WSJ wakes up to the psychobabble labeling of children for profit in the USA.
Opinion Journal Wall Street Journal Online
CITIZEN OF THE WORLD Shrinking to Excess I'll be damned if I let a psychiatrist near my son. BY TUNKU VARADARAJAN Tuesday, August 21, 2001 12:01 a.m. EDT I have a confession to make: I have a mental illness, and it is called Psychobabble Defiance Disorder. Since at this moment I am also afflicted with Ranter's Syndrome, I intend to have my say on a topic that troubles me. No, let me put that more strongly, a topic that makes me flood the room with rage. My boy, who turned two last month, will start to go to the local church school in the middle of September. His class, which will convene twice a week for two hours each time--short and sweet, which is how it should be for one so young--is called "Early Twos." I send him with mixed feelings, of course: How could I not? On the one hand, there is pride in his having grown up enough to go out in "the world," even if it is only to the assiduously controlled cocoon of an Episcopal school, three-and-a-half minutes by foot from our home. On the other hand, once out in the world, the little mite will be exposed to the vagaries of the benighted educational-medical complex, which regards it as its business to label all our children as being sufferers of some disorder or other. This won't happen at his church school, for sure--it's much too sensible and old-fashioned for that--but my boy will move on, by the time he's five, to another school, where the teachers, like most teachers of young children in this country, will be on ADD watch. Oops, sorry, forgive me. I should have said ADHD watch. The American psychiatric establishment now refers to Attention Deficit Disorder as Attention Deficit/Hyperactivity Disorder. Why the change? Beats me, but it's just as much nonsense-on-stilts as ADHD as it was pure poppycock as ADD. And I'd bawl out any teacher who said to me, "Mr. Varadarajan, I think your boy has an attention disorder," and then suggested Ritalin, or Adderall, or Metadate CD. Sunday's New York Times carried a front-page story on ADHD, and on how lawmakers in some states--Arizona, Connecticut, New Jersey, New York, Utah and Wisconsin--have introduced bills that would prohibit schoolteachers from playing shrink in their classrooms by telling parents that they must put their children on drugs to combat "attention deficit." Such instruction, the bills declare, must only come from doctors. This is good news, and to be vigorously lauded. Teachers must be stopped from playing God. Above all, they must be stopped from shirking their disciplinary duties and seeking to "fix" every boisterous child with a dose of drugs. What stops this legislative pattern from being excellent news, however, is that the doctors can't be trusted. After all, it was they who invented ADD and foisted it on a generation of American children. Twelve percent of all American boys between six and 14 have been diagnosed with "attention deficit" problems. (I get these figures from the International Narcotics Control Board, a United Nations agency.) These children all take medication--Schedule II drugs, which share the pharmacological effects of amphetamine, methamphetamine and cocaine--to sharpen their short-term attention span. Four million American children take such medication. Toddlers, and children under five, are being prescribed such medication. Ninety percent of all Ritalin popped in the world is popped in America. What is ADD/ADHD? According to the fourth (and latest) edition of the "Diagnostic and Statistical Manual of Mental Disorders"--DSM for short, the "bible" of the American Psychiatric Association--it is a disorder with nine diagnostic criteria. If your child shows six or more of the following behavior patterns, he's liable to be labeled: Often fails to give close attention to details or makes careless mistakes in schoolwork, work, or other activities Often has difficulty sustaining attention in tasks or play activities Often does not seem to listen when spoken to directly Often does not follow through on instructions and fails to finish school work, chores, or duties in the workplace (not due to oppositional behavior or failure to understand instructions) Often has difficulty organizing tasks and activities Often avoids, dislikes, or is reluctant to engage in tasks that require sustained mental effort (such as schoolwork or homework) Often loses things necessary for tasks or activities (e.g., toys, school assignments, pencils, books, or tools) Is often easily distracted by extraneous stimuli Is often forgetful in daily activities Easily distracted? Does not seem to listen when spoken to? Makes careless mistakes? Has difficulty sustaining attention in tasks? Is often forgetful? Often avoids homework? Homework, for Nora's sake! These are children they're talking about. Show me a child who doesn't avoid homework and I'd say he's not normal. Are these people for real? Are we to take this hysterical gibberish seriously? And what makes a child liable to be dubbed "hyperactive"? Here we go, again, from the DSM: Often fidgets with hands or feet or squirms in seat Often leaves seat in classroom or in other situations in which remaining seated is expected Often runs about or climbs excessively in situations in which it is inappropriate (in adolescents or adults, may be limited to subjective feelings of restlessness) Often has difficulty playing or engaging in leisure activities quietly Is often "on the go" or often acts as if "driven by a motor" Often talks excessively Fidgets? Squirms? Runs about? Leaves seat in classroom? Talks excessively? Has difficulty playing quietly? It is almost as if the psychiatric establishment wants to snuff the life, the joy, out of childhood, rendering our children robotic and docile. Teachers have latched onto this with alacrity. In part, they have an excuse: Denied access to more traditional forms of punishment, it is increasingly hard to maintain discipline in class. Ritalin, in many cases, has taken the place of discipline. How else can one explain that previous generations got by without recourse to such labeling and such medication? The label ADHD and the medication are, to quote Thomas Szasz--author of "The Myth of Mental Illness" and a professor of psychiatry--perfect examples of "the pharmacratic control of a social problem: how to educate children." Thomas Armstrong, author of "The Myth of the A.D.D. Child" cut right through the bull when he wrote: "ADD is a disorder that cannot be authoritatively identified in the same way as polio, heart disease or other legitimate illnesses." So how have we come to be saddled with this spurious syndrome? One reason might be that ADHD is but one example of a dangerous trend in our society, which is to pathologize everything. In the mid-19th century, in the days before the DSM and the APA, the U.S. government recognized only one category of mental illness: "idiocy/insanity." That, while hardly satisfactory, at least had the virtue of brevity. But now, in the grip of a dogma that holds that all troubles in people are the product of some internal dysfunction, we have had a veritable proliferation of madness. The ascendancy of this view can be linked, among other things, to a decline in the belief in individual responsibility. I cannot resist deploying a pithy quote here, from "Making Us Crazy," a book published three years ago and written by Herb Kutchins and Stuart Kirk, both psychiatry professors: "There is a growing tendency in our society to medicalize problems that are not medical, to find psychopathology where there is only pathos, and to pretend to understand phenomena by merely giving them a label." The latest edition of DSM lists more than 300 mental syndromes. Only two decades ago, an earlier edition listed a mere 106. Are we galloping toward madness? Or is the APA nuts? Judge for yourselves. Alongside ADHD, we have such new syndromes as these: "frotteurism" (defined in the manual as the irresistible urge to rub oneself against "a non-consenting person"), Asperger's syndrome (a pompous label for shyness), "dissociative fugue" (the urge to travel without clear plan, often under an assumed identity), "hypo-active sexual desire disorder" (found in people not at all keen on sex, and not to be confused with mere "sexual aversion disorder"), and "paranoid personality disorder" (the hallmark of someone who bears grudges). Children can suffer from "mathematics disorder" (you don't believe me, do you? It's Code 315.1 of the DSM), "disorder of the written expression," and "oppositional defiance disorder" (which my parents, bless them, would have called "disobedience" when they were raising me). The jewel in the APA's crown is "generalized anxiety disorder," from which 12 million Americans, or 5% of adults, suffer. And what is this? Well, silly of you to ask! Why, it's excessive worry, of course, and restlessness, and anxiety, and tension, and the feeling of being keyed up. Bring on the Prozac. One for mommy, one for dad, and for you, son, a nice bit of Ritalin for dessert. Before I go, let me add another twist. According to Drs. Kutchins and Kirk, the psychiatric establishment is foisting these invented illnesses on us in a bid to lay claim to handsome reimbursements from insurance companies. For psychiatrists to receive payment from health insurance companies, they must find a way to label a patient with a recognized condition--which is why they recognize more, and more, and more conditions. Wait for the next DSM, and there will be at least another 50 conditions added to the existing list. According to Drs. Kutchins and Kirk, "the unlabeled masses are a vast untapped market, the virgin Alaska oilfields of mental disorder." As I was saying, my son goes to school next month, for the first time . . . Mr. Varadarajan is deputy editorial features editor of The Wall Street Journal. His column appears Tuesdays.