Allen,
This thread discusses a topic of great interest to me. I have been away the past few days, though before I left TLC e-mailed me the article critical of the prescribing patterns of Ritalin. So I haven't read every word on this thread yet. But I did want to jump in to offer my opinion.
Aren't conspiracy theories fun?
I think the word "conspiracy", which many of Ritalin's opponents are fond of using, is as overused as Ritalin itself may be. The beneficiaries of Ritalin's widespread use need not be conspiring for them to act as they are. They are simply acting in their respective self-interests. The drug companies profit from increased sales, though they risk public backlash if they go too far in their marketing efforts. Pharmacies also benefit by increased sales. The medical establishment benefits (not always, though, for it depends on the structure of the patient's insurance plan; some plans penalize the doctors both for seeing patients and for prescribing expensive tests and drugs) to the extent that persons who previously would not have sought medical attention now become customers. Educators (a word that does not mean what it says anymore) benefit initially through the reduced disciplinary effort required when the student population has been pharmaceutically anesthesized to the point of being compliant little drones.
The piece has more than its share of villains to choose from, but that does not mean that they are conspiring with one another.
The reality is that, as we come to understand the human brain, there is a growing body of evidence that people with psychiatric diseases do in fact have abnormal brains. Genetic studies show evidence of genetic components. Scans of the brain show abnormal functioning. And the simple fact that the drugs themselves work to normalize behavior is itself evidence that the problems lie within the brain. Where is it you think behavior, emotions and intellect come from, if not the brain?
You said a mouthful there. Let me offer a few distinctions which may or may not be helpful. First of all, one must be cautious when identifying the goals of medical intervention. Is the goal to make everybody "normal"? You use a couple variations on the word "normal" in that paragraph. What does that word mean? I understand it as a statistical term first and foremost; in the Word thesauras its synonyms are "usual, standard, regular, ordinary, typical, customary, common, average, natural, habitual, routine, conventional."
Now, how many of us aspire to raise children who can be described best by these adjectives? How many parents do you hear say of their child, "I am so proud of little Johnny, he is so ordinary"? Or, "my Susie grew up to be so typical and common? How many courses in how to be a great manager in the New Economy drill into their subjects the idea that we should be "routine" and "conventional"?
And yet, we do want our children to be "normal" in many senses of the word. We generally prefer that they have ten fingers and toes, two legs and two arms, and one head containing one personality. We generally are happy that they are able to feel pain and emotion, taste food, see farther than the end of their eyebrows, and think well enough to add, subtract, multiply and divide, and on a good day, do decimals and fractions. And we want their genetic behavioral variations, which are caused by (or at least consistent with) certain brain chemistry characteristics, to fall within a certain range of behavior. Behavior that is, at least, not self-destructive, or excessively violent, or debilitating.
The brilliance of our design is that our species has variability, that it can adapt and change in response to a threat to survival. It is this variation which saves us, and its converse -- inbreeding -- has horrific results. And yet we often strive to "normalize" our existence, to straitjacket our behaviors so that they lose their variability. Drawing the line between behavioral traits which would benefit from medical intervention and those that are merely unpleasant to deal with in some contexts is quite difficult.
To provide an example. One of my daughters has had some neurological difficulties. She developed noticeably more slowly than our other two children, had measurable receptive language difficulties as well as a great bit of difficulty expressing herself. When she was three, she could barely talk, and her efforts to communicate more often than not resulted in screams of frustration. She slowly outgrew that with the help of a lot of early intervention services, but by age 6 the receptive language difficulties remained. They were harming her ability to follow and participate in classroom and everyday discussions. And yet she could read, do math, and so on like a normal 6-year old and maybe even a 7 or 8 year old.
Finally, we went to a pediatric neurologist in our area who is also one of the country's leading researchers on autism and related disorders. With the help of extensive testing including a sleep EEG, an MRI and other things, he identified an abnormality in her brain wave pattern indicative of seizure activity, most likely occurring while she was asleep. She was not falling to the floor with seizures, she was having them as she slept. All we noticed was the she would often wake up groggy. We concluded that she just wasn't a "morning person", but it turned out there was more to it than that.
The real dilemma, armed with this knowledge, was what to do about it. The type of abnormality she suffers from virtually always resolves itself without intervention by the time the child is 13 or 14 years old. But the brain's design is such that the ability to learn many types of things diminishes greatly by that age as well. This is particularly true of language receptivity. You are probably aware that persons who learn a language as young children speak it without an accent even though it may not be their native tongue, whereas those who learn the second language as teenagers or adults are far more likely to speak with an accent. Similarly, the ability of the brain to imprint other types of learning, especially those related to verbal skills, diminishes as the early years slip away.
Children whose brains are not functioning properly during this time period may never reach their full potential unless the abnormality is dealt with. And yet, the science has not fully established the cause and effect of medicating or not medicating for the problem at that stage. The doctor we went to did not push us in either direction, but simply laid out the case for and against medicating (the medicine is not Ritalin, BTW). The big wild card is side effects, for the long term side effects of most of these drugs is not known. The industry cannot experiment on children for obvious reasons, and that leaves no way of testing for long-term side effects other than prescribing the drugs and seeing if anything happens 20 or 50 years down the road. Or not prescribing the drugs for children at all.
Ultimately, we decided to have our daughter start on the medication, and then closely monitor the situation.
Her receptive language issues started to improve after a few weeks, and markedly so. After eight months or so, a follow up EEG showed a marked decrease or even total cessation of the seizure activity in the brain wave pattern. If that persists, we may be able to take her off the medication entirely in another three months.
I do not believe the answer is to medicate right and left. I do not believe the answer is to never medicate. I do believe that medicating merely for observed behaviors without corresponding evidence of aberrations in brain wave activity is something which should be done sparingly.
And I believe that medicating for the convenience of parents and educators who haven't equipped themselves to deal with challenging children is absolutely the wrong approach. |
