There's no way that I or anybody else can stem the tide of drugs. What are we telling the kids? Take a pill and it will be all better? How about a little heroin?
Nearly 3 million American schoolchildren get amphetamines to control their hyperactivity or cut through their lassitude; 600,000 get serotonin reuptake inhibitors like Prozac and thousands more get lithium, the anti-psychotic-turned-wonder drug. In some schools, a third of the boys are on Ritalin. There is something paradoxical about teenagers lining up for their noontime stimulant before filing into "Just Say No" lectures. But of course, Ritalin and Prozac aren't exactly the drugs of choice for getting you high. Kids do occasionally sell their extra Ritalin for $5 per pill behind the local high school, but word is it doesn't provide much of a buzz. The pills filing out of the pharmacy warehouses in metallic phalanxes of green, blue and yellow aren't for fun. They're intended to produce calm, well-adjusted citizens, their brains chemically altered to fit the marketplace that awaits them.
The key that opened the doors of prescription for most of these children is spelled A-D-D. That stands for Attention Deficit Disorder, a peculiarly American malady that is diagnosed roughly 10 times as often stateside as in Europe or Japan. If it weren't for the enormous dimensions of the ADD phenomenon, one might be tempted to suppose the syndrome was a huge hoax by the pharmaceutical companies. The definition of ADD is vague and complicated. In the DSM-IV, the most recent psychiatric diagnostic manual, an ADD patient is so declared when he or she consistently displays six or more symptoms of inattention or hyperactivity. But if these all too common symptoms are markers for ADD, maybe we ought to be putting Ritalin right into the water supply, like fluoride. An ADD child, according to DSM-IV, "often does not seem to listen ... does not follow through on chores ... has difficulty organizing tasks ... often loses things ... is easily distracted ... is often forgetful ... is often 'on the go' ... often talks excessively."
Still, add these symptoms together and you get a child who can't read or pay attention, and is likely to be suffering in class, and maybe at home. In therapeutic circles, the feeling is that the attention being paid to the attention disorder is society's way of showing it cares about children who once were dubbed Fidgety Phils and plunked down in the corner with a dunce cap until they dropped out of school and entered menial jobs, skid row or prison. Today, an ADD diagnosis can open doors: not only to medication but to federally guaranteed special education facilities, computer chat rooms and parental support groups. Today, particularly if you have enough clout or the cash to hire a private consultant, your ADD kid will be placed in a special classroom, and eventually get non-timed college admission tests -- about 40,000 SAT tests were administered this way last year.
A number of psychiatrists, educators and neurologists have begun to describe ADD as a physiological ailment that arises partly from a unique brain geography. Using the lingo of evolutionary psychology -- the totalizing ideology of the '90s -- some specialists describe the distracted or jumpy ADD child as an evolutionary remnant, a hunter personality trapped in a culture of desk jockeys. Such pseudo-scientific piffle is ubiquitous in ADD circles -- particularly, it seems, among medical doctors. Edward Hallowell and John Ratey, two Harvard Medical School psychiatrists who have done as much as anyone to raise ADD's profile, claim in their book "Answers to Distraction" that ADD diagnoses are prevalent in the United States for genetic reasons: "Our forebears were restless movers and shakers," they write. "This probably selected a gene pool of people who are chronically curious and willing to risk traveling down new pathways of exploration." And who, if they were alive today, would presumably meet the elastic DSM-IV definition of ADD.
If the ADD community includes parents who feel the need to dull their children's roughest edges enough to squeeze them onto the career track, the pharmaceutical industry is there to help. Ritalin was administered to control wild kids in the 1970s, but today's ADD child is just as likely to be the quiet, spacey type. Children are younger, now, when they leave the home and enter the structured, less tolerant worlds of day care and school. As students, they are pressured to perform without as much support from their frequently absent parents. The human gene pool cannot change for cultural or economic reasons in 25 or 30 years. Thus relatively greater numbers of children and adults may be found wanting in their abilities to concentrate given the current pressures of their academic and work environments.
One solution is a pharmaceutical assault on inefficient personality types -- Ritalin for the hyperactive, Prozac for the introverts. In late twentieth-century America, when it is difficult or inconvenient to change the environment, we don't think twice about changing the brain of the person who has to live in it. It's not the end of the world you are drugging your children. But on a broader social level, the drift toward fiddling with brain chemistry is deeply alarming. In today's America, the responsible citizen, like the epsilon of Huxley's "Brave New World," has the duty to take pills to combat inappropriate behaviors and feelings. But guess what? A lot of kids don't want to take their medicine. For them refusal is rebellion. People should talk to their kids, not just give them pills. Ritalin does improves the learning environment for other kids because the child is no longer tapping a pencil or looking out the window or pulling the hair of the child in front of him. But we don't know of any studies that have shown a real improvement in performance. Do they act better? Yes, because they're drugged.
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