EPIDEMIC PROPORTIONS

Posted in Rants on December 10th, 2012 by Ed

I couldn't comment on the career arc of Tom Cruise even if I wanted to – which is to say, even if doing so would not be an insipid waste of time – because as a rule I do not pay to see his movies. It is a personal boycott. Yes, I've seen bits of A Few Good Men because it is on cable basic every Saturday afternoon (apparently by law) and my dad took me to see Top Gun when I was six. In practice, however, Mr. Cruise's relentless public anti-psychiatry campaigning has earned him a place on my personal shitlist. I realize that he does not care. But like the anti-vaccine pinheads toiling away at the University of Google, this position does not merely make Mr. Cruise wrong. It also makes him dangerous. There are real people with real mental illnesses who are able to function thanks to the intervention of pharmaceuticals and psychiatry, and many more people who could benefit from doing so.

I mention this not to beat Mr. Cruise and his fellow cultists like the sad pinata of pseudoscience that they are. The point is that while I am many questionable things, I am not anti-psychiatry or -medicine. Re-read that sentence – multiple times if necessary – before you rush to the comments.

This must be good, right?

As a young faculty member there is both great value and great risk in listening to the Elders of academia. Much of their wisdom is invaluable; much of their complaining represents an unwillingness to change and/or a generational gap they are incapable of bridging. So it was with great hesitation that I engaged several older colleagues – not at my current university – bemoaning the over-medication and general over-diagnosing of the modern crop of undergraduates. The more they talked about it, the more I felt that there was a kernel of truth in it. Even the eight short years I have been teaching have been an eye-opening experience in this regard.

On the one hand this is an argument that should be treated with skepticism. An older person saying "We didn't have no 'ADHD' back in my day!" is foolish on the level of listening to old WWII veterans talking about how they didn't have PTSD back then. Of course they had it, they just didn't have a name for it. The treatment was alcohol, self-administered. Lots of problems exist long before medicine figures out how to diagnose and categorize them – postpartum depression, concussions, autism, and so on.

Once we reject that argument on its face and accept that the whole gamut of things we accommodate in the field of education – learning disabilities, developmental disorders, anxiety/depression, ADHD/ADD, and so on – are real, the question becomes more complex. We stop asking whether these things are real and start wondering how it is that suddenly every student in the educational system has them.

That is hyperbole, of course. But every year a larger percentage of the students I deal with, as is the case with other faculty as well, have various learning disabilities assigned to them. Often the student does not even have any idea what his or her disability is supposed to be; they know only that ever since they were in kindergarten, their parents and school administrators have been telling them that they are learning disabled. In the past ten years, conservative measurements show that the diagnosis of learning disabilities under the IDEA legislation has increased 40%.

Estimates vary widely, but something on the order of 15 to 20 percent of college undergraduates today are diagnosed with ADHD, and more than half (!!!) are taking Adderall or Ritalin without prescriptions either for fun or as a study aid. In graduate school and in my career I've met numerous academics who had legitimate addictions to these medications, and to a person they all stated that getting them legally from a doctor is as easy as walking into the office and saying "I have trouble focusing sometimes." Thirty seconds later they left with a prescription for amphetamines. (Check out this panel op-ed discussion of ADHD/prescription issues in education from the NY Times for more).

Of course you already know some of these statistics, just like you know that antidepressants, anxiety drugs, painkillers, and every other kind of medication on the planet is wildly over-prescribed in this country. But sometimes I stand in class and wonder that when we consider the recreational drug users (not a rarity in college, of course) with the students given pharmaceuticals by a doctor, are there any students left who aren't chemically altered by the time they get to me?

To hear the older faculty argue that back in the day, none of these things existed and somehow students managed to get through college anyway is misleading at best. Of course there were students with undiagnosed issues who never even made it to college or who failed because they couldn't study, couldn't focus, or couldn't do what was asked of them without some kind of necessary assistance. Despite that, I must admit that I wonder about the ratio of legitimate diagnoses to actual diagnoses in the student population. Doctors (especially the kind that gravitate to campus "health centers" and whatnot) will give pretty much anyone Adderall these days, but how many of those same students actually have ADHD? How many 18 year olds with diagnosed learning disabilities are simply reacting to the system (and Mom & Dad) telling them for the past ten years that they are disabled?

I have no answers to any of these questions. It's merely a set of observations. Despite all of these medical conditions being quite real and quite legitimate, I do not necessarily think my older colleagues insane quack-medicine theorists for questioning the rapid and substantial increase in the number of students so labeled in recent years. Those of you who have school- or college-aged children (or who are college-aged) are of particular interest to me here; what is your take on this? Is it the new moral panic – Druuuugs! Everyone's on druuuuuugs! Think of the childrennnn! – or is this a question we should spend any time thinking about?