off the speed.

[Jeff]

About a decade ago researchers found evidence that taxing the intellectual centers of your brain led to more efficient chemical and neural reaction times over a period of time. Current research keeps showing the effects of regular heavy brain activity in staving off Ahlzeimer's.
I can't help but wonder if the pharaceutically tempered adolescent anger/anxiety/attention centers of todays kids will suffer long term effects from not getting a similar work-out.

[meep]

Jeff, don't worry--tomorrow we'll have new drugs to compensate for the side effects of today's drugs. And they'll be free because the government will have decided it's best if we all are forced to take them.

Tangentially, did anyone ever see the movie Equilibrium? Related subject matter, but it also had absolutely the most novel and impressive action concept in years.

[Jennifer]

Did you notice that the kid's symptoms consisted of fidgeting in class and being disruptive? If the kid's fidgeting, maybe it's because he's a twelve-year-old. If he's disruptive, maybe he needs to be disciplined, made to stay after school, not be drugged out of his mind.

[Jennifer]

Jeff brings up an interesting point. Is it purely coincidental that the more school curricula are watered down, the more kids seem to be diagnosed with ADD? The kids aren't sick--they're bored out of their freaking minds.

[thoreau]

I may be the only H&R poster who actually thinks that ADD is real and Ritalin can help. But I think it would be 100% wrong to arrest that father.

[Jennifer]

Thoreau-
ADD is real, but for every one kid who has it there's a hundred who don't but are given Ritalin anyway. By analogy, suppose that every time a kid gets a bruise we assume he has leukemia and force him to undergo chemotherapy; in both cases you end up with a medical treatment which does far more harm than good.

[thoreau]

Jennifer-

Your 1 to 100 ratio is probably off, but I grant your point. An interesting study several years back (wish I could recall the reference) found that ADD is paradoxically both under-diagnosed and over-diagnosed.

The researchers used fairly rigorous diagnostic criteria (as opposed to the drug companies' preferred criteria like "Is the kid a little difficult in class? Are the parents too self-absorbed to try spending more effort on parenting? Is there any way we could scare you into using our product?") and found comparable rates of undiagnosed ADD, as well as falsely-diagnosed ADD.

It seems that an ADD diagnosis may be a function of a parent's attitudes as much as medical science. For every parent who says "No way are you drugging my kid!" despite evidence of a very real need, there's another who insists "No way could his misbehavior be my fault! Give him a pill ASAP!" despite evidence that the kid is normal.

Interestingly, kids who don't need Ritalin frequently just become worse if they take it. It's a stimulant for normal folks, and yet for a certain subset of the population it produces calmer, more focused behavior. That alone is strongly suggestive evidence that some sort of abnormal brain activity is going on.

[TWC]

Couldn't agree with Jennifer more.

It takes patience (and a whole lot more) to be the parent of an active child with a short attention span that produces somewhere on the order of 2.5 megawatts of energy daily.

Even in my moments of full-on exasperation I have never considered drugging my boy. The goal is to civilize him not break his spirit.

[Todd Fletcher]

This reminds me of TXH1138 - criminal drug evasion. Soon we might all be forced to shave our heads and wear uniform white jumpsuits.

[meep]

thoreau--

Actually, the brain chemistry involved is not abnormal. Low levels of stimulants don't so much produce a calming effect as they help you focus--and at low levels, you don't get the "speed" effects. A lot of neurochemistry is this way actually; a low dose of something produces one effect, and a high dose produces a seemingly different effect, even though chemically it is a linear ramping up of the same consequence.

This is one of the reasons so many people drink coffee or sodas--not just for the pick me up/wake me up factor, but to help them concentrate. Likewise nicotine, which mimics a stimulant your body produces naturally--smoking a cig helps you focus. A neurobiology professor of mine was fond of quoting his estimate that in the 10 years he spent smoking, he produced more academic output than in the 30 years after he quit. And that's the same basic effect Ritalin has on schoolkids; it helps increase their focus/output.

[Jennifer]

Here's a link to a Slate story where a man chose to take Paxil to see what would happen. Granted, Paxil seems to be sterner stuff than Ritalin, but it's fitting nonetheless. The whole time I read it, I kept thinking that this would be the perfect soma for the Brave New World.

http://slate.msn.com/id/95903/

[tomhynes]

How many kids with ADD does it take to screw in a lightbulb?

Wanna go ride bikes?

[ABC]

A year or two ago, I read a study where-in about 50 qualified psychologists were each asked to diagnose about 30 children for ADD. The results were that the diagnosis corelation was entirely random.

ADD is not a "disease" - it is simply a label given to random patterns of objectionable behavior. Furthermore, it is morally disgusting to drug a child in order to make them a more complacent drone in our corporate worker factories.

My sister-in-law was kicked out of high school for refusing to "acknowledge" that she was depressed and needed to be drugged. In reality, she was simply bored.

In high school, I was diagnosed as having a "brain chemistry imbalance" and informed that I was "bipolar" and would never live a "normal" life without drugs. My mother told the doctors to fuck themselves, and I never took a single drug. Yet, somehow, I've managed to become a happy, productive, 32 year old, husband and father worth $2.5 million. But I guess that proves them right - I guess I'm not "normal".

[Swamp Justice]

Some of the common symptoms of clinical depression include:

- sleeping more than usual
- sleeping less than usual
- eating more than usual
- eating less than usual

[Jennifer]

Swamp Justice-
And if your eating and sleeping habits are identical to what they always were, you're just in denial.

[Torquemada]

The government should certainly be able to arrest parents who refuse to allow medical treatment when their child is facing a life-threatening or crippling disease. This is not that kind of a case. The dad's "neglect" consists of not wanting his son to take psychiatric drugs to cure his bad behavior at school.

The article didn't focus on the real question, which is, "who decides?" Instead, the article was discussing "who's right on the merits: the parent or the government school/child welfare officials?" This is so clearly within a parent's range of discretion that the article shouldn't even be discussing who's right on the merits, or at least that shouldn't be the article's main thrust.

[Xrlq]

Drugs are good, mmmkay?

[Ruthless]

This helps explain to me why so many of us are so eager to get marijuana legalized.

The "not too sharp" among us who are the voting majority, have a bi-polar attitude toward drugs: If certain drugs are therapeutic, we should OD on 'em. If they are recreational, we should kill anyone with so much as an impure thought about taking them.

So folks such as Jacob Sullum want to try to be sure marijuana is perceived as therapeutic.

I still contend that the "not too sharp" are sharp enough to know that they own their bodies.

If I'm wrong, hey, let's give up, and just keep sneaking around with our mouths shut.

[Pavel]

I think this is an extremely difficult topic to do justice to, especially in a short post. My position on this issue is something I've thought a lot about, though, so it will take a while to explain. I agree and disagree with parts of what everyone has added.

First off, the issue of whether ADD is "real" or not. Sure it's real, in the same sense that hikikomori is real. But we don't tend to treat such things in sociocultural contexts. Why don't we don't ask where, in America, all the people with hikikomori are hiding and where all the ADD patients were 70 years ago?

We treat these things simply as "diseases." One upshot of medicalizing something (and there are enough upshots to fill a Thomas Szasz book) is the simplicity. It allows us to speak of the issue in a sanitary medical language. You either have this disease or you don't. That's certainly the case with having multiple sclerosis and AIDS, so why not ADD? When it comes to psychiatric medicine, it is very much a case of "when all you've got is a hammer, every problem looks like a nail."

So that's what Ritalin is, it's a pharmaceutical hammer. However, outside the issue of doctors coersively swinging the hammer at patients or the issue of parents imposing their will on their children (with chemicals as much as any tool of force), I can't at all agree with the sentiment that it's an oppressive dilemma.

Any psychiatrist who's honest enough will tell you, treating these "disorders" is largely a crapshoot. You give the "medicine" and see how it effects the "patient." If the patient responds largely positively (i.e. get what they came for) then you go ahead and say that they have ADD (if it was an ADD drug that did it) or depression (if it was a depression drug that helped).

So while I think the "children's disorder" approach is a lot of doublespeak, I don't think the end result is that terrible.

Jennifer asks an interesting question:
Is it purely coincidental that the more school curricula are watered down, the more kids seem to be diagnosed with ADD? The kids aren't sick--they're bored out of their freaking minds.

I couldn't agree more! My counter would be to ask this: What's wrong with giving them Ritalin for exactly this reason? In fact, if we're going to strip away all the BS and talk about what's really going on, let me ask this.

Is it wrong to say, "You know what? I know my child's cirriculum is boring, the teachers are stupid, and mostly public education sucks. But maybe if I give Ritalin to my utterly disaffected child, they'll be more likely to latch on to something interesting and that will get them through this difficult period and onto the next stage in their life."

I would dare to say there might not be anything wrong with it at all! And if you take away the issue of parents possibly forcing something unwanted onto their children, I don't think you could come up with an argument against it. The problem is we don't talk about it in such terms and we don't ask corresponding questions. Like, "wait...why *does* school suck so much?"

I think the libertarian position, taken to it's logical end, goes exactly like this. People have a right to drugs. Ultimately, to control their own brains. Even when we couch it in a medical language, drugs are tools. As they become more and more acceptable, people will use these tools for what ends they see fit. In 100 years, it's perfectly reasonable to assume that we'll all be on lots and lots of drugs that alter our minds. I, for one, don't find this terribly scary. It's pharmalogical Luddism and pure fantasy to oppose it, really.

I would still ask the question Huxley asked: Will the nature of our wants and desires, allowed to fully bloom, be the ultimate thing that destroys what it means to be human? Perhaps. Again I would counter with a question: Who is to say what it will mean to be post-human? And will they have the proper drugs to do it with?

[Pavel]

Not to toot my own horn here...but with the time I just spent on that last comment, I should have *sold* it to Reason instead of posting it for free.

[Pavel]

That hikikomori link didn't seem to work, it should go here.

http://news.bbc.co.uk/2/hi/programmes/correspondent/2334893.stm

[Ruthless]

Pavel,

Selling it to Reason plus a buck forty will buy you a "tall" at Starbucks.

[kevrob]

What has always creeped me out about Ritalin and ADD/ADHD assessments by public school employees is that there is an element of coercion. Unless one has the scratch to pay for a private school, or can take the economic hit associated with home schooling, the mandatory attendance laws force you to the government's schools. There, non-M.D.'s frequently make the assessment. "School psychologists'" and psychiatric social workers' opinions have much weight. They can report to "scrip-happy" practitioners, who they are fairly sure will write an order for pills.

"...Primary care and developmental pediatricians, family practitioners, (child) neurologists, psychologists, and psychiatrists are the providers responsible for assessment, diagnosis, and treatment of most children with ADHD. There is wide variation among types of practitioners with respect to frequency of diagnosis of ADHD. Data indicate that family practitioners diagnose more quickly and prescribe medication more frequently than psychiatrists or pediatricians. This may be due in part to the limited time spent making the diagnosis." From an NIH report:

http://consensus.nih.gov/cons/110/110_statement.htm#6_5._What

The Taylors aren't the only family to get a boot on their necks for not wanting to keep their kid on a stimulant. See:

http://www.breggin.com/schools

There is a distinct air of "shut up and take your meds" to the whole business.

Kevin

[Pedro]

Mmmm... coffee...

[Amy Alkon]

Personally, I don't see ADHD (which I have been told I have) as a disease, and quite frankly, I don't think I have some disease or disability. I simply have a different brain chemistry that a lot of people; one which would have made me a high-functioning person in an evolutionary environment, due to the ability to be attentive to a lot of things at once. In the current environment, it takes a diagnosis of illness to get the "better living through chemistry" you might need. I take Ritalin because it helps me focus better, as a well-adapted person for the evolutionary environment, but one not-so-well adapted to a job where I sit staring at a computer screen every day until the muse slaps me upside the head. I don't see Ritalin as medicine, but as concentration vitamins. That said, I see a lot of underparented children around these days -- and maybe the school isn't to blame for wanting to drug these brats. How come, when I was growing up (I'm 40, born in '64), no boys were running around the classroom acting out? Maybe because they'd get their rowdy little asses kicked by their parents if they did. Parents...remember them?

[Czar]

I've been diagnosed as dystemic (clinically depressed) and told I have ADD. While I'm not so sure my "problems" are so easily explained away (I fit some symptoms and not others), there's definitely SOMETHING wrong with me. I take 30mg a day of Celexa just to balance me out. If I go more than a week or so off of my meds (trust me, I've tried going without, sometimes for a few months), I get sick.

Basically, it comes down to this: around the age of 16 until about 21, I was getting sicker and sicker. I'd feel this wild, incredibly strong, unfocused fury (and there I feel is the real indicator that something was wrong--the anger was completely unfocused, unrelated to any internal or external stimulus). I was just plain angry, no matter how good or bad my life was at the time. Call me a perfect example of Mill's ideal back in the day--my passions were completely independent of reason (or my anger was, at least).

Again, I can't stress it enough--I was angry for no reason. Anger completely devoid of any correlation to any rational/irrational stimulus. The part of my brain that made me angry was just firing like mad for no reason, like a key jammed down on a keyboard just typing the same thing over and over until the system crashes.

30mg a day evens me out and allows me to live my life. My mind is under control and able to make rational decisions without having irrational anger clouding everything. I'm not out to always be happy. I'm still angry, sad, annoyed, etc. all the time--but on meds, I feel those ways when I have a reason to, not just because my brain produces too much of chemical x.

So yes, if you're medicating just to be walkin' on sunshine 24/7, or if there's just something external irking you, taking meds isn't the best alternative. In situation where your brain is just firing willy-nilly without any rhymhe or reason, however, I see nothing wrong with something to correct the problem. I can see where people are wary about medication... hell, I'm not "normal" by society's standards even with my meds, but that "abnormality" isn't something that needs to be medicated--it comes from the way I think and choose to live my life. There's a difference between an abnormal personality and abnormal brain functions.

[Mr. Nice Guy]

I would feel much better if we stopped beating around the bush. Pharm companies need to have their own private security forces and be permitted to arrest and re-educate those who refuse to take their drugs.

[Alan]

I've observed since moving from Canada that there is an interesting attitude here in the US with regards to drugs. Drugs that come from the pharmaceutical industry are 'good'. All others are bad.

My son has some issues behaving like a drone in school. His clashes with the teachers have him labeled as a discipline problem. Then a committee was formed to discuss his behavioural problems. Next thing I know I get a call from a doctor appointed by the school who tells me (having never met my son) that he needed medication. When I asked about 'zero tolerance' for drugs she didn't get it.

In the end they tested him and found he was off the charts in abilities. Now he's at a 'gifted' school where they actually challenge the kids. Guess what? No problems.

I'm sure that there are extreme situations where medication is the only recourse, but it should be the last recourse. The current US attitude of drugging children to make life easier for teachers is wrong and especially hypocritical as they post 'drug free' notices around the school.

From talking to other parents what I've observed is that any kid who isn't in the center of the bell curve is at risk of being singled out and drugged.

[Steve Horwitz]

A few comments:

1. One of the problems in testing/treating ADD is a class issue: wealthier kids can afford the testing and treatment in ways that poorer ones cannot. Teaching at a university with some very wealthy kids and some ones of very modest means, I see this effect all the time. There are also some interesting differences between public and private schools in this regard.

2. I generally agree with the comments about the role of parenting here, and the effects of crappy schools on kids' attention spans. I don't doubt that changes in brain chemistry are real, but I wonder if they are the effect, not the cause, of other things. Many of the "symptoms" of ADD etc are also the symptoms of boredom and the like.

3. They are also the symptoms of being a 12 year-old boy. It's interesting that boys are much more likely to be diagnosed than girls. How much of this is related to what some have called the "feminization" of boys? Of course we shouldn't tolerate "boy" behavior that's coercive, but we shouldn't see "boy" behavior that can and should be corrected through parenting/discipline as a disease requiring mind-altering drugs. And we probably should recognize that some boy behavior just is part of being a boy.

4. And the question raised by the original link about abuse and neglect is indeed *who decides?* I think parental rights issues are among the very toughest for libertarians. Even if we grant that the state should be able to prevent parents from denying life-sustaining medication to a child, determining what counts as "life-sustaining" and who should make that judgment can be very tricky propositions in many real-world cases.

[Lisa Simpson]

Thoreau: so those around the patient are suffering more than the patient himself?

Recently I've heard it posited that ADD is the result of maternal (antenatal) stress. More specifically, Gabor Mate (MD) suggests that it stems from maternal stress + innate emotional sensitivity in the child + poor discipline/attention (see the book "Scattered").

[thoreau]

Lisa-

I think the scientist was half-joking. But the point was that depressed patients are a nightmare to deal with, and there's no point in feeling guilty if you can't keep them happy. There's nothing you can do to make them happy, and they'd respond to you irrationally no matter what you might do.

[Pavel]

Pavel,

Selling it to Reason plus a buck forty will buy you a "tall" at Starbucks.

You'll be interested to know that Reason gets four out of four $s in the 2004 Writer's Market (that's twice the freelance rate listed for The Nation). Considering the subscription price, it's obvious that Reason prints its own money or that "donate" button is working better than you'd think.

[Pavel]

I've observed since moving from Canada that there is an interesting attitude here in the US with regards to drugs. Drugs that come from the pharmaceutical industry are 'good'. All others are bad.

I've been working with the drug legalization movement for a while now. One of the most irksome things that I've noticed within the movement is the widely held corollary to your sentiment.

Illegal drugs are good. Pharmaceuticals are bad.

These sentiments often seem tied to holdovers from the '60s--strange and radical/leftist anti-drug messages. You can see some of it in Huxley. Alan Ginsberg expressed it when he said "speed kills" and labeled it a state tool of control.

I can understand attacking government hypocrisy on this point. But too often, there's an element of anti-corporatist Brave New World paranoia and, quite simply, a personal preference for who should be doing what drugs and why.

[Mo]

Alan:
Daddy, is that you?

Seriously though, my parents told me this exact same scenario happened with me as a kid. Gee, imagine that a bored kid being disruptive. I ended up staying in the public school system in the GATE program, but supposedly my behavior got better (I never did get rid of that disruptive streak).

[dhex]

and i hope that research in the future figures out where, when and if that line begins, and how much influence they have on each other.

i'm now helping a third friend off of paxil when he needs someone to sit with him and hold the bucket and all that fun stuff, and i'm sort of in the mood to beat the living shit out of a glaxo rep. and he's got at least another 5 weeks of this crap to go through.

nefarious cunts they be.