Medicating of schoolchildren II
Joar Tranøy
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Joar Tranøy is a criminologist (MA), psychologist (BSc.),
historian (BA) and School Counselling Advisor. Previously a
researcher/research scholar at the University of Oslo and Senior Scientific Officer
at the University College in Østfold. This article was previously published in UKS-FORUM FOR CONTEMPORARY ART 2001. It is republished here with the kind consent of the author. |
The
central stimulating narcotic agent Ritalin (methylphenidate chloride) is an
amphetamine-like material that, in the 1950s, was employed in psychiatry in
order to control mild depressions and senile behaviour in adult persons. In
1961 there were warnings published in the medical journals against the abuse of
Ritalin. In 1963 Ritalin was tested systematically for the first time on 81
children in an American treatment centre. The testing was financially supported
by Ciba - Geigy, who naturally had a capital interest in a positive assessment.
The
breakthrough for the use of Ritalin on children came in 1967 when the public
health authorities in the USA decided in favour of trying the material directly
on schoolchildren. The material was employed on Afro-American children in the
ghetto schools of Baltimore. The unrest was quelled in the schools and Ritalin
was hailed as a means of controlling disruptive behaviour. This was the
beginning of a decisive breakthrough in the USA where at least 3 million
children under the age of 18 years are currently legal users of Ritalin. The
situation in Norway is not that dramatic, but the trends in the treatment and
support apparatus are, nevertheless, disquieting. The medicating of behavioural
problems in Norwegian schools is approaching epidemic conditions with regard to
diagnosing and treating children with behavioural difficulties. This is
particularly true of the diagnosis Attention Deficit Hyper-activity Disorder
(ADHD) and Ritalin where at least 3000 schoolchildren are medicated by means of
the central stimulating agent. The number is twice as large as in our
neighbouring country Sweden, with twice our population.
Figures
from the Norwegian Pharmaceuticals Depot show that the use of Ritalin in the
period 1986-96 had quadrupled in Norway. The increase for Ritalin was 125 per
cent from 1996 to year 2000. The head of the state nationwide expertise centre
for ADHD, Tourette’s Syndrome and narcolepsy recommends that at least 10 000
Norwegian children need Ritalin. School-related behavioural problems have
become a major individual clinical area of attention connected to regional and
nationwide centres with psychiatrists, neurologists, psychologists and special
pedagogues in a professional medical environment.
Behavioural
problems are regarded as a functional disorder in the brain of a biochemical
nature. Children are heavily medicated in order to achieve calm in the school.
In this way the adults concerned are exempted from responsibility. Such a
medical disciplining of disruptive and inattentive schoolchildren often leads
to fundamental problem-creating system conditions. Alternative provision (such
as alternative schooling) is precluded because the authorities wish to preserve
the semblance of "integration of all" within a uniform school system.
The
diagnostic basis for ADHD is extremely unclear. It is said that children are
inattentive because they have ADHD and that they have ADHD because they are
inattentive. On the form for diagnosing ADHD the question is asked, for
example, whether the child has the following bad habits: Is it not attentive
enough to details or does it make careless mistakes in its schoolwork? Does it
fumble with its hands and feet, or sit restlessly on its chair. Does it have
problems in sustaining attention in tasks or games. Does it often leave its
place in the classroom or get up elsewhere, when he/she should be sitting
still? Does it not appear to hear when being directly addressed. If the answer
is ‘yes’ to these questions, the criteria for the diagnosis are, so to speak,
met. The border between "sick" and normal is a fluid one.
The
registration is undertaken at home by the parents and at school by teachers.
When the reports from the teacher and the parents are contradictory,
consideration is normally given to the teacher’s report since the latter
possesses greater awareness of age-related norms. The symptoms are more easily
registered in situations that require self-development, as in the classroom.
The deviation may actually not be present in other situations.
The
teacher’s assessment often appears to be the decisive one, and the
School-councelling service as the expert instance normally follows up the
school assessment of who is a "normal" child. It is not necessarily
the case that it is the pupils that create the problems, but rather the
school’s teaching and frameworks that create difficulties for the pupils.
The
diagnosis of ADHD is highly subjective and is decided on the basis of
culture-relative norms. In addition there are framework conditions and contexts
such as, for example, the child’s daily pattern etc., that is not taken into
consideration. Moreover the treatment level may vary considerably with a child.
Even within the same family.
The incidence
of ADHD shows itself to be proportional to the presence of, and influence by,
behaviour diagnosticians, testers and therapists in the schools, not only in
the USA but also in Norway.
Social
conditions also exert an influence. For example there is the worsening of the
physical and social environment in the schools with reduced opportunities for
play and physical development. At the same time the pressure of theory has
increased. Children can easily be run over in the school system with its behavioural
experts, towards whom even the teachers and advisors feel powerless.
One
example is the teenager Tore. There was disagreement as to whether Ritalin
could help Tore. After a few months of medication the opinions were divided.
The school’s advisor stated, for example: "I am now doubtful as to whether
we have proceeded in the right way. Tore has been calmer during the lessons.
But several of us are somewhat uneasy. We do not really recognise Tore now. His
charm has almost disappeared. There is hardly ever a smile to be seen. His
school performance is about the same as before. Purely egoistically one may say
that he has become easier to have dealings with. But he is not entirely Tore
any more."
Neither
Tore’s parents nor the treating psychologist were willing to comment. But
Tore’s friend expressed the following: "It has become calmer, yes. Most of
those in the class are, perhaps, happy about that, but not me. Tore is not
quite the same. I miss his funny and crazy things. Now there is nothing there.
The worst time is in the breaks. He doesn’t join in with anything any
more."
Tore
himself did not wish to say very much. His face showed that he was not
particularly satisfied: "I feel that I am no longer in control. My body
takes over. I have to have the tablets in order to feel my body. I am no longer
able to be aware of everything. I don’t really know what the other think about
me. Not that it really makes any difference. I’m the one there is something
wrong with."
Tore’s
class tutor did not really wish to say anything. But he expressed himself in a
very serious manner: "This is a very difficult and sad case. The classroom
disturbances have been greatly reduced. It is clear that certain pupils have
profited from it."
The
employment of Ritalin appears to serve as a solution or an alternative to
changing the school environment and the school system. Ritalin becomes a
short-term aid. The child becomes easier to deal with without there being a
documented effect on school performances and psychosocial functioning in the
longer term. A particular difficulty is the danger of addiction. It is
difficult to stop taking the material after long-term use. The problem is
referred to as "Withdrawal syndrome", and involves a serious and
sustained depression and suicide danger.
Follow-up
examinations are subject to serious limitations. The observation time is seldom
longer than a year. The assessment of the results are completely restricted to
the actual symptoms, and do not include subjective reports regarding well being
etc.
It is
not necessarily the case that the absence of symptoms is synonymous with
subjective well being and quality of life. Even in those cases where freedom
from symptoms also involves subjective well-being, the Ritalin treatment is not
necessarily ethically defensible if, in the longer term it contributes towards
social invalidity. Ritalin and the label ADHD individualise social and moral
problems. Social and ethical problems will, by means of the diagnosis, be
constructed as a question of deficient individual adjustment. How are
trouble-makers, disruptive elements, to be dealt with? The child is rendered
ill and stigmatised. Other cultures look at such troublesome behaviour
differently. An erstwhile neighbour from Sri Lanka explained that there are
hyperactive children there, too, but that they are treated with respect and
care because "something big always emerges from such children."
We
adults save our own honour, but not that of the child. With the power and
disciplining perspectives of Michel Foucault, we are able to regard the
medicinal practice in respect of children as a kind of separating and excluding
practice, where the treatment represents an extension of society’s excluding
procedure, where children are subjected to a chemical control.
Those who
determine normality possess power and it is groups of experts who possess this
power through their social technology. The determination of the deviation
concept becomes increasingly fine-meshed: classification of the deviation is
subjected to constant new categorising and dividing lines. It is particularly
children at whom the new diagnoses are directed. Among these are ODD
(Oppositional Defiant Disorder), CD (Conduct Disorder) and OCD (Obsessive
Compulsive Disorder). The diagnosis ODD applies to what is referred to as the
defiance illness for children aged 5-6 years who are "egocentric and
narcissistic." Since the 1950s the diagnoses in the two international
psychiatric diagnosis systems have increased more than twofold. The Norwegian
post-war era has also shown that there have occurred significant encroachments
with psychiatry’s illness categories conditioned by the culture’s tolerance
limit and moral standards. It is enough to mention the LSD treatment of
homosexuals, transvestites and the sterilisation, castration and lobotomising
of gypsies and the persecution of dissenters such as Knut Hamsun and Arnold
Juklerød.
In
conclusion: Do we wish to have a society comprising only well-controlled and
pliant people - Are we about to realise Aldous Huxley’s frightening vision of
the future in "Brave New World"?
©
UKS-FORUM FOR CONTEMPORARY ART 2001
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