Biopsychiatry Illuminated

THE CANDLELIGHT PROJECT
by Bob Collier

10 November 2003
Issue 67

MEDICATING NORMALITY:
THE PSYCHIATRIC COLONIZATION OF CHILDHOOD
By Antony Black

In the popular lexicon 'normality' has come to express a paradoxical meaning. Having cleverly eluded confinement within the official compass, it now resonates with the mocking echo of a diversity that will not be denied. What is 'normal' one asks? And the unlettered shrewd among us reply, 'nothing' - or at least, very little.

In the medical lexicon, however, 'normality' has, over the last few decades, beaten a sharp, 180 degree retreat into a highly specialized, bureaucratically defined cell. This has led to the proliferation of countless new diagnoses and, in turn, to the spawning of endless psychiatric sub-specialties by which to profit from a diversity that has been exiled into the scientifically dubious, politically reactionary, yet highly lucrative firmament of medical abnormality.

That the 'disease' modality has virtually hi-jacked modern psychiatry, and infiltrated to the core of popular culture may, of course, be readily apparent to the reflective reader. What is often less appreciated, however, is just how scientifically unsubstantiated, how philosophically and ethically untenable, and how medically indefensible this modality is. And nowhere is its defence more questionable than in its application to that class of involuntary patients - children.

Drugging Kids, Legally

It is an irony completely lost on the mainstream political and media culture that whilst a vicious, absurdly punitive 'war' is waged against illegal drugs, the state should itself be engaged in a vast, legal, drug laundering operation(1).

Thus, ignoring the staggering arsenal of regular prescription and over-the-counter medications, a conservative estimate of the proportion of the adult population in the US and Canada now taking *prescription psycho-active* drugs is well over ten percent(2).

Indeed, the introduction in the late 1980's of the modern serotonin-specific anti-depressants (i.e. Prozac and kin), spurred a sharp rise in the use of legally sanctioned mind-altering medications, due in large part to the extraordinary media fanfare and scientific claims - almost entirely bogus -accompanying them. For though this was not the first time that a class of drugs had been alleged to specifically target the presumed biological cause of a complex psychological function (depression), it was the first to benefit from the notion that it had, finally, got it right, *and* that it might, moreover, enhance the normal human condition as well. Suddenly, the stigma of taking a psychiatric pharmaceutical was largely lifted. It became 'okay', even sexy or cool. A quick, efficient, and cost- effective way to boost performance in an increasingly competitive world.

Paralleling these trends in the adult population was, over the same time period, an explosion in the practice of medicating children. In 1980, for instance, it was estimated that, in the US, between 300,000 and 500,000 elementary school children were receiving stimulants (either Ritalin or Dexedrine). By 1997 that figure had ballooned to roughly 5,000,000. The actual production of Ritalin itself, just over the last decade, has increased by a whopping 700%. Fifteen tons of Ritalin are now distributed to children in America every year. In some communities, at some grade levels 1 in 6 children (mostly boys) are drugged - legally.

In Canada, heavily influenced as it is by cultural trends south of the border, there has been (conservatively estimated) a quadrupling of Ritalin usage since 1990. And though the per capita rate here is still only half that of the United States, the fact remains that there has, in the same time era, been no significant increase in Ritalin use in Western Europe and the developed nations of Asia. This combined with the fact that 90% of Ritalin usage worldwide occurs here in North America clearly argues for a cultural as opposed to a scientific basis for the Ritalin phenomenon. The question then is why? What constellation of forces have contributed to this runaway 'drug crisis'?

Numerous social factors have been cited to account for this steep rise in the number of children targeted by psychotropic drugs. The socially rapacious nature of 'globalization', including the acceleration in the pace of working life and the conservative assault on social programs, has clearly added to the stress impacting kids and their caregivers. The high incidence of divorce and separation, the well documented epidemic of abuse and neglect, and the continuing rise in child poverty rates have all borne heavily on the young who then bring their emotional travails into crowded, under-resourced classrooms taught by overburdened and increasingly frazzled teachers. On top of this are piled the overweening expectations of the overachieving baby boomers who sense, only too accurately, the need for greater competitive efforts from offspring destined for future combat in a cutthroat world. In this uncertain and harsh social milieu, both parents and teachers, faced with behavioural malfeasance, are then predisposed, it is argued, to opt for a quick, clean, technical solution to an otherwise messy problem. After all, far easier to medicate children than change society.

Then, of course, there is the notion that the far ends (or at least one end(3)) of the normal spectrum of human physiology and temperament fail, quite simply, to find a proper fit within the narrow and conformist confines of post-industrial society. Children, in this scenario it is proffered, were never really designed to sit like little toy soldiers in rows for hours on end, and though many manage, under constant surveillance and correction, to do it rather well there is bound to arise some failure of adaptability within the broad bounds set by human variation and human 'normality'. In this sense one can, under present normative definitions, consider this 'failure of adaptability' as a social *disorder* though hardly one of individual *disease*.

That there is much to recommend these psycho-social-political and normative forces in both the defining and aetiology of childhood behavioural 'abnormalities', as a proximal cause of the 'stimulant epidemic' itself they fail to convince. This because they do not explain why such an epidemic is absent from the rest of the developed world for whom much the same broad social and economic conditions obtain as in North America. A more immediate causal schema is to be found, then, in a nexus of historical and philosophical trends peculiar to the American experience.

Of Physics Envy and Biological Reductionism

It is by now an old story that from the very beginning of their careers as scientific disciplines, both psychology and psychiatry were plagued by an intellectual inferiority complex as they sought desperately to attain the standing and pre-eminence of the 'hard' sciences(4). That this was a futile endeavour, given both the spectacular advances in early 20th century physics (and later biology), and given the intrinsically artful nature of their own field, seems never to have twigged on them. Instead, the drive to achieve 'scientific' respectability blew as a constant wind fanning a reductionist philosophy.

Now whereas in Europe the Freudian psychoanalytic revolution eventually established itself as the dominant model of scientific psychology, in North America, psychoanalysis and its brethren quickly ran into competition from the empiricist school exemplified by Watsonian behaviourism and, later, Skinnerian conditioning. Very much influenced by the philosophy of logical positivism emanating from physics this school saw value, not so much in what could be *observed* (as is often claimed), but in what could easily and meticulously be *measured*. Such a program naturally consigned to oblivion the entire contents of the little 'black box' wherein lay such trifles as emotion, character analysis and, indeed, the whole field of human psychology as commonly understood by the layperson(5).

By the early 1970's the pressure on psychiatry to demonstrate its medical/scientific credentials had grown particularly acute, and it was then that the maturing reductionist program finally succeeded in winning the day; a victory that was symbolically enshrined in 1980 with the publication of the third edition of psychiatry's bible, the Diagnostic and Statistical Manual of Mental Disorders(6). DSM III signalled both a power shift away from the neo- Freudian old guard and a return to a pre-Freudian classification shame dominated by the commitment to a purely medical orientation.

Though one might be tempted into thinking that a stuffy medical manual could have little bearing on society at large, one would be misthought. For it is precisely from this dusty tome that such weighty matters as the direction of research, the framing of legal rights, the adjudication of disability claims and the like, are decided. More to the point, it is through its authoritative imprimatur that a *particular definition of human nature* is given official, political voice. A definition, which in this case, has blossomed into the full-blown biological reductionist cultural movement we see before us today.

How often does one hear, for instance, that alcoholism is a 'disease', that depression is a 'bio-chemical' imbalance, or that reading difficulties are 'neurological'. That these maunderings go much further into positing such absurdities as that war is a matter of 'aggressive' genes (rather than a matter of power and profit) or that the rich are more intelligent than the poor (rather than that wealth and poverty exist in inverse causal relationship), and we begin to see the outlines of the 'invisible hand' of capitalist market philosophy and capitalist social relations. Social Darwinism has never been very far from the surface of the biological psychiatric paradigm and it is clear that in addition to helping rationalize the manifest inequalities of societal wealth and privilege(7) the paradigm is strategically poised to divert attention from any genuinely social and political problem by reformulating it as a concern of the individual.

Moreover, just as psychiatric reductionism has buttressed the capitalist state, so has capitalist ideology(8) - whose very essence is to partialize and fragment one's perception of reality - come to nurture an over-arching reductionist scientific philosophy.

In addition to this sort of general incubation provided by capitalist ideology - an ideology of a particularly virulent American form - North American psychiatry has, of course, received some rather more specific capital assistance. Over the last forty years institutional psychiatry has developed an increasingly, one might say scandalously, intimate association with the pharmaceutical industry. Not only are the former's journals, conventions and professional associations now substantially underwritten by the latter, but the drugs provided psychiatrists, by integrating them ever more tightly into what they perceive as the fraternity of 'objective' science (indeed, by returning psychiatry to a state of pre-Freudian neurology), serve only to bias any true scientific objectivity. The full measure of this bias needs some exploration.

Notes

(1) In fact, the 'drug laundering' metaphor is more apt than one might, at first, suppose. It is widely conceded that between $500 billion and $1 trillion of 'dirty' money flows through the major US banks - with their conscious connivance - every year and that this is a prime buttress of the US imperial economy, offsetting their $300-400 million yearly trade deficits.

(2) Thus, a Wall Street Journal report of 1997 reported that 28 million Americans were taking Prozac or one of its SSRI cousins. The number of those partaking of the rest of the psychotropic arsenal would boost these numbers substantially. Many of these figures, by the way, are not obtained directly, but by indirect means, i.e. production amounts divided by average dosages etc.

(3) There are, of course, no drugs for kids who are too quiet, or too conforming, or who are internalizing psychosomatizers. After all, they don't present a control problem.

(4) The term 'hard sciences' reflects, naturally, the blatant sexual machismo at the heart of these matters.

(5) This discrepancy between the common perception of 'psychology' and its actual academic representation is particularly evident in the universities. After all, there are no undergraduate curriculums (to my knowledge) in North America that allow a student to study 'real' human psychology i.e. character analysis etc. Not one student in a thousand properly understands this, and not one university curriculum calendar tells them.

(6) DSM III came out in 1980, followed by DSM-III-R in 1987, and DSM IV in 1994.

(7) It bears noting here that our culture, all odes to democratic ideology aside, is deeply imbued with anti- democratic sentiment. Elitist ideals and sympathies are, indeed, so omnipresent as to fail to prick the sensors of the average citizen.

(8) Capitalism is unique as an ideological structure in that it claims not to be one. Claiming is one thing, of course, and reality is another.

Copyright © Antony Black

Antony Black is a freelance writer concentrating, for the most part, on international issues from a 'radical' left perspective. Having incubated first in an intellectual context of psychology and psychiatric theory, then veered into the sciences, thence to writing and teaching, he has yet retained an abiding interest in his first 'career'.

PART 2 OF 'MEDICATING NORMALITY' NEXT WEEK

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