How many of you recognize those little orange pills? Have they played a big role in your life? Helped you through some tough times? Kept you up and studying (or partying) all night long?
In the article "A New Way to be Mad," Carl Elliot argued that "certain social and structural
conditions—diagnostic categories, medical clinics, reimbursement schedules, a common language to
describe the experience" have made it not only more possible, but also more likely for those who are dissatisfied with their sex to be diagnosed and "treated," using sex-reassignment surgery. Elliot extends this analysis to other so-called psychological disorders, using Ted Hacking's term "semantic contagion" to describe the way in which naming and publicly identifying a condition in some way causes it to spread. As someone who has been diagnosed with and treated for Attention Deficit Disorder, I think Elliot's assessment offers a very useful analysis of the ADD/ADHD "epidemic" that "struck" the U.S. in the late 20th century.
As a child, like Robin, I was fidgety, loud, inattentive, habitually late, disorganized, and impulsive. When I was 8 years old, we moved from south Minneapolis to a rural commune in southeastern Minnesota, and I became chubby and depressed as well. My mother, as a physician, was (and still is) constantly on the lookout for conditions to diagnose; so, at age 12, I was diagnosed with Attention Deficit Disorder (ADD), and treated (first with Concerta, and then with Adderall).
My mother believed that my ADD was a hereditary condition, pointing out similar personality characteristics (symptoms) in herself, her siblings, and her parents to support this conclusion. In the literature on ADD, I've read the theory that ADD/ADHD defines a certain (heritable) set of behavioral tendencies which would be beneficial in a survival hunting/gathering situation, but which are detrimental within the confines of our contemporary advanced capitalist society. Those of us with ADD could thrive if we lived in a different world, the story goes, but since it's very hard to change the world, we should instead adapt to its constraints, with the help of Adderall.
Let's take a look at Adderall - what is this miracle drug that could transform my unruly personality into one better adapted to the constraints of school and work? According to Wikipedia, Adderall is composed of racemic amphetamine aspartate monohydrate, racemic amphetamine sulfate, dextroamphetamine saccharide, and dextroamphetamine sulfate, which are all amphetamine salts. What this means, for those of you less familiar with drugs, is that Adderall is essentially speed, legalized and prescribed to kids. Interestingly (also according to Wikipedia), all amphetamines, including Adderall, are currently banned in Japan. What are all the poor hyperactive Japanese children to do? What about the poor Japanese college students, cramming for their final exams?
Within half a year after being prescribed to Adderall, I was no longer chubby and became much less disruptive in class. Whereas I used to try to chat with other students when bored with class materials, I learned instead to quietly read a book or write in my notebook while paying just enough attention to answer correctly if a teacher happened to call on me. I no longer had spontaneous, uncontrollable fits of laughter. When I wrote a story for my 7th-grade English class about my old personality, my teacher commented in red ink that she couldn't imagine me ever being loud and unruly.
Full disclosure: I still take Adderall daily, to this very day. The debate about whether or not disorders like ADD are "real" is thus very personal to me. When I bug my friends and roommates about smoking cigarettes, they point out that I am essentially a speed freak. On the other side, I have heard others argue that, because I have ADD, Adderall has a different effect on my than it does on other people. Part of me likes this distinction, likes to insist that I have a "real disorder," that I am in some way essentially similar to other people with ADD/ADHD and different from those who are "normal." It justifies my continued "treatment" with Adderall, as well as the emergence of my disorderliness, impulsiveness, and other obnoxious personality characteristics at inopportune times. However, a close friend recently suggested that being on amphetamines since age 12 might have been detrimental to my development into an emotionally mature and socially capable adult. Because I have been taking Adderall almost daily since pre-adolescence, I can't know what I would be like without it. In this view, being treated with Adderall only slowed/prevented my development of "internal" (non-ingested) mechanisms for adapting to my environment. Perhaps the difference between the way that Adderall affects me and the way it affects "normal" people can be explained away by the fact that I take it in small doses every day, whereas they take it in large doses once or twice a semester.
Pinker might argue that, since I am genetically predisposed to be somewhat under-productive and disorderly, Adderall is just the right treatment to realign me with society, and with the interests of humanity as a whole. Lewontin, on the other hand, argues that neither biological nor social explanations should be given priority, but that they should be understood as dialectically related to one another. Without denying the existence of the "semantic contagion" that Elliot describes, Lewontin would argue that the set of characteristics that led me to be labeled ADD are not merely socially constructed, but have some sort of biological basis. However, Lewontin would also ask us to take a step back to understand how these (perhaps inborn, perhaps socially influenced) personality traits have come to be understood as problematic in our society, and to think about who benefits economically/politically by stigmatizing my condition, and then putting a brand name on speed and selling it as a treatment. Looking at my situation on an individual level distracts from the broader historical/cultural/social/political/economic picture of how ADD/ADHD and its treatments are used - by whom, for what ends, and with what actual effects?
A study I found online reported that "among children with ADHD, use of any prescription medication was reported less often for Hispanic and African American children than white children" (http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1497740/). Another study found rates of ADHD in children to vary according to race and family income levels: apparently, poor white children are most likely to have ADD. The authors of this second study speculate that increased likelihood of ADHD amongst this specific group might be due in part to "the elevated prevalence of ADHD risk factors (i.e., premature birth and in utero or childhood exposures to toxic substances) in this group" (http://www.medpagetoday.com/Pediatrics/ADHD-ADD/6579). Unlike these medical researchers, I would speculate that additional social and cultural factors probably play their fair share in creating this disparity of diagnosis/treatment as well.
Perhaps my decision about whether or not to take Adderall (or recommend it to others) should be based, not on whether ADD/ADHD is a "real" psychological condition, but rather on whether putting more people in the specific mental and physiological state induced by Adderall is likely to cause more harm or good to society and/or humanity as a whole. Or perhaps I should make my own personal decisions without worrying about their miniscule effects on society as a whole? Can I separate my personal ethical decisions from my beliefs and hopes for society and humanity as a whole? Should I base these decisions on Science, Sociology, Economics, a mixture of these perspectives, or none of the above? What is at stake in framing this question in one way or another?
See this Onion article for a pop-culture reference to Adderall:
http://www.theonion.com/articles/adderall-receives-honorary-degree-from-harvard,17527/
