June 03, 2009

So pervasive is the current trend toward labelling any unwanted behaviour as deviant and then finding a drug to "fix" it, one has no fears for the future of pharmacology.

This is not a new thing. Without going into a whole history of mankind, one needs only look to the Victorian age and what was labelled hysteria, as well as some of the treatments prescribed for hysteria before Sigmund Freud's relatively gentle psychoanalysis.

Today, virtually every behaviour that does not fit into quiet acceptance is suspect. Too rambunctious is labelled attention deficit and hyperactivity disorder (ADHD). Too teary, depression. Too energetic, mania. Too rebellious, oppositional defiant disorder. Attention ought to be paid to context for diagnosis, but the DSM-IV makes no mention of context, only of approximate frequency of specific types of behaviour with the proviso that it be "detrimental" to a person's social, physical, or academic development.

(Nothing said, here, about what exactly "detrimental" means. After all, "detrimental" can as easily refer to a teacher's frustration as to a student's disability. Does the rumbunctiousness actually get in the way of learning? or is it that the student is bored? or that the teacher prefers not to expend the extra effort?)

Few physicians and fewer patients even pay that much attention. If it gets in the way, medicate it.

Methylphenidate (Ritalin) is the most commonly prescribed psychostimulant, used most often but not exclusively to treat ADD and ADHD. Its pharmacological effects are very similar to those of cocaine, and several different research approaches suggest that long term use of Ritalin may include a heightened susceptibility to amphetamines such as cocaine. Whether former Ritalin users are also more likely to be smokers has not yet been studied, but a very high percentage of cocaine addicts were formerly on Ritalin and also smoked.

How many diseases are slanted so strongly toward a single country? Numbers are difficult to obtain, but some studies estimate that 8 million American adults have ADHD. Similarly, between 3-5% of children globally are estimated to have ADHD, but the diagnosis in most European countries is 1% or less; and in most other parts of the world the percentage is even lower. Until 2000, nearly 90% of Ritalin was used in the United States; even today the percentage is still over 80%. Most of those diagnoses and prescriptions were based almost entirely upon the testimony of teachers. Only 20% of children diagnosed with ADHD show any signs of hyperactive behaviour in the physician's office. Some United States schools even receive extra funding for every child diagnosed with ADHD.

How many of those diagnosed with ADD are perfectly capable of spending non-medicated hours at a videogame? One adult I knew who was considered disabled with ADD for government purposes ran a small gaming business on the side, and had no trouble participating in table games that lasted for hours at a time. Back when I was GM to a tabletop roleplaying group, two teens in my group had been diagnosed with ADD, and in one it was strong enough to be very noticeable. Yet as soon as I was able to catch his attention enough for him to start caring, he could maintain complete focus, again for hours. What made the difference was not a pharmaceutical addition, but an attitude shift: what I had to offer was interesting. Full behaviour shifts were beyond me: I was not his parent, after all.

My experience is not alone. Several studies have found that over periods of three years or more, behavioural modification is just as effective a treatment for ADHD as medication, with none of the side effects. Most interestingly, a 2008 review of Ritalin found that while teachers and parents reported improved behaviour, the children's academic performance was absolutely unchanged. Whatever it is that Ritalin is changing, it apparently is not something that was "detrimental" to academic performance.

So many artists find that, once they were diagnosed for depression and medicated, some essential spark is missing. Maybe there was a reason so many artists suffered from depression or bipolar syndrome (and so many fought with their parents besides). Maybe art requires plumbing the depths as well as the heights. Powerful art speaks in emotion, of emotion, to emotion. Medication erodes emotion.

Antidepressants were the most frequently prescribed medication in N. America, and there much more frequently than anywhere else in the world, even before the current economic crisis. Now, I suspect that new prescriptions are going through the roof. But -- it is normal to feel depressed when your job or your house are at risk. If you have spent the past several years in job turmoil with absolutely no job security, a few "unexplained" tears are normal. Until recently, many jobs were assumed to be secure. How can you not grieve for their loss?

Grieving is not a process that ends overnight, or is expected to. Long illnesses turn families upside down. Why would we expect anything different during long periods of job insecurity or loss? Our jobs define us. Without the once-secure job we used to have, who are we? How can anyone expect to rediscover themself in a mere matter of days?

It is admittedly much easier to medicate, much more difficult to learn and apply coping techniques and alter behaviour. It does not get easier as one grows older. Consider, however, that the trade-off for the extra effort is your own independence: of body, of thought, of spirit. What is it worth to you?

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