Give em Ritalin

"Although the exact number of people taking Ritalin is not known, this year, experts estimate, as many as two million Americans - the vast majority of them children -- will take the medication, some as often as five times a day. … Critics within the medical community itself say the drug is being overprescribed by doctors whose understanding of ADHD [Attention Deficit and Hyperactivity Disorder] is woefully inadequate. They charge that the hallmark symptoms of the disorder - inattention, hyperactivity and impulsivity - could describe just about any child."

-- "The Rise of Ritalin" from The Morning Journal

Although there is no medical proof that there is such a thing as Attention Deficit and Hyperactivity Disorder (ADHD), over 3.5 million children in the United States are diagnosed as having some form of it. It is considered America's number 1 childhood psychiatric disorder and in the U.S. we prescribe Ritalin to treat it at a rate that is five times higher than the rest of the world combined.

Ritalin and other medications represent the second prong in what appears to be the medical community's two-pronged effort to treat or control the "disorders" suffered by a whopping 10 to 20 percent of U.S. children [Boston Globe, 6/28/99]. (See my previous July 1999 commentary, "Children: Their Deficiencies, Disorders, and Developmental Delays" for discussion of behavior modification - the other prong in the treatment effort, spearheaded by the new medical specialty Developmental and Behavioral Pediatrics.)

Peter R. Breggin, M.D., of the International Center for the Study of Psychiatry and Psychology writes in Talking Back to Ritalin (published by Common Courage Press) that:

• A large percentage of children become robotic, lethargic, depressed, or withdrawn on [Ritalin].
• Withdrawal from Ritalin can cause emotional suffering, including depression, exhaustion, and suicide. This can make children seem psychiatrically disturbed and lead mistakenly to increased doses of medication.
• Ritalin is addictive and can become a gateway drug to other addictions. It is a common drug of abuse among children and adults.
• ADHD and Ritalin are American and Canadian medical fads. The U.S. uses 90% of the world's Ritalin. CibaGeneva Pharmaceuticals (also known as Ciba-Geigy Corporation), a division of Novartis, is the manufacturer of Ritalin. It is trying to expand the Ritalin market to Europe and the rest of the world.
• Ritalin "works" by producing malfunctions in the brain rather than by improving brain function. This is the only way it works.
• Short-term, Ritalin suppresses creative, spontaneous and autonomous activity in children, making them more docile and obedient, and more willing to comply with rote, boring tasks, such as classroom school work and homework.
• There is a great deal of research to confirm that environmental problems cause ADHD-like symptoms.
• A very small number of children may suffer ADHD-like symptoms because of physical disorders, such as lead poisoning, drug intoxication, exhaustion, and head injury. Physical causes may be more common among poor communities in the United States.
• Ciba spends millions of dollars to sell parent groups and doctors on the idea of using Ritalin. Ciba helps to support the parent group, CH.A.D.D., and organized psychiatry.
• The U.S. Department of Education and the National Institute of Mental Health (NIMH) push Ritalin as vigorously as the manufacturer of the drug, often in even more glowing terms than the drug company could get away with legally.

Dr. Breggin goes on to ask, what if, instead of diagnosing the child, we diagnosed the situation? He lists several ADHD-inducing life experiences, including (among others):

• Environments that don't meet a child's basic needs for positive involvement with life, including unconditional love from attentive adults … ;
• Environments that don't meet a child's basic needs for rational and consistent discipline, reasonable principles of conduct, and firm but loving limits on negative behavior;
• Environments devoid of older children and adults who can provide models for rational, moral and loving behavior; and
• Environments created for the convenience of adult managers rather than for the growth and development of children [Talking Back to Ritalin, pp. 328-329].

While the medical community should be identifying diseases, conditions, and symptoms, and administering treatments and cures if possible, it should also concern itself with the larger context. When considering an inattentive child, for example, perhaps we should consider the possibility that it is quite reasonable that a small child would have an attention deficit in an institution like a school - many of which are so clearly deficient themselves and which offer very little that anyone would want to focus their attention on. Or perhaps "acting out" in the home could be seen as sensible given the isolation that many people experience at home, and the few outlets that children and parents have to interact productively in the larger society. Furthermore, doctors should ask: Who defines what is appropriate behavior? What is the range that is considered acceptable? Is our society structured to accept only a narrow range of behaviors, relegating the rest to medication, institutionalization, and/or ostracization?

Meanwhile, it is the job of progressive activists and commentators to keep questioning the role of large pharmaceutical companies in determining medical treatments, to investigate the social/political/economic institutions that mandate certain behaviors, to analyze the way the health care industry "treats" us and our perhaps quite orderly responses to the disastrous disorders we face every day, and to look out for children - our most vulnerable social grouping in our market-driven, expert-driven society.