Obedience Pills
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.
From Then to Now
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.
It was something of a sandcastle in the face of an incoming tide. 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.
Diseases or Temperaments?
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.
Celebrating Diversity
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 don’t 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 but ultimately they switch to another enthusiasm.
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 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 should we start paying more Attention to this Hyperactive Marketing.
Let us know if you can find any ADHD Recovery Groups.
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Patrick D Hahn has picked the perfect subject following Prescription for Sorrow published by Samizdat Health Writer’s Co-operative Inc.
https://samizdathealth.org/?msclkid=7e883155cf9611ecac83a747d55bea53
*****
“It’s psychiatry which is against the medicalisation of normality.”
“Medicalisation is not often done by doctors…
The new President of the Royal College of Psychiatrists, Simon Wessely, recently signalled his concerns about overmedicalisation in children. In an interview with The Times newspaper in the UK, he said that “Medicalisation is not often done by doctors…Now we see a huge rise in support groups, we see pressure brought to bear to bring in labels…You get obvious pressure from parents…It’s psychiatry which is against the medicalisation of normality.” Specifically in relation to attention-deficit hyperactivity disorders (ADHD), he went on: “It’s the same with Ritalin. It’s probably over-prescribed, but it’s also under-prescribed because we don’t have good enough services.”
https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(14)61146-6/fulltext?msclkid=19c2dd31cf9311ec81cb47bddaa22495
The new guidance from the American Academy of Pediatrics is therefore very helpful. And we also agree with Simon Wessely that mental health services for children and young people need to be substantially strengthened.
Prescription for Sorrow
One could scarcely have been alive and conscious anywhere in the Western world any time in the past twenty-five years and not have been aware of a raging controversy surrounding antidepressants, suicide, and violence—a controversy that shows no sign of abating. During that same period, prescriptions for antidepressants have skyrocketed. So what is the story?
“Prescription for Sorrow: Antidepressants, Suicide and Violence” by Patrick D. Hahn
But Drs. Singh and Wessely are mired in the traps of psychiatric dogma and complacency.
https://www.behaviorismandmentalhealth.com/2015/07/24/adhd-a-destructive-and-disempowering-label-not-an-illness/?msclkid=c46e34f9cf9711ecacd00dcea6bd5e74
And already there are some red flags. Firstly, the title Childhood: a suitable case for treatment? evokes the kind of concerns often expressed on this side of the issue, that the creation of the “ADHD diagnosis” is essentially a systematic and self-serving pathologization, on the part of psychiatrists, of normal childhood activity.
ADHD: The Money Trail
https://www.madinamerica.com/2022/05/adhd-money-trail/
At the age of four she died, a direct result of the drugs she had been prescribed.
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Editor’s Note: This piece is an edited excerpt from the author’s new book, Obedience Pills: ADHD and the Medicalization of Childhood.
Just noticed this in a tweet by Altostrata
Online Adderrall Prescription Mills
D
There may be no “ADHD support groups” in the USA (other than CHADD, NAMI and others that emphasize taking your meds). However, there are lots of programs for “stimulant abuse” and “stimulant addiction.” In fact, it’s a growing sector.
First, the term to put in your search engine is Adderall, not Ritalin. Here’s an example from the Chicago area:
https://www.timberlineknolls.com/drug-addiction/adderall-use-treatment/
And here’s an instructive story from a little blog called RxISK, about two young Adderall addicts whose addictions definitely both started at the doctor’s office:
https://rxisk.org/adhd-nation/
There are also a fair number of “lay-led” support groups, of which QuittingAdderall is one of the oldest. A link to that group is included here:
https://rxisk.org/its-alright-ma-im-only-punding-stimulants-and-compulsions/
However, if you want to live and prosper in this sector there is one rule you MUST observe: Don’t question the concept of ADHD — especially adult ADHD.
Even Adam Schwartz’ ADHD Nation (reviewed in the blog above) and Quitting Adderall’s founders take the position that ADHD IS a real disease, and some people really need their Adderall to be healthy. They are, however, willing to say that the net is cast way, way too wide, and that a medical prescription can indeed lead to an addiction.
It’s different for most of the profit-focused professional treatment centers.” There, the trick is to draw a line between “proper” medical use of Adderall, and “Adderall abuse.” That’s not as tough as it sounds — we are so awash in Adderall that many users get their supply on the informal black market. And even those who do get their first script from a doctor will often start taking it in ways the doctor doesn’t recommend.
It’s much like the Opioid Crisis: A drug given out by doctors as a quick solution to a real problem (if not always a real Disorder) leads to an epidemic of “abuse” and “addiction.” The first new wave of addicts emerge from the doctor’s office, but pretty soon you can become an addict on your own by buying the pills on the street (or in the college library). The medical system moans that drug “abusers” are ruining things for the folks who really need the drug. Old patients are cast out and demonized, while the new patients keep streaming in.
Shortly after Jo posted this comment, there was an email from Larry Diller saying:
Nice to see the names of all these veterans from the Ritalin Wars. It’s interesting for me to see a revival of concerns about overuse of, abuse of and addiction to prescription stimulants. I know all of you are aware of the four part series I wrote in 2016 called the United States of Adderall (https://www.huffpost.com/entry/the-united-states-of-adderall_b_8914480) and the Netflix documentary, Take Your Pills (still available on Netflix) that leaned heavily on the HuffPost series.
I know that Nora Volkow and her group at NIDA are aware and concerned about the problem as it rears its ugly head every now in then in a study or news story but the U.S. government doesn’t seem ready to take action — a well publicized bust of an Adderall mill near a university or the arrest of some students selling or giving their Adderall to someone without a prescription (yes even giving away a controlled substance is a federal offense) would rock the entire underground and doctor supported process.
But it ain’t happened yet and I’m not sure what has to happen to cause a shift. I couldn’t get a book publisher to support a full length book on Adderall abuse six years ago (which instead became Take Your Pills). I don’t think anything has changed in the intervening years.
I’m glad to know all of you are still around but I’m pessimistic on anything changing soon — but you never know.
Good luck to these efforts. If I can help let me know — but I’ll decide whether or not I think it will do any good before agreeing to
Larry
It’s not just the drugs . Maybe the shift is the growing research/imaging of very young childrens’ brains for example by the psychoanylist dept at UCL to supposedly find areas which point to causing psycho-social problems in future – unless they are lucky enough to be saved from a lifetime of unique up and downs and can be tweaked asap by superbly ‘well adjusted’ therapists ,whose involvement would then surely mean the authentic personality of that person would never be realised. Do they have fantasies of creating nice obedient groups of humans without annoying quirks or vunerabilities ,including some brain washed groupies to follow in their footsteps to create even more brain tweakers.. After all one well known psychiatrist who promotes attachment theory by adding more and more layers to prove it has said he sees his clients as his surrogate children. No sperm needed all done by psychoalytically informed behavioral techniques under the guise of ‘caring’.
What a boring world it would be if all humans behaved like robots – to be switched on or off at the touch of a button! Far fetched did you say? Not so far at all!
This is exactly what we are doing to our children – and have been doing for a good few years now.
“My child won’t sleep” – give them a pill.
“My child won’t eat a variety of foods” – give them a pill.
“My child won’t keep still” – give them a pill.
“My child won’t relax” – give them a pill.
“My child’s mind seems to be always buzzing” – give them a pill… and so it goes on.
The child then goes to school having taken “the pill” with his/her breakfast.
“Your child seems tired – is he a good sleeper?”
“Your child refuses most foods offered at lunchtime, is he a good eater?”
“Your child seems unresponsive during lessons – do you notice that at home?”
The parent’s reply:- “We used to have problems where he was too lively. The doctor put him on these tablets to help calm him down. Now he just seems to be tired all the time – no energy, no interest in anything, hardly eats, never talks about his day at school. I think we need to take him back to the doctor and see what he recommends…..”.
That type of picture is seen all too often. Now I hear that many employers are complaining that students who wish to become their employees lack the ability to “think for themselves and to be able to problem solve on a level expected for being part of a workforce”. Are we surprised? I’m not ! What else can we expect when, throughout their early lives we have tried to mould them in unison, to knock out of them their individuality. ‘Conforming’ has been the order of the day but, when, at last, they are allowed out into the big, wide world they are lost.
We should start celebrating the individual from birth onwards – accept that we each reach different stages at different ages and treat every ‘stage’ as one to be guided towards the following step at the rate of the individual and not at the rate dictated by a manual or a set of curriculum standards.
Medications for children should be kept to the absolute minimum rather than being handed out obsessively as seems to happen at present.
There looks to be a lot of conversation lately around ‘late diagnosis’ of ADHD especially amongst women in their 30’s and 40’s. Vogue have run several articles on this, including this one from last year: https://www.vogue.co.uk/arts-and-lifestyle/article/adult-adhd-diagnosis
Just this week the Guardian’s Science Weekly podcast discussed women and late diagnosis: https://www.theguardian.com/science/audio/2022/may/12/why-arent-women-getting-diagnosed-with-adhd
There are several high profile women with large social media followings who have spoken about being ‘neurodivergent’ a word I have seen much more of in recent times. A quick glance at some of the current hashtags-#ADHD on Facebook 1.5M posts, Instagram 2.6M posts. #neurodiversity 490K Posts on Instagram, 230K on Facebook.
I’ve heard Breggin interview Patrick Hahn a few times. He sounds like he does his research before speaking, like most Breggin interviews. I wish there was an audio book of this and his other book. I’ll have to do it the old way like your book “Children of”, David. Thanks too for the confirmation about doxy. I’ve been aware of the possibility of something being unlike most in my young daughter for quite a while and since experiencing effexor wd/pws and the repercussions of its use am on alert to defend her right to have a non chemically altered brain. I think this book’s a must for me and thank you for your review.
https://fb.watch/d38ZlhxUpl/ – This link nicely illustrates my comment above ( May 10) regarding children diagnosed with ADHD. ACCEPTANCE is key – followed by firmness and kindness giving a sense of inclusion rather than separation. From watching the monkeys we can see that it’s a natural response, of the monkey in red, to jump the gun and gain the keeper’s attention at every given opportunity. Should we REALLY need to drug this natural behaviour out of our children ? – in my opinion, certainly not.