Sunday, February 5, 2012

More unraveling: ADD and Ritalin

I’ve posted a little bit about the intense and widespread criticism of the DSM-5. (For up-to-the-minute news and commentary, see The Blog Formerly Known as DSM-5 Wat…er, Dx Revision Watch.)

I mentioned in concluding a recent post that
what we may be witnessing with the broad challenges to the DSM-5 is the beginning of the end for this psychiatric model. Its flaws, failures, and cooptation by corporate interests are becoming more widely known, and it’s unraveling. Efforts at evasion and intimidation like these merely dramatize the process.
And we’re now seeing another thread pulled away. An op-ed last week in the New York Times by L. Alan Sroufe* explains that the psychotropic drugs used to treat Attention Deficit Disorder, the use of which has grown dramatically along with the diagnosis, don’t work. Moreover, they’re likely to have negative long-term effects, and are based on an unfounded belief in the etiology and nature of the “disorder” and the drugs’ mechanism of action.

One point Sroufe raises relates to something that’s bothered me for some time – the making of claims about psychological differences based on the use of brain scans (even assuming the interpretations of these scans are correct and complete, which is often not the case):
[F]indings in neuroscience are being used to prop up the argument for drugs to treat the hypothesized “inborn defect.” These studies show that children who receive an A.D.D. diagnosis have different patterns of neurotransmitters in their brains and other anomalies. While the technological sophistication of these studies may impress parents and nonprofessionals, they can be misleading. Of course the brains of children with behavior problems will show anomalies on brain scans. It could not be otherwise. Behavior and the brain are intertwined. Depression also waxes and wanes in many people, and as it does so, parallel changes in brain functioning occur, regardless of medication.

…However brain functioning is measured, these studies tell us nothing about whether the observed anomalies were present at birth or whether they resulted from trauma, chronic stress or other early-childhood experiences. One of the most profound findings in behavioral neuroscience in recent years has been the clear evidence that the developing brain is shaped by experience.

…[O]nly one question is asked: are there aspects of brain functioning associated with childhood attention problems? The answer is always yes. Overlooked is the very real possibility that both the brain anomalies and the A.D.D. result from experience.
Incidentally, here’s another relevant article from last month, this one by Bruce Levine: “America's Mental Health Industry Is a Threat to Our Sanity.” Levine lists seven reasons why this is so. I’ll quote the last, which is so often ignored:
7. Diversion from Societal, Cultural and Political Sources of Misery

When we hear the words disorder, disease or illness, we think of an individual in need of treatment, not of a troubled society in need of transformation. Mental illness expansionism diverts us from examining a dehumanizing society.

In addition to pathologizing normal behavior, the mental health profession also diverts us from examining a society that creates the ingredients—helplessness, hopelessness, passivity, boredom, fear, and isolation—that cause emotional difficulties. We are diverted from the reality that many emotional problems are natural human reactions to loss in our society of autonomy and community. Thus, the mental health profession not only has financial value for drug companies but it has political value for those at the top of societal hierarchies who want to retain the status quo. [my emphasis]
*[via Hooked – the post there is worth reading as well]

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