The Ritalin Sham
Alice, the mother of a seven-year-old son, Nathan, recently visited my office for a counseling session. Nathan had reportedly been different and difficult from the beginning: exhibiting early seizure-like activity, a most challenging temperament, great sensitivity to various types of stimulation, intense frustration, aggressive tantrums, and other apparent developmental difficulties. Alice had taken him to doctors from a young age, obtaining a variety of mostly nonspecific diagnoses of developmental problems. Alice felt unappreciated as a parent, hurt and angry that the Montessori school her son had attended at ages four and five had ultimately rejected him. She felt judged by other parents, whom she felt blamed her for her son's challenging behavior. And she felt unsupported by both camps of opinion regarding "medication": the pro-Ritalin forces challenged her reluctance to use the drug for her son, and the antidrug group vehemently urged her to resist drug use.
Alice's personal stance on the Ritalin issue was clear. While she basically agreed that these "medications" are not good for children, she also felt that, in her family's case, it had been helpful. Nathan had been diagnosed at age five with attention deficit hyperactivity disorder (ADHD), and had taken Ritalin for a year. Alice thought the drug greatly helped her son, slowing him down enough so that he could listen and process information. She and her boyfriend both felt drugs made the boy much easier to be with; further, their own reduced stress eased them so much that they were now able to consider other alternatives for Nathan, such as nutritional supplementation.
Proponents of psychiatric drugs attest that they "work," meaning they alter mood, thought, and action. They also "work," of course, in that they assuage the medical community's expectation that drugs be used to "treat" these children. I believe that fully informed adults should have every right to voluntarily use any drugs they wish, as long as they don't endanger others in doing so. Children, however, are not able to give fully informed consent to drug use - especially those under six years of age, a group in whom we are witnessing a dramatic increase in psychiatric drug prescription.1 It is, therefore, our responsibility as adults to ensure every possible opportunity for optimal development for our children, to protect and defend our children from powerful toxic drugs, particularly those prescribed for psychiatric purposes.
Like Alice, a large percentage of adults who take psychiatric drugs or give them to their children would prefer to avoid them - and yet they capitulate and use them because the drugs provide relief: from tension, fear, and desperation, as well as from the external strains of judgment and coercion. Lawrence Diller, author of the best-selling book Running on Ritalin, argues that: "The 700 percent rise in Ritalin use is our canary in the mineshaft for the middle class, warning us that we aren't meeting the needs of all our children, not just those with ADD. It's time we rethought our priorities and expectations unless we want a nation of kids running on Ritalin."2 Dr. Diller decries the trend (as I do in my book The Wildest Colts Make the Best Horses), contending that this increased reliance on drugs reflects a society in distress. Rather than try to force our children to shrink into situations that do not meet their needs, he states, we need to take responsibility for our society.
Diller himself is, however, torn by the same conflict many parents have concerning Ritalin. On the one hand, he says: "As a citizen I must speak out about the social conditions that create the living imbalance. Otherwise I am complicitous with forces and values that I believe are bad for children." On the other hand, though, he concludes: "As a physician, after assessing the child, his family and school situation, I keep prescribing Ritalin. My job is to ease suffering and Ritalin will help round- and octagonal-peg kids fit into rather rigid square educational holes." 3
This seemingly contradictory stance is the same one Alice and millions of other parents face. It's not as if all parents readily accept the prescription of Ritalin. Alice, in fact, incurred the wrath of her son's neurologist because she refused to give her son Adderall, a combination of three different amphetamine-like stimulants often used as an alternative to Ritalin. Increasingly over the past ten years or so, millions of parents are nagged by their children's physicians: "If your child had diabetes," the doctors taunt, for example, "you'd give him insulin, wouldn't you?"
"What could I say to that?" Alice asked me. Her question was not so much a call for information as it was a need to express her hopelessness. It was encouraging to me that she was angry, for anger is a great antidote to hopelessness. She was mad about the treatment she had received from prior medical and mental health professionals, as well as the lack of support from two opposing drug camps. Before I would hazard a possible response for that neurologist, Alice and I talked about the feelings of relief, guilt, and anger the Ritalin issue had caused for her family. Finally, I gave her what would have been my response: the diagnosis of ADHD is, itself, fraudulent.
ADHD: Nothing but a Sham
A condition such as diabetes carries detectable physical evidence of disease - abnormal blood sugar levels, evidence of pancreatic malfunction - justifying medical treatment. Families confronted with the "wouldn't you give insulin" argument could begin by asking the neurologist to provide medical evidence that a disease requiring treatment exists. Between 1993 and 1997, neurologist Fred Baughman corresponded repeatedly with the Food and Drug Administration (FDA), the Drug Enforcement Agency (DEA), Ciba-Geigy (now Novartis, manufacturers of Ritalin), and top ADHD researchers around the country - including the National Institute of Mental Health - asking them to show him any article(s) in the peer-reviewed scientific literature constituting proof of a physical or chemical abnormality in ADHD and thereby qualifying it as a disease or a medical syndrome. Through sheer determination and persistence, Dr. Baughman eventually got these entities to admit that no objective validation of the diagnosis of ADHD exists.4
Prescribing Ritalin for something that is not a "disease" does not, in my estimation, constitute a legitimate practice of medicine. If ADHD is not a disease, treating it medically constitutes a fraud. Yet many physicians are true believers in medically treating "mental illness," despite the consistent lack of scientific evidence of "mental illness" as a "disease."5 Herein lies the conflict for parents like Alice.
The Significance of Oppression Theory
Victims of oppression are not only blamed for their condition, and usually thought to be deserving of their inferior position, they are eventually conditioned to accept it as their reality. As the great American writer James Baldwin stated: "It's not the world that was my oppressor, because what the world does to you, if the world does it to you long enough and effectively enough, you begin to do it to yourself."6 In what may be the ultimate power play, a victim is, over time, conditioned to internalize, accept, and ultimately, forget about the very fact that they are oppressed.
There are two specific forms of oppression that are pertinent to the discussion of psychiatric drug use for children. The first is adultism - the systematic mistreatment of young people by adults simply because they are young. Like other forms of oppression, adultism is self-perpetuating: when we are treated poorly as children, we internalize the idea and feelings that life is unfair; that rank and power should be used for personal advantage; and that we are somehow unworthy of respect, incapable of clear thinking, and unable to become our own authority.
The second form of oppression is what I call psychiatric oppression: the systematic mistreatment of people labeled as "mentally ill" - including children diagnosed with fictitious illnesses such as ADHD. Institutionalized in our society, psychiatry is also guided by a worldview that embraces biopsychiatry.7 Juxtaposed with adultism, psychiatric diagnosis and treatment enforce the message that an "ADHD child" is inadequate, defective, unworthy of complete respect, and in need of drugs to control and cope with the effects of his or her "illness."
Lies My Doctor Told Me
What exactly does it mean to "help round- and octagonal-peg kids fit into rather rigid square educational holes?" I believe there are at least six fallacies that underlie the rampant prescription of drugs like Ritalin to our children.
1. "Social adjustment is good."
While the ability to adjust socially may be important, it is not always a "good" thing. In its most extreme form, social adjustment leads to conformity and compliance, which has resulted in dire social phenomena, including slavery and genocide. This seems a particularly aberrant notion in a society like ours, which is so deeply grounded in the quest for individualism, free speech and association, and the "pursuit of happiness."
2. "Children must learn to conform."
When a child fails to adjust to school, we should at the very least think about our abilities to consider the child's needs. It is certainly important for children to learn how to get along in various situations, and how to avoid drawing sanction upon themselves. Nevertheless, young children must be enabled to express their unique gifts within their communities. It is a mistake to force our children to fit molds imposed upon them according to the needs and conventions of the adult order.
3. "Failed social adjustment causes suffering."
In our competitive culture, we tend to view mistakes as negatives to be avoided. It is hard to accept the notion that mistakes can be good, and actually, in fact, are the way we learn. We are obsessed with the notions of success and failure. We judge a child's actions as success or failure according to our expectations and demands, not through the eyes of a developing child. Eventually, the child internalizes both the standard and the evaluation: "I failed to live up to the expectations, therefore I am a failure." I would argue that it is not failure that causes suffering, but rather it is oppression - in the form of adultism - which imposes arbitrary standards, and an adult shame-based worldview. This is what causes children to feel and think of themselves as failures, and therein lies their suffering.
4. "A physician's job is to ease suffering."
Certainly it is - through the practice of medicine that incorporates compassion - not labeling, coercion, or guilt.
5. "Ritalin helps children conform."
Not always. Sometimes it makes them "psychotic," sometimes it makes them aggressive. Other times Ritalin makes children anxious or nauseous. It can make some children feel suicidal. And for some children, Ritalin has been a deadly prescription.8 When it "works" well, the child is observed to produce better in the classroom. This, the research shows us, is the only positive short-term outcome. There are no positive long-term effects in any aspect of child functioning - social, behavioral, or academic - associated with the use of Ritalin.9
6. "Therefore, giving your child Ritalin lets me ease her suffering."
In an 1854 speech on the Kansas-Nebraska Act, Abraham Lincoln said, "I would consent to any great evil, to avoid an even greater one."10 Many parents feel the compulsion to punish or discipline their child in hopes that even greater misfortune might not befall them. Given the reality of today's oppressive society, and its lack of resolve to truly meet the needs of our children, the argument goes, Ritalin may seem a better choice than continued pressure, disapproval, and sanction.
This "ease the suffering" argument reveals one of the most consistent justifications for the use of psychiatric drugs for children: on one level or another, Ritalin absolves each person of his or her responsibility. The child is not responsible, he's "sick." Parents, doctors, the community, the medical and educational institutions - the society at large - are relieved of their duty to meet the real needs of that child. We prescribe drugs; the child conforms; the educational and medical institutions don't have to change; and our standards of "normalcy" are passed on to the next generation of drug-assisted children learning to fit into the mandated square hole. We have endless justifications that allow us to conform to oppression with a seemingly clear conscience, while an estimated 5,000,000 children are on methylphenidate, and another 3,000,000 on other toxic drugs - given to them by adults who care for them. Some may call this "medicine," but a growing group of parents and others are beginning to see it as institutionalized child abuse.
Suffer the Children?
Although ADHD does not exist as a real disease, it is a very real label imposed on children, with very real consequences for the child. On a physical level, the recommended drugs are toxic, and they have a long list of deleterious effects.1
Regarding Ritalin, the fact is that "methylphenidate looks like an amphetamine (chemically), acts like an amphetamine (effects), and is abused like an amphetamine (recreational use, Emergency Room visits, pharmacy break-ins)."2 (parentheses mine)
On a psychological level, Ritalin produces two especially harmful effects. It deprives a child of the right to develop a character and a way of living with self and world, in a drug-free state. Ritalin also creates a burden of shame, a conviction that a child who is on this drug is somehow defective, unworthy, and neither lovable nor even acceptable in his or her "natural" state.
These stimulant drugs for children truly are about enforcement of our culture's preeminent value: productivity.3 Amphetamines, as we have learned over the course of the past century, increase output. But of course, with amphetamines, the trajectory is usually crash and burn. In the US, millions of adults, and an alarmingly increasing number of children, take psychiatric stimulants like Prozac to "keep going and going." Similarly, we give children as young as two years of age stimulant drugs to help their "impaired" productivity. But wherein lies the suffering, in the "failure" to produce or achieve, or in the so-called remedy we prescribe?
1 Peter Breggin, Talking Back to Ritalin (Monroe, Maine: Common Courage Press, 1998).
2 Mary Eberstadt, "Why Ritalin Rules," Policy Review 94 (1999): 24-44.
3 See John Breeding's new e-book, The Necessity of Madness and Unproductivity: Psychiatric Oppression or Human Transformation? (Online Originals, 2000), for an explanation of how psychiatry acts to enforce our social mandate of relentless productivity. (Available at www.onlineoriginals.com.)
Ritalin Use - Simply Out of Control
Psychiatric drug use by children in US schools is turning into an enormous problem. In 1970, an estimated 150,000 US children were taking Ritalin. By 1980, the estimates were between 270,000 and 541,000 - double the numbers of a decade before. By 1990, the numbers doubled again; close to 900,000 children were on Ritalin. The Drug Enforcement Agency (DEA) estimates there was a 700 percent increase in the production of Ritalin between 1990 and 1997, 90 percent of which was consumed in the US.
Based on the available data, a realistic estimate of the number of school-age children on Ritalin today in the US is 5 million. Considering that Ritalin - like other amphetamines, a Schedule II controlled substance that carries a significant risk of abuse - represents 70 percent of the total prescriptions for amphetamine-like drugs, it is reasonable to estimate that over 7 million US schoolchildren are on some sort of stimulant drug. We can add close to 2 million children now on so-called antidepressants, so it appears that over 8 million children in this country are on psychiatric drugs today. According to census data from 1999, the US population for ages six to 18 is just under 51.5 million, meaning approximately 15 percent of our schoolchildren are on psychiatric drugs. In many schools and districts, the estimations are quite higher, as much as 20 or 40 percent. A study reported this year in the Journal of the American Medical Association revealed that Ritalin prescriptions for two to four year olds increased 200 to 300 percent between 1991 and 1995.1
In an era when we are constantly told to protect our children from drug abuse, it seems there are some very disturbing exceptions to the rule.
1 Zito et al., "Trends in the Prescribing of Psychotropic Medications to Preschoolers," JAMA 283 (2000): 1025-1030.
1 J. M. Zito, D. J. Safer, S. dosReis, J. F. Gardner, M. Boles, and F. Lynch, "Trends in the Prescribing of Psychotropic Medications to Preschoolers," JAMA 283 (2000): 1025-1030.
2 "A Nation of Kids on Ritalin," an essay posted on Lawrence Diller's website: www.docdiller.com.
4 See the website of neurologist Fred Baughman, MD, for information on the ADHD fraud: home.att.net/~fred-alden.
5 See Peter Breggin's book Toxic Psychiatry (St. Martin's Press, 1991), or the journal Ethical Human Sciences and Services, for evidence on the pseudoscience of biopsychiatry.
6 Conversation between James Baldwin and Nicki Giovanni, November 4, 1971, "A Dialogue," cited in L. R. Frank, ed., Random House Webster's Quotationary (New York: Random House, 1998).
7 See John Breeding's book The Wildest Colts Make the Best Horses (Austin, Tex.: Bright Books, 1996) or his website, www.wildestcolts.com, for a fuller exposition of the belief system of biopsychiatry.
8 Dr. Fred Baughman is currently involved in three Ritalin death cases. His essay "Who Killed Stephanie Hall?", available on his website (see Note 4), tells of one of these three and includes a brief review of relevant cardiac literature. An article by Caroline Kern in the Oakland Press, April 14, 2000, entitled "Prescription Drug, Not Skateboard Accident, Killed Clawson Teen," reports on the most recent death in March of 14-year-old Matthew Smith of Clawson, Michigan.
9 See Peter Breggin, Talking Back to Ritalin (Monroe, Maine: Common Courage Press, 1998) or Lawrence Diller, Running on Ritalin (New York: Bantam Doubleday Dell, 1998) for summaries of this research evidence.
10 Abraham Lincoln, speech on the Kansas-Nebraska Act, Peoria, Illinois, October 16, 1854. Cited in L. R. Frank, ed., Random House Webster's Quotationary (New York: Random House, 1998).
This article is adapted from Dr. Breeding's website, "The Wildest Colts Make the Best Horses". It also appeared in Mothering, Issue 101, July/August 2000.
Reprinted with permission of the author and Mothering Magazine.