ADHD: Has this diagnostic fad run its course? –

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ADHD: Has this diagnostic fad run its course? –

This article is by Stephen R. Herr, an assistant professor in the Department of Educational Studies, Leadership and Counseling at Murray State University, and can be found over at the Christian Science Monitor. Let me begin by applauding Dr. Herr’s efforts to “broaden our view” (quoting the text) with respect to the culture—and huge $4 billion medical and pharmaceutical economy—that has popped up (like a bubble) around the DSM (The Diagnostic and Statistical Manual of Mental Disorders) diagnosis known as ADHD (attention deficit and hyperactivity disorder). Before I go further, let me state that, in all likelihood, the diagnosis of ADHD does point to a true medical condition, but I agree with estimates that suggest that of all the ADHD diagnoses made to date, only about 15 – 20% are accurate in that they point to a true medical condition. By talking about an ADHD “bubble” or “culture” or “economy” I do not mean to “de-mean” the experience of true ADHD sufferers. In essence, I don’t want to throw the baby (true sufferers) out with the (ADHD bubble) bath water. That being said, in this post I will try to argue that it’s a mistake to look at societal bubbles (such as the ADHD bubble Dr. Herr focuses on) as being isolated events. In fact, we should make an attempt to recognize the themes and processes that unite them.

According to the article, the “ADHD bubble” (as the article calls it) began to inflate back in the 1980s. Dr. Herr is correct in drawing our attention to the fact that a substantial amount of air began to enter the ADHD diagnosis balloon (which started life simply as ADD or attention deficit disorder) at about the same time women began entering the workforce en masse. As Dr. Herr puts it, “[M]ore parents went to work and the role of schools and teachers changed [to that of substitute parent].” In my opinion, the rise of the ADHD culture should be looked at as “rise of the parent substitute culture.” As Mary Eberstat talks about in her 2004 book Home-alone America—The Hidden Toll of Day Care, Behavioral Drugs, and Other Parent Substitutes, the 1980s marked the emergence of all manner of parent substitute:

  • drugs (both legal and illegal)
  • schools and teachers
  • day care and pre-K programs
  • food (which has contributed to our current obesity problem)
  • sex (which has contributed to our current teen pregnancy problem)
  • certain forms of popular music (such as rap)

Dr. Herr (not unlike Eberstadt’s efforts) is trying to get us to “pull the curtain back” and look at what’s going on in society rather than become mesmerized by the smoke and mirrors that surrounds the “Wizard of Oz-esque” ADHD bubble (my quotes). And Dr. Herr “pulls the curtains” on other recent Wizard of Oz bubbles. He tells us that if we look behind the curtain, we see that …

  • … the hysteria bubble (of the Victorian age) was about framing women as weak.
  • … the eugenics bubble (of the early 20th century) was about framing immigrants and minorities as being inferior.
  • … the ADHD bubble was about pathologizing children (and medicalizing normal childhood development).

But what purpose do these bubbles ultimately serve? Dr. Herr touches on the answer to this question but here’s my take: they’re all about assuaging fear. Here’s what I mean:

  • Hysteria (also know as “wandering womb”) is about mens’ fear of a liberated woman.
  • Eugenics (also known as “good gene”) is about white culture’s fear of an invasion by immigrant and minority groups.
  • The ADHD culture is (in part) about women’s fear over leaving their children as they enter the workforce.

Where there’s fear there’s usually some form of societal boundary transgression taking place. And where societal boundaries are transgressed, there’s usually some form of “othering” or scapegoating taking place. In the above cases, women, minority groups, and children were cast in the role of other or scapegoat. But to make sense of why a new other or scapegoat pops onto the scene you must go back upstream and look at not only the social boundary transgressed, but also the nature of the fear that such a transgression produces (and in whom). I’m pulling a lot of this from Elaine Graham’s 2002 book (which I have summarized) Representations of the Post/Human: Monsters, Aliens and Others in Popular Culture.

Allow me to try to deconstruct the scapegoating of children that the ADHD culture seems to represent. Dr. Herr helps here when he suggests that “it was easier for [prevailing power structures]” to scapegoat than it was for them to address “the difficult conditions that women, minorities, and children faced.” Dr. Herr continues, “The creation of ADHD as a psychological disorder was in part an attempt to deal with some of the difficulties of raising children. Unfortunately, that attempt has fallen short and led to problems in recent years.” Here are the problems Dr. Herr points to:

  • No standardized diagnostic measure for ADHD exists within the medical and psychological professions
  • A huge $4 billion medical and pharmaceutical economy has been built around efforts to pathologize children and medicalize normal childhood development
  • We are now feeding our children copious amounts of Schedule II drugs (i.e., Ritalin, Adderall, and Vyvanse), stimulants that in many cases are more potent than cocaine (according to Finn Bowring—see his 2003 book Science, Seeds and Cyborgs: Biotechnology and the Appropriation of Life).

But what social boundary is being transgressed here? Simply put, the biological boundary is being transgressed. In his 2002 book Our Posthuman Future—Consequences of the Technological Revolution, Francis Fukuyama argues that feeding kids copious amounts of behavioral drugs (which the ADHD diagnosis legitimates and normalizes) represents a red flag on the road to our posthuman future, that is to say, a future where “life” (if the term is still appropriate) is now mechanically-based as opposed to being biologically-based. Ernest Keen makes the same point in his 2000 book Chemicals For The Mind—Psychopharmacology and Human Consciousness. Keen calls the widespread use of behavioral drugs (like Ritalin, Adderall, Prozac, Xanax, Zoloft, Effexor, Wellbutrin, etc.) “the second coming of lobotomy” (which is my paraphrase).

All this to say that I think Dr. Herr is making a big mistake by not widening our view even further and looking at the possibility that the so-called bubbles he points to are not isolated events or “fads” (as he calls them) but are in fact emanating from the same sludge pond, namely, posthumanism. As Keen points out, surgical lobotomy (which was also a mainstay of the eugenics movement) was too harsh for the general public to stomach. So, a kinder, gentler form of lobotomy was developed, namely, chemical lobotomy. As Wendy Kline argues in her 2001 book Building A Better Race—Gender, Sexuality, And Eugenics From the Turn of the Century to the Baby Boom, eugenics programs did not fall with the fall of Nazi Germany; in fact they continue albeit in kinder, gentler forms (not unlike Keen’s kinder, gentler chemical lobotomy). Kline points to such present-day things as gender roles, advertising, and even marriage practices as having decidedly eugenics overtones (if not outright purposes) to them. Using Kline as a backdrop, I would argue that the ADHD culture goes a long way toward defining what a good and compliant child is (the “eu-child”) as well as what the good and compliant parent is (the “eu-parent”). I would suggest that the DSM plays a huge role in defining the various “goods” or “eu’s” of society by defining the bad or the pathological. (I’d be remiss if I did not point out that back in the 1950’s, the DSM-I listed homosexuality as a mental disorder, and it looks like Asperger’s will be removed from the fifth version, this pointing out how much pathology is a moving target.)

So, all this to say that I don’t frame Dr. Herr’s bubbles as isolated passing fads. I think its dangerous to do so. Instead, I view them as emanating from the same eugenics sludge pond that has as its ultimate goal moving us from biologically-based entities to mechanically-based entities populating a posthuman world. DSM diagnoses, feeding children (and adults) copious amounts of behavioral drugs, moving women into the workforce (see Paul Stiles’s 2005 book Is the American Dream Killing You?: How “the Market” Rules Our Lives for more on this theme), genetic engineering, artificial wombs (again, see Finn Bowring’s work), prisonification of our schools, commodification of youth (see Henry Giroux’s 2009 book Youth in a Suspect Society for more on these last two themes), etc., are all signposts mapping our movement along the road toward our posthuman future. I may be alone in this opinion but I do not see this movement toward posthumanism as a passing fad or isolated bubble. Again, to see it thus is a personal mistake at best and a moral danger at worst.

PS – If you need an analogy to keep in mind here, consider the following: the Hawaiian Islands taken as a whole map the presence of a large magma chamber below. Find the islands for sure (as Dr. Herr has done) but focus on the magma chamber below.