Attention deficit hyperactivity disorder (ADHD) is an odd psychiatric disorder as it appears peculiar to learning within a school environment and, in its newest guise, career development. Its causes are unknown and drug treatments can, in extreme instances, lead to psychosis and mania. Not surprisingly, given the random behaviour patterns associated with the condition, it appears to affect boys more than girls. While medication is rarely used in Britain, it is used extensively in the USA. It is worthwhile to consider the intrinsic problems with such diagnosis.
The symptoms of this condition are inattentiveness, hyperactivity and impulsiveness expressed predominantly within a learning context. The recognised behaviour signs are:
- having a short attention span and being easily distracted
- making careless mistakes – for example, in schoolwork
- appearing forgetful or losing things
- being unable to stick at tasks that are tedious or time-consuming
- appearing to be unable to listen to or carry out instructions
- constantly changing activity or task
- having difficulty organising tasks
And the main signs of hyperactivity and impulsiveness are:
- being unable to sit still, especially in calm or quiet surroundings
- constantly fidgeting
- being unable to concentrate on tasks
- excessive physical movement
- excessive talking
- being unable to wait their turn
- acting without thinking
- interrupting conversations
- little or no sense of danger
In an attempt to avoid facetiousness, these traits were once simply accepted as traits common at some point or another to childhood, especially when children are placed in formal environments. Many of the above signs for example can be attributed to boredom or just the consequences of being a child. Simply watch young lions, for example, or young chimpanzees and notice how their behaviour is subject to the same variable traits. Children in school desire play! Play is a learning process! Children often act without thinking. They are children! They often appear to have little or no sense of danger. They are children! They often, like young lions and chimpanzees, exhibit excessive physical movement. They are children!
Recently, psychiatrists have delineated a fresh version of the disorder. Adult ADHD. This apparently involves the inability to organise yourself, to be on time for appointments, lack of motivation, poor concentration, reckless driving and marital troubles. Everything in fact except the kitchen sink. In the USA, these problems are dealt with by medication. But surely, these difficulties are in relation to largely middle-class concepts of success within careers and society. Artists are notoriously, if stereotypically, subject to being disorganised so are they all, for example, ADHD sufferers? I fear that many psychiatrists would say ‘yes’. Fit in, don’t be disruptive, do not have your own personality and ideas, be successful, have a stable marriage and you will be unlikely to be diagnosed with ADHD.
As usual blame is placed on synapsis not functioning correctly, or problems with the prefrontal lobes. Einstein, who along with Churchill is invariably dragged into every theory of human development, has been identified as one sufferer. After all, genius and madness are near aligned. But nothing of his brain development, as specified in the literature, indicates any of these real or imagined causes. The available literature agrees that the cause lies with defective genes, and not with environmental factors. But surely that presents a considerable contradiction? If parents of ADHD children suffer from the condition itself, surely their behaviour would affect the children? This is simple psychology!
My concern is that ADHD is part of the general process that increasingly medicalises human behaviour, whereby any slight deviation from the norm becomes a psychiatric disorder. The prominent British neuroscientist, Susan Greenfield, expressed her concerns on ADHD to the British Parliament in 2007, feeling that it was too rapidly and easily diagnosed and too often treated with drugs. Neurologists have pointed out that psychiatrists’ training involves the identification of aberrant behaviour and advice on follow-up treatment, they are not trained in neurology and should not pronounce on it so freely.
On the surface, and below it, this seems grossly un-scientific, based on the influence and credibility of psychiatry with its obsessive labelling. But, can the process of learning really involve behavioural aberrations and is daydreaming in class, as claimed in the advisory literature, actually an instance of psychiatric disorder and not perhaps evidence of creativity, as previous generations believed? Is it evidence of great potential, as in the case of many writers and artists, or an excuse for the use of unsuitable, dangerous drugs on children? Research has revealed that children diagnosed and treated for ADHD commonly become equally difficult adults; often incarcerated. And yet, surely any child labelled as suffering from a behavourial disorder, placed under the stress of being socially isolated as a consequence, given endless drugs, would grow up in such a fashion?
As a teacher and lecturer of many years, with, also, qualifications in psychology, I have dealt with many disruptive children, and with those often unable to function at a high level in classroom environments, but rarely any instance that requires medical intervention. I usually have extensive contacts with students, and I become familiar with their lives and backgrounds, while a psychiatrist working more or less from a list connected to a variety of disorders knows little to nothing of the individual before them, has no direct experience of their lives, knows nothing of educational psychology, theories of the classroom, or any matter external to their profession.
It is also wise, I think, to remember that intensive class/school based teaching is a recent phenomenon constructed upon the economic, philanthropic, political requirements of late 19th century national states.
Given the above, the variable reactions of children to intensive teaching has to be expected. According to ADHD literature, the first signs of the phenomenon were identified at the beginning of the 20th century. But what exactly was being identified? Perhaps, that many ungrateful poor children did not appreciate or adjust to intensive schooling, a very recent invention? Prussia introduced compulsory education in the 18th century. When Germany became a state, combining Prussia and a number of much smaller German states, the education of children was centralised. German officials felt it was necessary to do so in a highly competitive Europe. In Britain, the Elementary Education Act of 1880 enforced compulsory education for children from 5-10. By the early 20th century most children attended extensive tuition in schools throughout the western world, forced or obliged to sit in un-escapable, claustrophobic environments for hours at a time with rare opportunities for fresh air. This determined their futures, to the extent children could adjust themselves to educational pressures. Some would always find this more difficult than others. Some would be stimulated by the educational process, others, less equipped to deal with it would not. Can such an artificial practice, although with limited occasional precedence, which is social and economic in origins, induce a psychiatric condition?
Clearly, AHDH, from my review of articles in the Lancet, concerns obstacles to positive careers and academic achievement. It predetermines failure in very young children (from 6 years old), providing intervention that seems rarely evaluated as to problems it may cause the individual child’s future development. Psychiatrists view mental health in much the way doctors view physical health, whereby mental illness involves negative foreign bodies that require medical intervention. Such illnesses are separate from the environment in which they appear. A psychiatrist deals with the mental illness (cognitively viewed as a disease) without consideration of psychological effects on individuals in the same way as doctors treat influenza or measles.
While providing a model of normality based on western, middle class cultural imperatives, they insist that ADHA is increasing amongst the disadvantaged in western society. Is this little more than class and professional prejudice, I wonder? While asserting that many celebrated, long dead figures must have suffered from ADHD, after treatment by a bevy of myopic psychiatrists, would they have achieved anything at all?