Why am I writing about ADHD on what purports to be a retirement blog? Well, the answer is because I can and because I’ve rather enjoyed saying the things I’m about to say. Also I have an ex-colleague who, I believe, is saying good things about the area and I want to support him.
The fact that this is the first (although not the last) blog in a new category, that of mental health, I suppose merely reflects my career history working as an educational psychologist. I said that my blogs would be both amusing and serious, this blog is in the latter category. I warn you it is a polemic, sometimes known as a rant.
The topic of this blog is fraud. Nothing new there you would say. We live in a world of fraud, banks, energy companies, pay day loans, politicians, even some criminals, so we need not be surprised that drug companies fit neatly into the ‘you’re being conned’ list. And oh for the days when you could trust academic research without first having to check whether the research was being sponsored by, in this case, the drug companies. Ridiculous you say, a fact is a fact. Wrong.
In the case of the drug companies it seems to me, as with depression (much of what I’m about to say I’ve already laid out in my blog on depression but I think it bears repeating), is that they operate on the wholly dishonest, we’ve got this drug – developed for other purposes entirely but wouldn’t it be great if we could persuade people that it was good for other problems, basis. We could make millions. So we’ve got the drug all we need now is a ‘condition’ (wow, that’s a serious word, must be real) that can be lined up with the drug. Drug cures condition, that sounds much better than drug suppresses symptoms but with serious side effects.
Of course a condition needs a name, a label. It’s part of the human condition to label things. Categorisation brings a sense of order to our lives. This makes sense otherwise, every time we came across a chair, we would have to consider, is this a chair? So much easier to be able to say – this is a chair, that is a chair, they’re all chairs. So fair enough, a label can be a helpful thing but so can paracetamol providing we don’t take too many. In other words we don’t take this labelling business (irony intended in case you didn’t recognise it) beyond the weight that it can bear. Categorisation shades all too easily into stereotyping and that’s not good.
In my view negative stereotyping is exactly what is happening in the world of psychiatry and the drug business. Yes, I know they (drug companies) do an awful lot of good but that doesn’t excuse them doing an awful lot of harm. And let’s not forget that what good they do do, they do for profit not out of the goodness of their hearts. If it benefits us as well, well then that’s a bonus, but it is not a starting point. Yes, this is polemical.
My real problem with a label, as I’ve written elsewhere, is that, in the world of mental (as opposed to physical) health, it is a false friend. A label, in this case Attention Deficit with Hyperactivity Disorder – ADHD (note the last word, I will return to it) has certain advantages of course, otherwise they would not be as pernicious in the world of mental health as they in fact are. Let me deal with these supposed advantages of a label. First, they are a comfort, you’re not alone, so if you subscribe to the ‘misery loves company’ school of thought, you’re helped already.
Second, it is a sad fact that labels lead to funding. That’s what a statement of Special Educational Needs does –another potential millstone for a child but then I can’t, in all honesty, lambast this system too much because that is the system I spent many years supporting. Now that ADHD has been ‘recognised’ (a weasel word – recognised by who? Psychiatrists and drug companies, yeah, right) as a condition (a medical term wholly inappropriate in my view to the world of mental health but, yes, I accept that this might place me in a minority), this too brings funding. Sometimes, the money itself (although not the label) is well deserved but it is a myth, in my view, that funding can only go to the deserving on the back of a label. This correlation between ‘diagnosed’ condition and funding is an evil gift from the American branch of psychiatric practice -The Diagnostic and Statistical Manual of Mental Disorders (DSM), that ever-expanding, money-making comfort blanket / bible of the intellectually marooned. It may take a little more time to attach funding to need without a label but it is not impossible. The current system is simply lazy (or worse) thinking. Tick the boxes, count the points, give the label, job done. I know I’m being a little simplistic here but as I told you at the beginning this is a polemic.
In some cases even the immediate relief (in my experience this relief never lasts when we get past the emperor’s new clothes stage) it gives to parents and carers and, to a lesser extent, educators is misguided. Parents, who through pressure on their GPs – for ADHD is a medical ‘diagnosis’, a lovely word, so neat, so proper, so trustworthy, manage to get their child labelled, do so solely so they can get more money. And in some ways, good luck to them you might say and I might agree were it not for the cost to the child and I would suggest in the quality of the relationship between parent and child, the nature of the relationship redefined forever. And not, in my humble opinion, for the better.
Yes the medication slows them down, takes care of the hyperactivity part and, if you like the concept of ‘child as zombie’, then you’re on a winner here. I prefer the term over-active and what’s wrong with exercise or yoga? – you wouldn’t make any money, that’s what’s wrong. I worked in a school with an over-active child, they let him get up and walk to the other side of the classroom where they had deliberately placed his water bottle – a release, a form of exercise, you see. Go ahead, scoff, but, in my (considerable) experience, of such small strategies are life changing experiences crafted.
So slow them down and make sure you overlook the side effects of the Ritalin even the Daily Mail is on to this small disadvantage of medication on children. Well small if you call stress and anxiety, cardiovascular complaints, decreased appetite and weight loss, stomach problems, dizziness, tics, skin problems including bruising, stop, stop, and all in children sometimes younger than 10. Wow, we must be proud. The headline in the Daily Mail is :
Ritalin calms hyperactive children and prescriptions are soaring – but experts warn of serious side-effects and it’s even being linked to suicide
Incidentally, the evidence for improving attention and hence performance in school seems less convincing to me. Yes, but you might further say, but the child will take great comfort in the fact that they’ve got a condition which means they cannot help what they do. And we know that parents often like to think that their child is uncontrollable rather than uncontrolled. Not my fault, guv, he’s got a condition. The label promises salvation and leads only to disempowerment. If I had a pound etc for every child or young person who starts our conversation with the line ‘I can’t help it (my behaviour) I’ve got ADHD (or ODD or Aspergers etc etc.). And all to give somebody a quieter life. Never mind the harm. And yes, I know there are parents out there desperate for help. How much more unsavoury it is then that we deceive them.
I would have less problem with a label if it led to a unique strategy, other than medication, that could not be accessed by any other method other than the giving of the label. Read any strategy book on ADHD and the strategies are primarily good and sensible behaviour management strategies. You don’t need the label, and all the baggage that goes with it, to access these strategies. The only ‘unique’ strategy with the label of ADHD is medication. The quick fix, calm them down, shut them up
Even a genuine, i.e. has a bio-chemical basis, label like Down’s Syndrome a genetic disorder caused by the presence of all or part of a third copy of chromosome 21 (from Wikipedia) is fairly useless. Yes, we accept that children have the ‘condition’ Down’s but the range of abilities, personalities, prognoses, etc that are contained within the label make it virtually useless (definition of useless – when within group variables are bigger than between group variables) except perhaps as a funding mechanism. But here again funding would more properly be allocated on a precise needs-related basis rather than on the say so of the label. So even a genuine label is quite useless often serving only to depress our expectations rather than enhance them. Isn’t that our job as psychologists – to enhance prospects, potential, outcomes, choose your own word?
ADHD has none of the legitimacy of the Down’s Syndrome label. It has no ‘scientific’ basis. In the bogus world of ADHD what people do not seem to realise is that it is not actually a medical condition. ‘Wire’ a child supposedly with ADHD up to an EEG machine and there is no difference in their brain patterns. I know that some colleagues and some friends would disagree with my conclusion but nothing in the research I have read would suggest otherwise. Yet continually professionals and the media in their sloppiness refer to ADHD as if it were a bio-chemical or physical condition, a disease or disorder These terms are linked in the dictionary. He’s got a disease doesn’t sound so great, does it? He ‘suffers from’ ADHD, the newspapers or whoever will say. The terms diagnosed, condition, disorder, disease etc, all those quasi medical terms are regularly and carelessly littered through writings and conversations ranging from the pub to the university, from The Sun to the Harvard journal. The so-called diagnostic process, consists of the child obtaining a given score on a checklist completed by parent/s and teachers. 7 out of 10, that’s you sorted, you’ve got ADHD.
I have spent my professional life as a psychologist refusing to collude with the duplicity of diagnosis. Sounds grand but it’s not really. The world of psychiatry is rife with diagnosis, understandable when you realise that psychiatrists are trained as doctors then specialise in psychiatry, conveniently taking their diagnostic processes with them. Nothing heroic in my refusal to collude as can be seen from this blog. It needs to be done.
Don’t we know by now that, in the world of mental health, there is no such thing as a quick fix (even Brief Therapy, of which I am an advocate, takes time), just a series of small, sometimes tiny, steps. How despicable is it that the people in greatest need become the victims, as with pay day loans, are conned into believing there is a quick fix by those who should know better. Some people stand up for those who have small voices. I’d like to think in some very small way that might be the role of this blog.
So polemical, you bet, a rant, yes, unfair and unbalanced, maybe, but then that’s the nature of the opposition, sometimes you have to be ‘unfair’ to make the point – ADHD has not been proved to exist, medicating children for something not proven is a very bad thing. That’s what I needed to say. Maybe I needed to be retired to say it.