Ritalin pills

Last week BBC Radio Four reported on a care home in Kent who routinely drugged its teenage residents during the 70’s and 80’s. Records show that one young girl was medicated against her will over 1,200 times with a cocktail of tranquillizers, antidepressants and ‘other drugs’. Whilst the focus has largely been on the long-term genetic consequences for these women’s children, the wider issue of medicating young people in the first place remains a controversial one.

Mike Lindsay of the Children’s Rights Alliance for England has said that “using drugs to control the behaviour of children was perfectly acceptable as far as the professional understanding at that time went,” the assumption being that such methods are no longer a part of professional practice. However, in a country in which children have been deemed to be the unhappiest in the western world, GPs are now writing prescriptions for children as young as seven at the rate of 250 a day.

One child in ten is currently thought to be living with some kind of emotional or behavioural disorder, including (but not limited to) Bipolar Disorder, Depressive Disorder, Anxiety Disorder, Attachment Disorder, Adjustment Disorder, Attention Deficit Hyperactivity Disorder, Oppositional Defiance Disorder and Conduct Disorder. This recognition of the mental health issues faced by children has undoubtedly been a vastly positive one. The last twenty years have seen incredible developments in neurobiology and developmental psychology, leading to the emergence of a wealth of child-centered services that would have been unheard of only a generation ago.

However, such developments have also brought with them a number of serious problems. These include: the tendency to medicalize difficult or challenging behavior, framing problems as an illness rather than as a natural response to painful feelings; the changing of the margins of definition for these illnesses according to social and cultural expectations of ‘acceptable’ behavior; the increasing involvement of pharmaceutical companies in health policy, research and public education programmes; and, inevitably tied in with this, the increasing likelihood that an unhappy child will be medicated rather than talked to.

The tendency to medicalize difficult or challenging behavior can be demonstrated by looking up the diagnostic criteria for any of these disorders in the Diagnostic and Statistical Manual (DSM). Oppositional Defiance Disorder, for example, can be diagnosed if a child meets a number of generalized criteria listed in DSM IV TR including ‘often loses temper’, ‘often angry’ and ‘often actively defies or refuses to comply with adults’ requests or rules.’ Conduct Disorder can be diagnosed if a child meets any three of fifteen criteria which either inflict harm on others or — more worryingly — break accepted social norms. The criteria range from violent and aggressively sexual behavior to truanting and running away from home.

The danger lies in the possibility that children exhibiting natural (though perhaps not desirable) reactions to high levels of stress will be labeled as ill, and treated for their symptoms rather than the situations that create them. Professor Rose of the Brain and Behaviour Research Group has commented that “in the past their unruly behaviour might have been ascribed to trauma, poor parenting, poverty, impoverished schools or unsympathetic teachers… now we blame the victim instead.”

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The flexibility of the margins of these definitions is a further cause for concern. Psychiatry is not an exact science. Indeed, some argue that it is not a science at all. Many behavioural disorders have no specific cognitive, metabolic or neurological markers and there is no medical test that can be carried out in order to diagnose them. In essence the diagnosis is solely down to the opinion of the professional making it. The definition of Attention Deficit Hyperactivity Disorder (ADHD) has been changed four times since its ‘discovery’, each change broadening the scope of potential sufferers so that currently 360,000 — one in twenty — children are thought to be living with the condition in England and Wales alone.

With the absence of any kind of medical proof for ADHD, the condition needs to be recognized as one which is based on the definition of the western medical community, one which will necessarily be bound up with the accompanying social and cultural beliefs surrounding acceptable and healthy behavior. As child psychiatrist Dr Timini writes:

“It dawned on me that the concept of ADHD was intimately tied up with our modern, western beliefs about childhood and child rearing… and that by promoting the idea that scientific certainty exists in the field of subjective human experience, modernist practitioners contribute to a discourse that stifles diversity and devalues difference.”

The increasing involvement of pharmaceutical companies in the promotion of these disorders has also had a substantial affect on how they are managed. Alliances between drugs companies, public relations companies, doctors groups and patient advocate groups ensure that the public are continuously reminded of the “hidden epidemic” sweeping the country, and the dangers of leaving these problems untreated. One parenting website warns against behavioral or educational interventions to help deal with difficult children’s behavior, telling parents that avoiding the use of medication could lead to pathological tendencies: “the danger is that these attempts will be ineffective and our child’s condition will worsen. Vital emotional and social skills development may be delayed and a pattern of pathology become ingrained.”

On this basis 500,000 prescriptions were written for stimulant medication for under 16s (including children as young as seven) in 2007, more than double the number issued only four years earlier. One pharmaceutical company, Novartis, explains medicating in this way is “an integral part” of treatment for “developmentally inappropriate symptoms.” Another parenting website describes it as the best way to “identify and control behaviours”. But what are the effects of giving such strong mind-altering medication to brains that are in their most vital formative stages?

Recent studies have linked Ritalin (the medication most commonly prescribed for ADHD diagnosises, a substance strikingly similar to cocaine) to low self-esteem and the suppression of creativity. Side effects listed on the manufacturer’s website include: new or worse behaviour and thought problems, new or worse bipolar illness, new or worse aggressive behaviour or hostility, new psychotic symptoms (such as hearing voices, believing things that are not true) or new manic symptoms.

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To criticize the way that these behaviours are assessed, labelled and treated is not to deny that they exist in the first place. Similarly, to criticize the fact that young children are medicated for displaying these behaviours is not to deny that drugs can sometimes play a helpful part in treating extreme emotional distress. It is the ease with which we relegate expressions of healthy emotions such as pain, frustration, terror and anger to the realms of the unacceptable that is so worrying. In a society in which we seem less and less able to tolerate the expression of the negative emotions, it seems we are also less and less able to tolerate them in our children too.

Freud has noted that all cultures struggle with the issue of gaining control over the suffering that is an inevitable part of living amongst others. The construction of a medical framework through which to view difficult behavior and painful emotions in children is complicit with society’s wish to be absolved of guilt. But to live with the illusion that spontaneous expressions of pain and anger have no basis in environmental circustances, and that their causes lie solely in some kind of malfunction within the brain will ultimately be damaging. In medicalizing these reactions we leave children without the help their behavior is screaming out for. In treating their developing brains with drugs we leave them unable to understand or manage their own feelings in the future. In treating problems of the mind and the heart as an illness we deny them the opportunity to experience a more creative and hopeful approach to their own healing. Parents will be relieved, teachers will have easier classrooms to manage and pharmaceutical companies will make money. It will only be the children who suffer the consequences.

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