English 654 Rhetoric of Science
Professor Wexler
Nami Olgin
October 30, 2013
Disorder or Not: Medicalization Debate on ADHD
In pediatric medicine for the last two decades, there has been a growing emergence in the diagnosis of behavioral problems that are perceived as a challenge to both parents and teachers and of which management and containment become out of their bounds. Characteristics such as disobedience have officially become a medical matter with its indicative labeling of the characteristic as Oppositional Defiance Disorder. Just about every what used to be as just a personal quirk now has a medical nomenclature of which designation implies abnormality so called disorders. One of the most prominent of all is Attention Deficit Hyperactive Disorder or ADHD - the four-letter word combination, which now seeps into the mind of every parent with a school age child who is hyper (or energetic, to add the neutrality of this adjective) and has difficulty in focusing. With that diagnosis, their children’s hard to manage behaviors can be medically acknowledged as symptoms that are subjected to psychiatric medicinal treatments.
Beginning in the late 80’s, the number of the ADHD diagnosis has rapidly increased thus without much exposition to counter arguments, the public, or the layman community started acknowledging hyperactivity and a lack of focus as a medical disorder, which legitimized medical interventions, as with any other diseases, by physician. However, there was a community of physicians that was alarmed by this trend and negated the medical designations of the problematic behaviors by mythologizing ADHD. Their criticism of the rampant ‘over diagnosis’ of ADHD evolved around the diagnostic methodologies that could lead to undetected misdiagnosis such as disguised giftedness, unproven drug effectiveness along with long term negative consequences of prescribed medication both physically and psychologically. Author David Nylund in his book Treating Huckleberry Finn attributes the dramatic increase in the ADHD diagnosis, what he calls a epidemic, to US’s “current biopsychiatric climate” (12).
A preliminary ADHD diagnosis is largely initiated by the observations from individuals who have been deeply affected by the symptoms; in ADHD’s case, they are teachers and parents. Most often, the teacher detects something abnormal about a student and suggests to his/her parent(s) for diagnosis. Any on-line search on ADHD quickly puts a concerned layman in the medical context as the first few hits will lead him/her to the how-tos of preliminary ‘diagnosis,’ or the layman’s as it were litmus test even though in this diagnosis, there is no numeric value associated with it unlike blood pressure or cholesterol level that gives one distinction between what is normal or abnormal. A decade ago, even a doctor admitted there have been no biological measures to confirm the disorder. In analyzing the underlining intention of the standardized ADHD evaluation mechanisms such as Conners Rating Scale or Diagnostic and Statistical Manual of Mental Disorder, or DSMs, Nylund states, “the standard evaluation for ADHD purports to offer concise, objective assessment of the presence or absence of ADHD symptoms” (24) as well as suspecting the presence of non-medical factors that contributed to the much established diagnostic tools: “The influences of managed care, with its omnipresent focus on time and money, have forced many clinicians to make rapid-fire diagnoses, often after one brief intake session”(24).
The etiologies of the disorder has been inconclusive and as with any medical symptoms, the determination of causes underwent a conceivable progression: first it was the environmental surrounding the child such as family dynamics; then biological and ADHD is now widely being accepted as a neurological disorder in which there is a certain chemical deficiency proven in the ADHD’s brain. Eventually, as with cancer of which causes pose much complexity, the genetic component is confirmed in the development of ADHD as a possible reflection of emerging bioreductionism. At the same time, there has been an on-going debate over the factors that trigger the symptoms of ADHD such as food and video games. But the environmental factors that put the parents in control of the symptoms are at this point no more than hearsay and a scientific probing of it is not systematic but fragmented. Furthermore, according to Nylund, “some of parents of children who receive the diagnosis of ADHD characterize the [biological] diagnosis as liberating and empowering, [as well as] comforting” because the finding in “child’s faulty chemistry provides relief from blame and guilt” (29).
Being acknowledged as a neurological disorder, the treatment has involved a plethora of medications to correct the chemical imbalance. Ritalin, a stimulant, has been widely prescribed and according to Nylund, “marketed” to lessen the symptoms of ADHD and of which sales has grown by 700 percent [over a decade] since 1990 (Nylund xv). Nylund explains that Ritalin was developed in response to the finding that ADHD is attributable to a dopamine deficiency. For a layman, it seems logically counterproductive to use a stimulant to suppress hyperactiveness but the idea, Nylon states, “is based on a widely accepted psychiatric premise: if a patient responds to a psychotropic medication, it proves that a chemical imbalance is a present.., thus the medication makes up for the deficiency and restores a patient’s chemical balance” (28). Nylund consistently refuted the notion of ADHD being a biological disorder and being a physician, his refutation separated from other kinds of criticisms that lacked scientific basis. In 2002, clearly referring to Nylund’s Huck Finn metaphor, a group of international (mostly U.S. physicians) scientists released a consensus statement in response to skepticism though small but had the potential to shake the widely subscribed medical belief. The statement ending reads: “To publish stories that ADHD is a fictitious disorder or merely a conflict between today's Huckleberry Finns and their caregivers is tantamount to declaring the earth flat, the laws of gravity debatable, and the periodic table in chemistry a fraud. ADHD should be depicted in the media as realistically and accurately as it is depicted in science -- as a valid disorder having varied substantial adverse impact on those who may suffer from it through no fault of their own or their parents and teachers.” (International Consensus Statement on ADHD) and it immediately followed an extensive and impressive list of physicians – as sociologist Antonio Maturo aptly describes in “Medicalization: Current Concept and Future Directions in a Bionic Society,” its implications through Foucault who considered the process of indefinite medicalization to be one of the main features of society and stressed the role of doctors in deciding what was normal and what was pathological.
Since the turn of the century, the perception of ADHD as a medical condition becomes mainstream, thus the use of prescription drugs has become the standard practice with little resistance on the part of educators and parents. Many resources on ADHD start with a premise that the “medical breakthroughs” have proven that ADHD is a neurological disorder caused by a neurochemical deficiency and that ADHD brains are wired differently. Maturo sheds light on the public’s acceptance of this premise as a fact: “the expansion of medical categories into social spheres, which were not previously “read” medically, may play a reassuring role. For example, if we think that boisterous children are sick and have neurological problems and chemical imbalances, we allow ourselves to avoid looking at social problems… A pill which works on serotonin levels is easy to prescribe, and is cheaper and “cleaner” than any social policy” (page number not shown on web format).
Although it has been emphasized at least on the surface that the purpose of medication is to improve the life of the affected, who really benefits from the medicalization of ADHD? Not the parents who have to deal with the times of waning effectiveness of the drugs but the teachers who can restore a well managed class with corrected ADHD students through medications.
Works Cited
“International Consensus Statement on ADHD, January 2002.” Clinical Child and Family
Psychology Review 5(2): 89-111; Jun 2002 Web. 18 Oct. 2013.
Maturo, Antonio. "Medicalization: Current Concept and Future Directions in a Bionic Society."
Mens Sana Monographs, 10.1 (2012): 122-133. Web. 22 Oct. 2013.
Nylund, David. Treating Huckleberry Finn. San Francisco: Jossey Bass, 2000. Print.
See Annotated bibiography for additional Sources
Professor Wexler
Nami Olgin
October 30, 2013
Disorder or Not: Medicalization Debate on ADHD
In pediatric medicine for the last two decades, there has been a growing emergence in the diagnosis of behavioral problems that are perceived as a challenge to both parents and teachers and of which management and containment become out of their bounds. Characteristics such as disobedience have officially become a medical matter with its indicative labeling of the characteristic as Oppositional Defiance Disorder. Just about every what used to be as just a personal quirk now has a medical nomenclature of which designation implies abnormality so called disorders. One of the most prominent of all is Attention Deficit Hyperactive Disorder or ADHD - the four-letter word combination, which now seeps into the mind of every parent with a school age child who is hyper (or energetic, to add the neutrality of this adjective) and has difficulty in focusing. With that diagnosis, their children’s hard to manage behaviors can be medically acknowledged as symptoms that are subjected to psychiatric medicinal treatments.
Beginning in the late 80’s, the number of the ADHD diagnosis has rapidly increased thus without much exposition to counter arguments, the public, or the layman community started acknowledging hyperactivity and a lack of focus as a medical disorder, which legitimized medical interventions, as with any other diseases, by physician. However, there was a community of physicians that was alarmed by this trend and negated the medical designations of the problematic behaviors by mythologizing ADHD. Their criticism of the rampant ‘over diagnosis’ of ADHD evolved around the diagnostic methodologies that could lead to undetected misdiagnosis such as disguised giftedness, unproven drug effectiveness along with long term negative consequences of prescribed medication both physically and psychologically. Author David Nylund in his book Treating Huckleberry Finn attributes the dramatic increase in the ADHD diagnosis, what he calls a epidemic, to US’s “current biopsychiatric climate” (12).
A preliminary ADHD diagnosis is largely initiated by the observations from individuals who have been deeply affected by the symptoms; in ADHD’s case, they are teachers and parents. Most often, the teacher detects something abnormal about a student and suggests to his/her parent(s) for diagnosis. Any on-line search on ADHD quickly puts a concerned layman in the medical context as the first few hits will lead him/her to the how-tos of preliminary ‘diagnosis,’ or the layman’s as it were litmus test even though in this diagnosis, there is no numeric value associated with it unlike blood pressure or cholesterol level that gives one distinction between what is normal or abnormal. A decade ago, even a doctor admitted there have been no biological measures to confirm the disorder. In analyzing the underlining intention of the standardized ADHD evaluation mechanisms such as Conners Rating Scale or Diagnostic and Statistical Manual of Mental Disorder, or DSMs, Nylund states, “the standard evaluation for ADHD purports to offer concise, objective assessment of the presence or absence of ADHD symptoms” (24) as well as suspecting the presence of non-medical factors that contributed to the much established diagnostic tools: “The influences of managed care, with its omnipresent focus on time and money, have forced many clinicians to make rapid-fire diagnoses, often after one brief intake session”(24).
The etiologies of the disorder has been inconclusive and as with any medical symptoms, the determination of causes underwent a conceivable progression: first it was the environmental surrounding the child such as family dynamics; then biological and ADHD is now widely being accepted as a neurological disorder in which there is a certain chemical deficiency proven in the ADHD’s brain. Eventually, as with cancer of which causes pose much complexity, the genetic component is confirmed in the development of ADHD as a possible reflection of emerging bioreductionism. At the same time, there has been an on-going debate over the factors that trigger the symptoms of ADHD such as food and video games. But the environmental factors that put the parents in control of the symptoms are at this point no more than hearsay and a scientific probing of it is not systematic but fragmented. Furthermore, according to Nylund, “some of parents of children who receive the diagnosis of ADHD characterize the [biological] diagnosis as liberating and empowering, [as well as] comforting” because the finding in “child’s faulty chemistry provides relief from blame and guilt” (29).
Being acknowledged as a neurological disorder, the treatment has involved a plethora of medications to correct the chemical imbalance. Ritalin, a stimulant, has been widely prescribed and according to Nylund, “marketed” to lessen the symptoms of ADHD and of which sales has grown by 700 percent [over a decade] since 1990 (Nylund xv). Nylund explains that Ritalin was developed in response to the finding that ADHD is attributable to a dopamine deficiency. For a layman, it seems logically counterproductive to use a stimulant to suppress hyperactiveness but the idea, Nylon states, “is based on a widely accepted psychiatric premise: if a patient responds to a psychotropic medication, it proves that a chemical imbalance is a present.., thus the medication makes up for the deficiency and restores a patient’s chemical balance” (28). Nylund consistently refuted the notion of ADHD being a biological disorder and being a physician, his refutation separated from other kinds of criticisms that lacked scientific basis. In 2002, clearly referring to Nylund’s Huck Finn metaphor, a group of international (mostly U.S. physicians) scientists released a consensus statement in response to skepticism though small but had the potential to shake the widely subscribed medical belief. The statement ending reads: “To publish stories that ADHD is a fictitious disorder or merely a conflict between today's Huckleberry Finns and their caregivers is tantamount to declaring the earth flat, the laws of gravity debatable, and the periodic table in chemistry a fraud. ADHD should be depicted in the media as realistically and accurately as it is depicted in science -- as a valid disorder having varied substantial adverse impact on those who may suffer from it through no fault of their own or their parents and teachers.” (International Consensus Statement on ADHD) and it immediately followed an extensive and impressive list of physicians – as sociologist Antonio Maturo aptly describes in “Medicalization: Current Concept and Future Directions in a Bionic Society,” its implications through Foucault who considered the process of indefinite medicalization to be one of the main features of society and stressed the role of doctors in deciding what was normal and what was pathological.
Since the turn of the century, the perception of ADHD as a medical condition becomes mainstream, thus the use of prescription drugs has become the standard practice with little resistance on the part of educators and parents. Many resources on ADHD start with a premise that the “medical breakthroughs” have proven that ADHD is a neurological disorder caused by a neurochemical deficiency and that ADHD brains are wired differently. Maturo sheds light on the public’s acceptance of this premise as a fact: “the expansion of medical categories into social spheres, which were not previously “read” medically, may play a reassuring role. For example, if we think that boisterous children are sick and have neurological problems and chemical imbalances, we allow ourselves to avoid looking at social problems… A pill which works on serotonin levels is easy to prescribe, and is cheaper and “cleaner” than any social policy” (page number not shown on web format).
Although it has been emphasized at least on the surface that the purpose of medication is to improve the life of the affected, who really benefits from the medicalization of ADHD? Not the parents who have to deal with the times of waning effectiveness of the drugs but the teachers who can restore a well managed class with corrected ADHD students through medications.
Works Cited
“International Consensus Statement on ADHD, January 2002.” Clinical Child and Family
Psychology Review 5(2): 89-111; Jun 2002 Web. 18 Oct. 2013.
Maturo, Antonio. "Medicalization: Current Concept and Future Directions in a Bionic Society."
Mens Sana Monographs, 10.1 (2012): 122-133. Web. 22 Oct. 2013.
Nylund, David. Treating Huckleberry Finn. San Francisco: Jossey Bass, 2000. Print.
See Annotated bibiography for additional Sources