Unresearched Diagnoses Vulnerable To Misuse

The love and concern for our children is one of the most powerful things in the lives of parents. We want them to succeed in what is an increasingly competitive world. Attention Deficit Hyperactivity Disorder (ADHD) touches on our fears and aspirations for our children. It also puts to the test the manner in which we accept their imperfections and the effect of those imperfections on us. This is why understandably the topic of ADHD causes such distress to parents.

When I queried this catch-all diagnosis, giving voice, incidentally, to a robust and ongoing debate underway in the scientific community, readers objected. I was accused of neglecting to do "research," although talking to ADHD stakeholders was usually how readers defined research. Let me say that while the human story is emotionally powerful and makes for good copy, in isolation, it is an anecdote with little research validity beyond that of a case study. I would hope, however, that people use their critical faculties to question orthodoxy. Arguments must ultimately be judged on their merit, not by the authority or the qualifications of those who make them.

In 1997, Robert Sternberg, a prominent Yale professor of psychology told The New Republic magazine there was no medical evidence to support the view that children who are labeled learning-disabled have an immutable neurological disability in learning. A year later the flagship American National Institutes of Health (NIH), confirmed his pronouncement. In a Consensus Statement on the Diagnosis and Treatment of ADHD, prepared by a non-advocate, non-Federal panel of experts, the NIH cautioned that there exists "no independent valid test" for ADHD, adding that "further research is necessary to establish ADHD as a brain disorder". This paper offers a distillation of the relevant research to date in the field.

There are persistent concerns in the research and clinical communities regarding the psychiatric Diagnostic and Statistical Manual of Mental Disorders (DSM) from which the ADHD and many other fashionable diagnoses are culled. The latest critical examination of the manual is entitled Making Us Crazy DSM: The Psychiatric Bible and the Creation of Mental Disorder. Written by two American academics, it received a nod from no less than the august British Times Literary Supplement (TLS), whose reviewer ventured that the DSM is an American invention, unique to that culture. The DSM, wrote American reviewer and social psychologist Carol Tavris, represents a "brilliant orchestration of pseudo-science, marketing and promotion," which has "succeeded in transforming the normal difficulties of life into mental disorders."

The book points not only to the shabbiness of scientific evidence inherent in the DSM, but to the hundreds of diagnoses created which are vulnerable to misuse. Conditions like "Oppositional Defiant Disorder," or "Conduct Disorder" harbor Orwellian possibilities. Such diagnoses were likely the bailiwick of the mental health professionals in the former Soviet Union, when they needed to dispose of dissidents. For real double-bind value, look no further than a DSM condition called "Non-Compliance with Treatment." Disagree with the medical demiurge, and he slaps you with a diagnosis. Safer not to risk that second opinion. Not only are "most of the DSM labels circular," avers the TLS reviewer, but they "confuse labels with explanations". Ultimately they aim to give the public a psychiatric explanation for the pain in their lives, and hope that a pill can eradicate it.

There are now approximately 5-6 million children on Ritalin in North America, up from 1 million in 1990. Most of the children being medicated are boys, with minority boys 11 times more likely to be on this stimulant. Ninety per-cent of Ritalin, which is supposed to help children focus, is marketed in the US. One can't help but wonder why American and Canadian children don't score very well on international scholastic tests. Maybe there isn't enough Ritalin going around? On the other hand, maybe the schools are failing children. Either way, it doesn't really matter: As long as Ritalin is making kids happier, who cares? Certainly not the pharmaceutical companies who are making merry with between $30 to $60 a month per medicated child.

By masking the pain of living with a pill, mental health professionals are abnegating their responsibility and traditional mandate to explore and improve the many psychosocial factors that influence a life. In the process, vital interventions are overlooked, and we whittle down control over and responsibility for our lives to the inaction and resignation inherent in a biological determinism. Finally, by allowing emotional life to be homogenized through pharmacology, we are passing up on what it means to be human.

The Calgary Herald

January 13