Samizdat has just published Patrick Hahn’s Obedience Pills, a book that reviews the ADHD scene from its origins in the US to its current bloated stimulants-in-the-drinking-water state and the extension of the ADHD franchise to other countries.
Like Patrick’s Prescription for Sorrow, Obedience Pills makes no excuses for grabbing people by the throat, pinning them against the wall and asking – Do you really think what we are doing makes sense?
We struggled with the title – one option was Drugging them into Submission, another Children’s Mental Health Pandemic: ADHD Variant. We invite to suggest other possibilities but you’ll have to read the book to make meaningful suggestions.
Roughly a quarter of century ago, it was very tricky to prescribe a stimulant like Ritalin for ADHD in the United Kingdom and Europe. I organized a conference and invited speakers from the United States, including Don and Rachel Klein, as well as Stan Kutcher (of Study 329 fame), Paul Leber, then head of the CNS division of FDA, Ed Cook, Mark Riddle and others.
There were child psychiatrists from the UK such as Stephen Tyrer, Jonathan Hill, David Bramble, Mike Kerr, Richard Harrington, Chris Hollis, Dave Wilkinson, clinicians like Dave Nutt and Susan Bailey, researchers like Trevor Robbins, Barbara Sahakian, and clinical psychologists like Sonia Sharp and Rea Reason, who worked on guidelines for a therapy approach to ADHD. There were psychiatrists from Europe like Martine Flament, Helmut Remschmidt, Willem Verhoeven, Siegfried Tuinier and European regulators like Barbara van Zwieten. In addition, several pharmaceutical companies sent representatives.
My goal was to steer this distinguished group to an Osheroff agreement – that is no-one approach is necessarily right and if the young person is not responding to therapy for instance, medicines should be tried and vice versa and equally if someone is doing well on one approach they should not be switched.
I wrote the final paper which is HERE. A full transcript of the all-day meeting is also available.
The Osheroff case was a celebrated US lawsuit where a surgeon in need of treatment went to one of the very best mental hospitals, Chestnut Lodge, where he got worse and worse, losing his livelihood and marriage, with all this being seen by his therapists as a necessary part of the therapeutic process. He was removed by a friend to nearby hospital where he was put on antidepressants and a few weeks later was well. Experts, from both the biological and therapy side in the case, agreed that the problem was not the use of therapy in the first instance but in persisting with therapy only in the face of an obvious decline.
It was very clear in 1997 that the floodgates were about to open and release a torrent of ADHD diagnoses and stimulants. Far from opening the floodgates, this paper offered psychologists and others a chance to say that stimulants should not be persisted with if they were not obviously working – that an alternate approach should be considered. Something of a sandcastle.
Thirteen years later, I surveyed all 50 adult psychiatrists in North Wales on the topic of Adult ADHD. There was a 100% response rate.
They were asked did they think Adult ADHD was a real entity, did they think they would think it was a real entity 5 years from then and would they be treating it.
The answers in brief were that no they didn’t think it was a real entity, but that they would think it was a real entity soon and would probably be treating it with stimulants. the paper is HERE.
This little paper deserves to be cited in the annals of disease creation, but at the moment it is not politically correct with Greta Thunberg’s generation or the doctors treating them to suggest that Adult ADHD might be manufactured. Its not just Greta’s generation – their mothers and fathers seem to have been infected with this non-communicable disease.
It’s a wonderful irony that we can call diseases like Adult ADHD non-communicable when communication is the sole means of transmission.
There is another extraordinary feature of the ADHD story. Mention extraversion and introversion to any North American and they have no idea what you are talking about. This includes Leon Eisenberg, the man who ran the first Ritalin for ADHD trial. Eisenberg was a professor of psychiatry at Harvard, who to many Europeans would have seemed much more nuanced than the average died-in-the-wool biological or analytic American psychiatric academic.
The terms extraversion and introversion have been around for over century. They are biologically rooted. Your extraversion-introversion score predicts how much anesthetic it will take to put you to sleep, and how likely you are to respond to a stimulant. It predicts how you will perform on a range of hard-wired neuropsychological tests. There are no tests like this for ADHD. See Interview with Gordon Claridge.
This response to a stimulant doesn’t necessarily call for treatment. It indicates that temperaments differ. Some of us have a loose focus and are more likely to be risk-takers, artists or salespeople, and people people. Others of us are more focused and are better at tasks that require focus, will be risk managers and are much less likely to ‘bounce’ off others.
Success in life is more likely if we find the right work and relationship niches that suit us. Sit an extravert down with spreadsheets and they are likely to figure they need a drug to help them focus. Put an introvert in a sales position and they will develop social anxiety or become depressive and figure they need an SSRI. The marriage of an extravert and introvert however can be very successful.
Our work issues are made worse by the current managerial culture that doesn’t recognize differences and wants us all to be the same. It’s like a football manager not recognizing that some people are good at scoring and others at stopping the opposition from scoring. A team with diverse skills will usually beat a team of clones.
Recognising and celebrating diversity is important and these temperamental differences between us are at least as great as any differences between sexes or ethnic groups.
Just because something is biologically based and chemicals can make a difference to it doesn’t make it a disease.
This doesn’t mean stimulants have a place but it does undercut the idea that if you only you take your stimulants you won’t get divorced, have business and educational failures, turn to drugs of abuse and die from suicide. Stimulants may be more likely to lead to these outcomes than not.
Stimulants have a rich history and can be helpful but like all chemicals they come with risks. There is a concerted effort at present to stop people learning that stimulants increase the risk of early Parkinson’s Disease, for instance. After several years of attempting to get published on this topic Alan Baumeister had to mention in the title of his article on this topic that ADHD poses a risk of Parkinsons. The problem here is that this message can easily become – hurry up and start taking your stimulants to prevent this happening.
As Patrick’s book makes clear, though, all this nuance has been swept aside. More and more people and their children are getting trapped in an increasingly senseless situation. The only hope seems to lie in American enthusiasm. Just as with religions, at one point Americans took psychoanalysis to an extreme and then biopsychiatry.
There is sometimes a brief point of nuance when the pendulum is in midpoint between extremes. Can we ever hope for more?
Have we hit peak ADHD yet? There are no signs of ADHD Recovery groups around – googling ADHD recovery groups only brings up groups that will get you ADHD treated for you not groups that will help you recover from this diagnosis.
Hurry up and get Obedience Pills and see what you think. Are we about to turn the corner or might we start paying more Attention to this Hyperactive Marketing.
Let us know if you can find any ADHD Recovery Groups.