Friday, May 21, 2010

The ADHD Fantasy

Peter Hitchens claims that ADHD doesn't really exist.

The Hitch takes apart the 5 most common angry responses he receives when he writes about ADHD. Here are two of them (the full list and his answers is available by following the link above):

"1. "Dear Mr Hitchens, I feel utterly insulted by your gratuitous claim that there is no such thing as ADHD'. You are obviously an ignorant moron. You should do some research on this, and then you would know that it was a real problem."
A. An insult can only be offered to a person, directly, and concern his personal failings or faults. It is not possible to be 'insulted' by a statement of fact, or by an argument you disagree with. If the statement isn't true, then you are well placed to prove that. If you disagree with the argument, then you can say so. To say that you have been 'insulted' is to refuse to accept that there may be some truth in what I say, possibly because you have some doubts about the matter yourself. In fact I often find that angry, personal vehemence in an argument is a sign that the person involved has serious doubts about his or her position. Let us begin as we mean to go on, and treat this as a matter of facts and logic. Also, as it so happens, I have done a great deal of research on this matter, not least as a result of dealing with several waves of correspondence on the subject. And the more research I have done, the more alarmed I have become at the great numbers of children and teenagers being drugged because they are supposed to be suffering from a complaint for which there is no established, objective test.
The question here is one of scientific fact, which - let us agree here to accept Karl Popper's view - has to be proved by experiment, and in such a way that it could later be disproved by new discoveries. Anything else is speculation, not fact or knowledge. If someone wants to say that there is something called 'ADHD', and prescribe actual drugs for it, the burden is on him to prove it by experiment, and to present a proof which could be exploded by new discoveries. I say no such proof has ever been produced. There are, it is true, some attempts to produce it. But one has been pretty thoroughly knocked down, and the other is tentative. Crucially, neither is generally used to diagnose 'ADHD', which is generally done by a subjective assessment.
I must also stress that, if you have been told that your child is suffering from a 'disorder', that does not actually mean that this must be so. Sceptics and doubters may be right. Doctors, regrettably, are often mistaken. Medical practice, even in physical medicine, undergoes fashions and fads just like every other field of human activity. Some examples: To my own knowledge, 23 years ago parents were told that the best way to avoid cot death was to lie babies face down. Five years later, the advice was the exact opposite. Putting them face down was likely to be fatal, and they must be laid on their backs. In the mid-20th century many psychiatrists believed that pre-frontal lobotomy was a miracle treatment. It is now universally decried as a barbaric and destructive operation.
Fashions in psychiatry have changed even more completely than fashions in ordinary physical medicine and surgery, during the short period of psychiatry's existence, with many of Sigmund Freud's original theories now regarded as wrong or flawed. As for neurology, the discipline which deals with the human brain, neurologists themselves admit that we know startlingly little about this complex, delicate and vulnerable organ. Undoubtedly, drugs can affect the brain. But neurologists are often extremely vague about how they operate and why they have the effects that they do have. Many drugs prescribed for neurological complaints, or for complaints which are assumed to be neurological, also have severe side-effects, and long-term consequences which are often discovered after some time. Some physical treatments for allegedly neurological complaints, such as electro-convulsive therapy, have been described to me by doctors as the medical equivalent of thumping a TV set that has gone on the blink.
In my childhood, operations for tonsillectomy were routinely given to children with nothing seriously wrong with them. Shoe shops provided machines in which you could X-ray your own feet, machines which were believed to be wholly safe and advertised as such. Most first-aid textbooks recommended treating burns by putting greasy creams on them, now acknowledged to be one of the worst things you can possibly do. When I first became a blood donor, in the 1970s, I was given iron pills by the nurse and told to take them without fail. This is now considered unnecessary, and possibly harmful. And so on. Many of us have also been misdiagnosed by doctors at one time or another. I certainly have, and once ended up in hospital being prepared for a wholly needless operation because I had been prescribed the wrong antibiotic. The mistake was discovered just before I went under the anaesthetic. It is perfectly reasonable for informed laymen to question the wisdom of doctors, and often wise to do so.

2. "You plainly have no idea of what you are talking about. If you came and spent a week at our house, then you would know that ADHD existed."
A. I did once respond to such an offer, asking the writer to name a date. I warned that I spent rather a long time in the bathroom in the morning, but promised to bring my own wine and do my own laundry and ironing. But I heard nothing more, perhaps because I added . "I can assure you that, even if I spent a year in your home, I should still not be persuaded that 'ADHD' exists." How can I be so sure? Why wouldn't I be influenced by daily contact with a badly-behaved or uncontrollable child?
First, because the fact that there are such children is not in doubt. There are many. I wouldn't have to spend a week watching them misbehave to be convinced of that. Many modern British and American children, especially young boys, cause their parents and their teachers great difficulty. They defy authority, they run wild, they break things, they yell and shout and are horrible to their brothers and sisters. But their existence does not prove that 'ADHD' exists. That is a separate issue. It just proves that in modern Western societies there are a lot of ill-behaved boys. The question is not "do children behave badly in increasing numbers, especially at school?" Everyone knows this is the case. The question is "what is causing their bad behaviour?" Is there one simple reason, that can be cured by giving them all a drug? Or are there many reasons, some of which might be curable by drugs (I am suspicious of this method under all circumstances, but don't rule out the possibility that there might be cases where drugs could help), some of which can be cured by sleep, exercise, diet, the rationing of TV watching, a different pattern of family life, a better school, and some of which have actual physical causes and may or may not be treatable?
One of the problems with the diagnosis of 'ADHD' is that it covers such an extraordinarily broad range of behaviours including -in my experience - children who may actually suffer from birth trauma or brain damage, and children who are merely wilful and obstinate, or are driven to distraction by dull schools and bad teachers. Worse, it closes the subject. If they are all suffering from a treatable physical disorder, then we need not worry about our debased family life and our useless schools. And the small minority of children who do actually have something physically wrong with them are dosed with drugs that pacify them, and their real problems are ignored and go uninvestigated This means firstly they are not treated, and secondly that medical knowledge ceases to advance. The 'diagnosis' of 'ADHD' helps none of those to whom it is applied. But it gets a lot of adults off the hook of responsibility and closes off scientific inquiry.
Even if some of these children do actually have a physical defect curable by drugs, they cannot conceivably all be the same - six or seven million children now in the USA, hundreds of thousands in Britain.
Among the 'ADHD' children are those who have been exposed to an enormous amount of TV from early infancy, or to violent computer games. There are those who suffer from an almost total absence of physical exercise, and those who have never been introduced to a routine of mealtimes and bedtimes, and so are unwilling to adapt to any environment in which there are routines and timetables. There are those who have never been taught to read, and so would find school a constant frustration. There are those whose schools are unbearably dull test-factories, in which they are compelled to spend hours at uncongenial, repetitive and maddening tasks. There are those whose diet is packed with sugar and unhealthy chemicals, and those who suffer from a grave lack of sleep. there are combinations of some or all of these factors. There are what I refer to as 'spirited ' children ( who are well described by Mary Sheedy Kurcinka in her book on this subject) who are simply very bright and rebel against being treated as normal children. Others are seeking attention because they feel neglected by absent, busy parents or are angry about divorces or separations or the unwelcome appearance of step-parents in the home. Some are just plain badly brought up.
Surely a proper, medically-defined complaint couldn't encompass so many different sorts of child, and still mean anything? Also, if it's a physical manifestation, why does it affect boys so very much more than it affects girls? No other medical complaint - except those involving reproductive organs - discriminates between the sexes in this way. Yet the very name "Attention Deficit Hyperactivity Disorder" is - or appears to be - highly precise and specific. It is intended to sound scientific and exact. It cannot be both precise and vague. Yet, if it exists, it is. Year by year, especially in Britain and the USA, thousands of children damaged, disadvantaged or neglected in hundreds of different ways - or with nothing wrong with them at all - are alleged to be suffering from it, on the basis of a sketchy, subjective assessment - which I'll come to later.
This wouldn't matter so much if the 'treatment' for 'ADHD' were as vague and variable as the thing itself. But it isn't. In most cases, some of them involving very young children indeed, the medical response is a highly specific one. It is to prescribe powerful psychotropic (mind-altering) drugs - notably ones containing the chemical methylphenidate ( most commonly marketed as the pill called Ritalin). In the USA (though not, so far as I know, in Britain), it is also often 'treated' with Adderall, an actual amphetamine which I believe was once marketed as Obetrol, an appetite suppressing diet drug ( among whose users was Andy Warhol). It is a controversial substance. Look it up on Google for more information, and see if you think it is a good idea to give it to children.
And what about Methylphenidate? Unlike Adderall, it isn't technically an amphetamine, but it is very similar to amphetamines, which are generally strictly controlled by law in most civilised countries. It is claimed that it 'treats' 'ADHD', but there is a major problem here. First, there is no recognised objective chemical, physical or biological test for the existence of 'ADHD'. Secondly, nobody actually knows what effect methylphenidate has upon the human brain. It is said to 'aid concentration' ( as are amphetamines) and anyone who took it would certainly find it was easier to concentrate on dull, repetitive tasks and unwanted duties such as last-minute exam revision. If you worked in a call centre, you would probably find it helped you get through the day. But why? And at what cost?
One theory, unproven by research, is that 'ADHD' is caused by a dopamine imbalance in the brain. Since Methylphenidate increases dopamine levels in the brain's synapses, this would, if proven, at least justify its use in this case. But it isn't proven, a point I'll address in more detail. Another theory is that Methylphenidate affects the action of serotonin in the brain, the chemical that provides feelings of well-being. Personally, I think it's amazing that even an adult should swallow a substance about which so little is known, which affects an organ so sensitive, valuable and little understood. It is even more amazing that it should be given to children with unformed brains. Methylphenidate is sold on the black market as a stimulant, as amphetamines are, both in Britain and the USA. It has recognised side-effects, including stomach-ache, sleeplessness, headaches, dry mouth and - more rarely - palpitations and high blood pressure. Anti-Ritalin campaigners in the USA allege that it has even greater problems, and some American websites suggest that it may actually be dangerous to some users. In the US, there have allegedly been cases of cardiac arrest in children taking methylphenidate, and the US authorities have been divided about whether to place health warnings on the labels of Methylphenidate-based medications. Some experts have strongly urged that such warnings should be displayed, but so far the authorities have declined to do so."


JP said...

Fascinating article. I wonder to what extent similar arguments may be true of dyslexia, and Hitchens himself mentions autism.

For the record, and as a great fan generally of PH, I think he made the wrong call on MMR:

* Pete Hitchens reckons your child probably won't die
* The media’s MMR hoax

Andy said...

Hitchens responds to comments on his ADHD piece:

"'You [Hitchens] know nothing about science, so you cannot judge a scientific question'. This again is a (rather moronic) misunderstanding of how human knowledge is acquired and organised. Were 'ADHD' to be supported by a genuine scientific proof, then it would indeed be open only to those skilled in chemistry and neurology to debate the validity of such a proof. But it isn't, which is the absolute precise hinge of this argument. No knowledge of chemistry, neurology or physiology is necessary to determine that, if experts agree there is no proof, there is no proof. The definition of 'ADHD' given in the DSM-IV is in clear English and open for any normal human being to read and understand, as he or she wishes, since it is crammed with expressions and definitions for which there can be no objective standard or proof. Any literate adult may form an opinion upon it. Which brings me back to the unalterable fact, that it doesn't have an objective proof. There is therefore no objective scientific dispute about this, and no requirement for scientific skills or knowledge in determining the state of affairs.

And, as I have said time without number, this would not be so important were it not for the fact that in many cases, alleged sufferers from 'ADHD' (usually powerless children in the hands of trusted adults) are dosed with powerful, objectively existing, measurable doses of chemicals. These chemicals are known *to* affect the operation of the human brain, largely because they alter the behaviour of those who take them, making them more docile and able to endure tedious and repetitive tasks (this description of the drugs' effects should give any free human being cause to shudder, in my view). However, there is very limited knowledge about *how* they affect the human brain, an organ of which we know startlingly little. I might add that there are disturbing suggestions that long-term use of these drugs can also result in unpleasant and considerable physical side-effects, for which there is a growing quantity of objective evidence. What is more, once these drugs are ingested, permanent, irreversible changes are effected on the brain of the patient. (Indeed at one stage 'ADHD' partisans grotesquely attempted to claim that these changes, caused by the very 'medication' they had themselves fed to the children, were objective evidence of the existence of 'ADHD'. Fortunately, this outrageous claim was dismissed. The obvious truth was that the physical changes were the consequence of the drugs.)

Further, the chemical involved would have the same effect upon anyone who took them, whether 'diagnosed' with 'ADHD' or 'diagnosed' not to have 'ADHD;' or not diagnosed at all. This makes them different from proper medicines, which will generally affect the symptoms of those given them for specific complaints. Eg, antibiotics, properly prescribed will cure the specific complaint for which they are prescribed. Wrong antibiotics, that is to say, those which are not specific to the disease being suffered (as I can testify from personal experience) will not cure that disease. And a person who has nothing wrong with him at all could take those antibiotics and feel no effect whatsoever. This stark difference between the juju 'medicine' of 'ADHD' in which allegedly sick and undoubtedly healthy are affected in the same way by the supposed 'medicine' - completely different from the normal practice of medicine - should surely give pause for thought to anyone seriously interested in science or medicine. Why doesn't it? Because the partisans of 'ADHD' do not see because they do not want to see. They do not want to see because they are interested parties."