Ritalin Nation: Rapid-Fire Culture and the Transformation of Human Consciousness

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9780393046854: Ritalin Nation: Rapid-Fire Culture and the Transformation of Human Consciousness
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Based on the latest psychological, biological, and social scientific research, a psychologist argues that the causes of Attention Deficit Disorder lie in society and not in its children and that the drug Ritalin is the wrong solution. 15,000 first printing.

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About the Author:

Richard DeGrandpre is visiting professor of psychology at St. Michael's College in Vermont.

From The New England Journal of Medicine:

It has been almost a century since the initial description of what we now call attention-deficit-hyperactivity disorder (ADHD) appeared in the English-language medical literature, and it is remarkable that the disorder continues to provoke strong feelings and controversy. It is particularly striking in view of the substantial advances in our understanding of ADHD, including its underlying neurobiologic features and its treatment. In Ritalin Nation, DeGrandpre argues that ADHD reflects cultural changes rather than any underlying biologic predisposition. The essence of his argument is as follows. We are living in a continually speeded-up society -- in DeGrandpre's words, a "rapid-fire culture," one in which rotary phones have been discarded because they are too slow and in which single-tap faucets are used to speed up the mixing of hot and cold water. This rapid-fire culture has important consequences for children. As compared with children in the past, today's children experience many more stimuli and, as a result, are motivated to engage in more and more stimulus-seeking behavior. In a sense, they become "addicted" to and dependent on continuous sensory stimulation. In DeGrandpre's scheme, the symptoms of ADHD -- hyperactivity and an inability to attend to unstimulating activities such as paying attention in class -- reflect a kind of escape behavior used by the child to maintain sensory stimulation. According to this view, methylphenidate (Ritalin) is effective because it also provides stimulation -- in this case, pharmacologic stimulation.

DeGrandpre's formulation of the cause of ADHD has a certain seductive appeal. Who among us, inundated and often overwhelmed as we are by e-mail messages, faxes, telephone calls, and seemingly endless meetings, would not like to go back somehow to a slower pace -- "stop the world, I want to get off." The feel-good rhetoric in Ritalin Nation has an eerily familiar ring. It is strikingly reminiscent of arguments for the use of what are best described as idiosyncratic therapies for cancer, brain injury in infancy, and an array of other ailments. These arguments generally share a number of characteristics. Antiprofessionalism is common; there is a strong distrust of modern medical practice. The proponents of most of these idiosyncratic therapies dismiss conflicting points of view, claiming that any controlled studies are biased, perhaps reflecting a conspiracy between institutionalized medicine and government or, as DeGrandpre states, "the immense power, resources, and momentum of the pro-ADD [attention-deficit disorder] medical establishment, the huge commercial push by pharmaceutical companies," and "the authority of American psychiatry." Evidence cited to support these idiosyncratic approaches is often in media other than peer-reviewed scientific journals. DeGrandpre supports his claims that Ritalin is dangerous by quoting "newspaper reports across the country" and accounts on the Internet. Another hallmark of idiosyncratic approaches is their reliance on "natural" treatments -- presumably, treatments that are not only natural but also implicitly or explicitly said to have no possibility of side effects.

The treatment offered for ADHD in Ritalin Nation is consistent with such idiosyncratic therapies. DeGrandpre views the characteristic behavioral traits as developing from family conditions that encourage hyperactive and inattentive behavior. His solution to the problem follows naturally from this formulation: slow the pace of the child's life, specifically by having the parents spend less time at work and more time with the child -- that is, by better parenting.

Here is the great disconnection. We would all agree that life is moving rapidly and that it would be nice if we slowed down a bit. But nowhere is there anything but anecdotes to suggest that rapid-fire culture leads to ADHD and that better parenting would prevent the disorder. Blaming parents for the symptoms, as DeGrandpre suggests, has the ominous overtones of the notion of the "schizophrenogenic mother," long since proved to be a terrible error. In a recent review of Ritalin Nation in the New Yorker, Malcolm Gladwell notes, "Only by a strange inversion of moral responsibility do books like Ritalin Nation seek to make those parents and physicians trying to help children with ADHD feel guilty for doing so."

DeGrandpre fails to acknowledge the tremendous progress that has been made in our understanding of ADHD; instead, he presents homilies about the rapidity of modern life and how the culture of the 21st century may influence children's behavior. Many of the advances in our understanding of ADHD have been reviewed in the Journal within the past few months, and other reviews examine electrophysiologic measures of brain activity and brain imaging, including functional imaging studies, in ADHD. As for treatment, readers of the Journal need to know that rigorous double-blind, placebo-controlled studies have demonstrated the effectiveness of pharmacologic treatments in patients with ADHD and have begun to compare pharmacologic and behavioral approaches. These therapies have been tested in carefully designed scientific studies. Children and adults with ADHD face many difficulties. Denying the problem is not the solution.

Reviewed by Bennett A. Shaywitz, M.D.
Copyright © 1999 Massachusetts Medical Society. All rights reserved. The New England Journal of Medicine is a registered trademark of the MMS.

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