Pharmaceutical companies dislike the word ‘addictive’. In the prescribing information given by Medeva for their drug Equasym it says, ‘Chronic use can lead to tolerance and dependence with abnormal behaviour.’ ‘Chronic use’ is not defined. It could be six years or six months. Such companies do not like to reveal the adverse effects of any of their drugs and try to meet the legal requirements for disclosure while saying as little as possible. Adverse effects are minimized by calling them ‘side effects’ and by listing as few of them as possible. Medeva list for Equasym ‘nervousness, insomnia, decreased appetite, headache, drowsiness, dizziness, dyskinesia, abdominal pain, nausea, vomiting, dry mouth, tachycardia, palpitations, arrhythmias, changes in blood pressure and heart rate, rash, pruritis, urticaria, fever, arthralgia, scalp hair loss’.
Peter Breggin, the American psychiatrist who has devoted his life to researching the deleterious effects of the drugs used in psychiatry, pointed out that the list of behaviours given as symptoms of ADHD in the Diagnostic and Statistical Manual (DSM-IV) focuses on behaviours which interfere with an orderly, quiet, controlled classroom. ‘The first criterion under hyperactivity is “often fidgets with hands or feet or squirms in seat”. The first criterion given under impulsivity is “often blurts out answers before questions have been completed” and the second is “often has difficulty in waiting turn”. None of the ADHD criteria is relevant to how the child feels. Mental and emotional symptoms, such as anxiety or depression, are not included.’ In his book Talking Back to Ritalin22 Peter Breggin ‘catalogued dozens of “causes” for ADHD-like behaviour. Most commonly it is the expression of the normal child who is bored, frustrated, angry, or emotionally injured, undisciplined, lonely, too far behind in class, too far ahead of the class, or otherwise in need of special attention that is not being provided. More rarely, the child may be suffering from a genuine physical disorder, such as a head injury or thyroid disorder, that requires special medical attention rather than stimulant medication.’23
In his book Naughty Boys consultant child psychiatrist Sami Timimi told how he would ask his colleagues ‘to explain to me what diagnoses like attention deficit hyperactivity disorder (ADHD), conduct disorder and Asperger’s syndrome were, what was going on physically in these children, and how they “knew” which child had a conduct disorder caused by family problems as opposed to ADHD caused by an immature frontal lobe (in other words a physical problem in the development of the brain). They couldn’t explain this to me and didn’t know how to differentiate physical from emotional or other environmental causes. The best they could come up with was “it must be so”. Shockingly, I realized that the whole profession is built on subjective opinion masquerading as fact.’24 Writing about the psychiatric conferences supported by the drug companies, he said, ‘All too often I leave these mainstream events feeling like I had attended a cult convention, not a scientific conference, so bad has the lack of democratic debate or interest in non-drug-industry-driven perspectives become.’25 Sami Timimi was born in Iraq and came to England when he was fourteen. He could see very clearly how different his upbringing was from that of his English fellow students. Later, as a child psychiatrist, he could relate this understanding to the problem of ADHD, which is a problem only in countries which have a western culture. Outside these places it is unknown. Of course in these places there are some naughty boys, but haven’t there always been? What is it that happens to boys particularly in western societies that does not happen to boys elsewhere?
Sami Timimi pointed out that, ‘Early in the twenty-first century we in the West are living in the bizarre paradox of Western governments spending billions every year to fight a war on drugs with the right hand whilst the left hand hands out millions of prescriptions for cocaine-like stimulants to its children.’26 Peter Breggin explained the long-term significance of these ‘therapeutic’ effects in an article which he called ‘The New Generation Gap: Today’s Kids Suffer Legal Drug Abuse’. He wrote:
We are the first adults to handle the generation gap through the wholesale drugging of our children. We may be guaranteeing that future generations will be relatively devoid of people who think critically, raise painful questions, generate productive conflicts, or lead us to new spiritual and political insights. Growing up on psychiatric drugs, millions of children are developing little sense of their own personal responsibility. Instead of discovering their own capacity to improve their lives and transform the world for the better, they are being taught they are brain-defective - and require lifetime treatment with psychiatric drugs.27
When I was a child my family gave me to understand that there was something intrinsically wrong with me as a person because I had a chronic lung disease, bronchiectasis. This so undermined my self-confidence that it is only in recent years that I have been able to talk to people, other than the doctors I consulted, about the effects this disease had on my life. How much worse it must be to be told that you have a defective brain, that the way you behave is unacceptable, that you are incapable of controlling your behaviour, and that only by depending on a drug will you be in any way acceptable to your family and to society. A number of studies looking at what children on Ritalin thought of the drug confirmed this. One child said, ‘I think it is a kind of sickness, because it, it kind of takes over, I know it takes over my body… it’s like you don’t have that much control… I kind of feel weird, because you need a pill to control yourself.’28
The child psychiatrist Sandra Scott, writing in New Scientist, said, ‘Contrary to what some parents presume, drugs do not treat bad behaviour directly. Using drugs to treat conduct disorder exposes the child to unnecessary side effects and makes it harder to apply more effective methods such as cognitive behavioural therapy - getting the child to understand why he behaves in the way he does - or therapy involving the child’s family.’29 The ‘comprehensive treatment programme’ recommended by NICE includes both cognitive behavioural therapy and family therapy.
Another consultant psychiatrist, Felicity, told me how, while she did prescribe Ritalin, she was well aware that many of the mothers of children diagnosed with ADHD had little idea how to use praise in getting a child to behave well. These women relied solely on criticism and punishment, often physical punishment. The multi-disciplinary team of which Felicity was a member used group methods to help the mothers learn how to praise their children. One sticking point was often the mother’s inability to see that praise which is followed immediately by criticism is in effect not praise at all. There is no point in saying to a child, ‘You behaved really well then,’ if this is immediately followed by, ‘Why didn’t you behave like that yesterday?’
However, using praise effectively to encourage a child to behave well is not simple. Over the past century much of the research carried out by psychologists has been devoted to proving the obvious, but then the obvious is only what people are prepared to see. For many people what was obvious was that children will learn to behave correctly if all their errors are punished. This ‘obvious’ fact psychologists have shown not to be true. We all learn best when our correct behaviour, or even just-approaching-correct behaviour, is rewarded and our errors ignored. This has been shown to be the case not just with our own species but with a wide range of other species.
The idea that rewards, not punishments, should have primacy was gradually, though not completely, taken up by teachers and education specialists. However, knowing what response to reward can be tricky. What nearly right answers should be rewarded? Is 6 + 4 = 11 less wrong than 6 + 4 = 13, and thus deserving some modest praise?
The