EPIDEMIC PROPORTIONS

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?

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75 Responses to “EPIDEMIC PROPORTIONS”

  1. T.W. Says:

    Keeping it real, as always. From an undergrad perspective, amphetamines are given out like candy. The vast majority of students know that staying up 18 hours straight to do all homework without blinking is pretty awesome. But there is a small fraction who takes the medication seriously, and most of them "know" they have AD(H)D because mommy and daddy told them so on a young age.

    Granted, there are some people out there who legitimately need it. I've met a man who refused to take his ritalin and would have many outbursts and distractions. It definitely disrupted class. The people who legitimately have issues tend to let it be known. The rest are just giggling to themselves in disbelief about how much adderall they scored.

  2. Graham Says:

    Two points:

    1. The diagnosing of ADHD and the prescribing of amphetamines to children is nothing less than child abuse – the medicalisation of what is usually normal childhood exuberance. I pity the poor little bastards.

    2. Youth have problems concentrating, huh? Well now maybe that's because they never do any one thing at a time: talk? What, without some background beat? Study? What without frequently checking Facebook status? Read? What, without talkback radio on in the background?

    All religions have noted that distraction is the enemy of thought and enlightenment, and many a modern philosopher has noted that we are very good at distracting ourselves to death.

  3. duck-billed placelot Says:

    I've been diagnosed with major depressive disorder. Medicated, therapy filled depression. You know when I started getting treatment? Age 30. Because my whole life, I'd been taught that it was totally normal to be sad sometimes, but that those silly, weak people that were overmedicated and just complainers were Being Dramatic. That needing a psychiatrist or psychiatric drugs was shameful and bad, and that they didn't work, anyway. I'm pretty high functioning, so unless you physically came to my house during my two or three time a year slumps and watched me sleep for 12+ hours a day and sob uncontrollably, I seemed totally normal. All those 'overmedicating, doesn't work anyway, drugs are bad' voices are pretty much perfectly pitched to hit depressed/sick people where it hurts and keep them from getting treatment. Regular, healthy people just don't understand how high a barrier that can be too someone who is depressed or bipolar or what-have-you. People don't go around telling cancer patients that it's their fault they're sick, if they even are sick, which they doubt, and that they should suck it up. If they did, people with cancer would be outraged, not believe them and add on several tomes worth of self-denigration to boot.

    TLDR; I'd rather we err on the side of offering treatment to too many than too few; mental illness is still pretty damn maligned in our society, and not just by nutjobs.

    P.S. They did have a name for PTSD in WWII: shell-shock.

  4. zombie rotten mcdonald Says:

    It may come as a surprise, me being a zombie and all, but I spend some amoutn of time teaching taekwondo to people from 3-63 years of age; I also mentor a FIRST Robotics team of high school kids. I know for a fact that there are behavioral problems beyond 'distraction' and 'kids being kids'.

    Sometimes, kids are able to get beyond some of these things on their own, if they find a focus and something they can become engrossed in. But when that is not happening, some of these youngsters get flighty and hard to control. And it's not an easy thing to do; made even more difficult if they are very young, when focus and concentration are still developing. I often say that teaching five year olds is the most exhausting thing I have ever had to do, and that includes arguing with contractors on a job site while they hold lethal tools.

    I also suspect that prescriptions are used in lieu of control, many times; but I am not trained in that area, and other than my opinion, don't really know. But from an anecdotal level, we have good friends whose son is definitely not able to control himself without the medications he is working with. It's not imaginary that people need help at various levels….

    All religions have noted that distraction is the enemy of thought and enlightenment,

    Well, if you want to believe fairy tales, that's your choice. But "All" religions? Is there a source for that claim?

  5. zombie rotten mcdonald Says:

    mental illness is still pretty damn maligned in our society,

    Agreed, if that did not come through in my comment. I suffer from mild depressive episodes my own damn zombie self, although not to your level, and from what I experience, I feel for you.

  6. Wes Says:

    There's gotta be a lot of different factors at work here. One is, obviously, as we become more aware of mental illness, people who in the past would have suffered and died without anyone noticing are today becoming functioning members of society that the rest of us notice. To me, saying "No one had a learning disability back when I was in college" isn't that much different from saying "No one had black skin and/or a vagina back when I was in college." Of course you didn't see those people back then. What's really frustrating is when someone relates their inability to see these people suffering 40 years ago as evidence of how we shouldn't care about their suffering today. "I can't see the problem because I'm participating in its creation, therefore I should be allowed to continue creating it by ignoring you when you point out the problem. And fuck you for suggesting that the problem exists while I can't see it because I'm causing it." That pretty much sums up the populist wing of American conservatism.

    But "gaming the system" is also a real concern. Psychiatric diagnosis is still very subjective, and it's not hard to imagine how someone might play up to the expectations of clinicians and get themselves diagnosed with an illness they don't actually have. A lot of the diagnostic criteria in the DSM V are rather mushy.

    And I know that "Corporations are evil" is a bullshit cliche, but there really is good reason to suspect that doctors are being pressured into prescribing drugs. Let's not forget that the pharmaceutical companies have a huge presences at medical conferences, and psychiatrists do in fact receive pressure to prescribe people with anti-depressants and other drugs.

    Given all that, I still can't get on the "Oh my god our generation is over-medicated!!!" bandwagon. Of course any time a new treatment or new technology is developed, people will take advantage of it. It happens, but is it a widespread problem? I have yet to see a real problem attributed to generational over-medication. Usually people just say that at one point in time people did things via method X, and today people do it with method Y, and X was so much better than Y, and Y involves some kind of pill, so OVER-MEDICATION! And the internet shortens our attention spans! And people don't talk to each other in the same way any more! That's a problem! Because…because… I don't actually have any solid empirical evidence to show that the internet or video games or drugs are a serious problem… But it's not what I'm used to. So there. Give me a column at some major news organization. I can write endlessly about how online gaming destroys youth or how internet porn ruins marriages. There's no limit to the number of op-eds I can produce so long as I don't have to present actual evidence.

    What boggles my mind is that the science on global warming is some of the best empirical work done in the modern era, and yet people act as if we can't be sure about the demonstrable fact that we are destroying the very environment on which we depend. But extremely shaky sociological crap about the internet or video games or ADHD drugs turning college students into murderous drug addicts who lack the imagined creativity and drive of earlier generations (note: the people who carry out these studies are usually from an earlier generation) are treated as if they diagnose some kind of national epidemic. We've got plenty of science, but most of it doesn't relate to everyone's non-empirical diagnosis of what's wrong with today's culture.

    Diagnosing what's wrong with culture is usually a waste of time. People are mostly alright. But they don't realize the effects of what they do, and that's a much more serious problem.

  7. Xynzee Says:

    Having needed to utilise anti-depressants I can vouch for their efficacy when utilised in ***conjunction*** with qualified care.

    Many forms of depression are a combination of a physiological issues combined w inadequate coping skills.

    I liken it to either a parachute or creating a false platform upon which to stand. By arresting the free fall into the abyss, and getting the neurochemistry under control I could then start the arduous and rewarding task of replacing bad habits w more successful behaviours and skills. This of course takes both time *and* commitment on the behalf of the individual.

    The problem is that most parties want/desire/expect instantaneous results. Insurance companies will only pay a meagre amount if anything for help in this area. Therefore the majority of your psychotropics are prescribed by a HMO physician with no understanding in the area, and the follow up care is based on concern for side-effects particularly if they involve sharp objects and others.

    So if meds are used as part of a broader treatment w the view of getting the person to self manage then they're great. If meds are the first and only stop with no proper consultation, then that's a problem.

    These are my views/experience w fairly severe depression, and can be broadened to most conditions. Many eg. bipolar or schizophrenia require stronger intervention, but that's where good consultative practice is necessary to tailor the best outcome for the individual in their situation.

  8. LK Says:

    Short version: it's complicated.

    TLDR: my wife works with special-needs children (different country, but I believe the general rules apply). During her career one of the main trends she's noticed (in some places it's official policy) is that the bar to enter the "regular" education system is constantly being lowered. Parents' autonomy has a lot to do with it, but legitimate research shows that in many instances integration has advantage to the kids themselves (both the "normal" and the "special needs"). Couple that with the rise in education attainment (2x over the past 50 years in the US), and you're bound to see more and more people with some sort of issue in college every year.

    The other side of the story, of course, is CYA medicine. A doctor is much more likely to be sued for _not_ prescribing a "normalized" drug like Ritalin than to be sued for prescribing it. And there's the positive motivation during diagnosis- if your clients (usually parents) are "happy customers" (because you just "discovered" their child's "problem") you are much more likely to get references and "repeat business".

    I'm sure both of these things exist. I'm sure they both contribute to the numbers of medicated students (at all levels of education). Anyone saying one or the other is "nonsense" is either plain wrong, has an axe to grind, or is trying to sell you something.

  9. J. Dryden Says:

    Conditions like ADHD are often the first step towards a more substantial, well-defined diagnosis down the road. Psychiatry is an insanely young science (and for most of its history, it wasn't very scientific) and the mind (not to mention the brain, which are not the same thing) is still mostly defined by dark matter.

    What this means is that we're still stumbling around in the "hey–if you bang these rocks together, you can make fire" stages of psychiatric medicine–we've done amazing things, but holy crap are we only beginning to know what we need to know to find out what we need to know about every patient with a complaint. And in such a heady mix of ignorance, breakthroughs, exuberance, frustration, peer pressure and, let's face it, a need to make a buck (both for research and for rent), we're going to be performing a lot of swing-and-misses.

    So we careen from underdiagnosis to overdiagnosis–from pretending the problem doesn't exist (or is something else) to embracing the diagnosis (and the meds) as the panacea for all erratic behavior/thought. Parents, too, want their kids to be happy and well-behaved–and believe that they're kids *should* be happy and well-behaved (neither of these desires is inherently bad–to the contrary.) But parents are A. irrational when it comes to their kids, B. panicky, C. overworked, D. lazy, or E. some or all of the above. Regardless, when you believe your kid isn't 'right,' you want a correction–a diagnosis of a popular (and therefore unembarrassing) disorder and a drug regimen that makes the tyke seem calm and happy is a Godsend. And I can't in good conscience fault many of these parents for choosing this path, nor the doctors for succumbing to the desire to A. keep the patients, B. feel like they can cure the ill, and C. pay the goddamned rent.

    Is there a nightmare side to this scenario–merely lazy parents and kids who are merely exuberant and doctors who are just Ferrari-payment-making Feelgood quacks? Oh my yes. But the problem's bigger than the worst version of it–too much of this dynamic is rooted in the better angels of our nature for us to simply dismiss it. And besides, there are legitimately messed-up kids who are cured of being messed-up by these parents, their doctors, and the meds.

    I'd like to see a course of non-medicated treatment become the first-step, let's-make-sure-this-isn't-just-childhood-itself treatment: more exercise, more time spent reading with parents and engaged discussion afterwards, more encouragement of creative activities, a better diet. I think a lot of misdiagnosis might get weeded out. But if the kid is still skipping a groove, then thank God for the diagnosis, the meds.

    Full disclosure: me –> suicidal depression –> meds, talk-therapy –> basically all better. So, you know, I might be biased in favor of the science and its practitioners that saved my life.

  10. Daniel Says:

    Plenty of people I know were on anti-depressants or ADHD meds in college. I doubt I'd qualify for ADHD but probably could have used Zoloft or Prozac. Personally, I am wary of using anti-depressants but I'm not sure why.

  11. Chris "Limey" Lewis Says:

    Similar problem in the UK (ANECDOTAL EVIDENCE ALERT!). These days kids who have simply been guzzling cokes all day and eating sweets and other unhelathy, sugar-loaded crap, are misdiagnised as ADHD because they can't sit still.

    Again, these problems do exist. But it's simpler to claim the kid has a problem than say "your kid is just badly-behaved" and deal with the outcry of parents whose Little Angel has a Real Problem.

  12. jjack Says:

    Is it really that easy?

    Because I've often thought, "my grades would not be total shit if I could get some sort of amphetamines without visiting the shadiest domicile in the trailer park and also completely dissolving my teeth." I just never really believed you could get so much mileage out of going to a doctor for something as lame as not being able to focus.

  13. Tim Says:

    I'll try to address the question at the end of this post as directly as possible, in reference to the experiences of my own life.

    I was 'diagnosed' with ADD (before ADHD was really commonly diagnosed) as a child in elementary school. I was also selected for GT (gifted-talented) classes. As far as I was told during my twelve years in public school, and as far as seemed to be the case in practice, was that I was a highly capable but easily distracted and ill-motivated student.

    I was prescribed Ritalin and took it for about two years before stopping. I never was really convinced of its effectiveness and stopped taking it after 5th grade. I did not switch to Adderall, as I was somewhat skeptical of my need to be on those drugs. I simply didn't feel like anything was wrong with me; I simply just didn't care about my schoolwork. As far as I could tell, these drugs couldn't give me the sort of deep motivation that I lacked.

    I slogged through middle and high school, largely caring only about video games–I had a problematic relationship with World of Warcraft until early 2009. I only graduated with roughly a 2.0 GPA. I passed by only one class, and probably because of the more than generous treatment by my English teacher. I even had to go to summer school between my sophomore and junior year to have enough passed classes to graduate.

    The interesting part of this story, that I feel should give some pause to those who diagnose ADD or ADHD lightly, is what followed my graduation. I spent a few years working at a local rock climbing gym and starbucks while going to a local community college (NOVA, one of the best CC systems in the nation). My performance at first was similar, and I was still struck by the same problems I experienced in secondary school.

    Eventually this changed from around 2007 to 2008. I started reading a lot of economic news and analysis, watching a lot of episodes of Frontline and going on long internet dives through historical subjects. This began to slowly shift my understanding of the world around me in a way that I still struggle to understand. I began to see contemporary human motivations and actions mirrored in those of Rome and Byzantium. I saw the economic, social and cultural struggles of today to be strikingly similar or comparable to those that had occurred in the past. I realized that even obscure events like Basil II's cowing of the nobility into paying taxes and the resulting effects on the Byzantine empire have real and definitive meaning to us today. In short, I finally found something personally compelling that could motivate me further than anything previously could.

    Classes became easier for me, and I found that I even enjoyed them and found myself enriched by their effects on my thinking, even if only in retrospect. Only a few semesters later I graduated from community college with a degree in social sciences, intending to transfer to GMU to finish a BA in history. My last semester, during a summer in which I took three classes within 6 weeks (9 credits) I got a 4.0. My first semester at GMU I got a 4.0. I kept about a 3.91 GPA since. I even took part in a mentored student research program and was paid $1,000 to do it. And now I'm graduating in ten days. I'll be back again soon–this time for a teaching program that will take me about a year to complete.

    I don't have any sort of definitive conclusions for our rate of diagnoses and level of medication, but I can say that we are bluntly analyzed by those around us. I definitely was, and the within the various medication-therapy-familial conflicts I rarely if ever felt anything that prodded me towards anything but negativity. I think the fundamental problem is that I did not believe the assertion that there was something wrong with me. I still struggle with keeping on task, with avoiding thinking about the future, and with lapses of judgment and effort. But is the person who struggled in public school inseparable from the functional person who I am now? I am inclined to think so.

    I am unsure if we are made better or worse by our desire to explain why our children do not function as we expect. My experience inclines me to believe that some children will adopt these labels and beliefs about themselves and some of them will not. Some of them will be in genuine need of assistance and medication and some will not. The best we can hope for is that we educate those who are responsible for diagnosing our children to be both skeptical of the finality and surety of their own judgment while attempting to be supportive, without stigmatization, of all those who they determine do have conditions that require treatment.

  14. Berkeley Says:

    As an undergraduate I don't think it'll be a surprise to hear me say I've both known large numbers of peers prescribed and not prescribed put still frequently using adderall. Two things. One, on the prescribed side, I think it's worth noting the sheer quantity of this stuff that kids are given. These are amphetamines and the concept of a medical professional giving 4 15 mg pills a day to someone who is still developing physically is atrocious. Your eating schedule is completely fucked, friends have reported that the comedown once you're pretty much dependent is awful, and to reiterate: you're on speed. Even if ADD/ADHD are as bad and prevalent as suggested, I really wonder how much worse they are than pumping your kid full of really clean speed every day for years on end.

    As for the un-prescribed usage, the temptation is pretty apparent from my perspective. I gave it a shot, not really my thing (though I wonder if my caffeine intake is much healthier), but who wouldn't at least be curious at the proposition of doing everything SUPER FAST for 4 hours? Finally catch up on the 200 pages of poli sci articles you've been assigned for the week and still be able to get shit-faced on Friday and lie in bed and bitch about it until you do it again Saturday. When you're constantly being told two things: 1 "College is your future, it is when you become an adult and decide what you want to do with your life" and simultaneously "College is about finding yourself, you're only young once, it's all downhill from here, don't let it pass you by" why wouldn't you want a wonder-drug that lets you function beyond your normal cognitive abilities so you can be "responsible" and have time to "live" at the same time? All that said, I do think the percentage of students using adderall regularly is well below 50%, though that's of course only anecdotal.

  15. Elle Says:

    I have only a couple of pieces of anecdata to add to this, which may be overshares.

    I was a really sad little kid, who had suicide in mind as an escape hatch at an early age. From the age of six, the journals that I kept religiously had two columns at the back labelled "Reasons to live" and "Reasons to die." My family doesn't really talk about anything of consequence, so it's hard to be sure what my parents were told, but they did take me to see a psychiatrist when I was five, and nothing happened except that I was promoted one grade.

    Of all the mental health services I accessed during my two major depressive episodes in my early twenties, my consultant psychiatrist was the one who stood out as being particularly useless. He may have just been a bad apple, but I could tell even through the fogged glass separating me from the rest of the world that he was a dangerously ill-informed chump. Some of the things he said were so egregious that he's given me a grey-tinted view of the whole profession. I didn't go back to see him after he suggested that a couple of years on lithium might be a helpful treatment.

    The thing that was most helpful to me was an online community for survivors of rape and sexual abuse that I stumbled across during major depression #2, which (as dramatic as this sounds) I credit with helping me recover my life and my happiness. One thing that became obvious during many of the discussions we had on many topics, was that the Americans in the community were significantly more medicated than everyone else. Sleeping pills, anti-anxiety drugs, more and better anti-depressants. I don't know what the long terms outcomes were, but in the short term it seemed like US people were better able to manage their own lives and processes. Drugs can, of course, be misused, but they also can provide a degree of agency. And an Ambien prescription, no matter how overgenerous, is probably better for you than the vast amount of ecstasy I self-medicated with during depression #1.

  16. Middle Seaman Says:

    Teaching college almost 30 years, I am totally unaware of the mental problems the post claims are prevalent among the undergraduate population. Is it my lack of sensitivity, the type of students studying engineering and pre-med? I have no idea.

    As for PTSD. I have fought in wars and have colleagues from those days. I haven't seen one case of PTSD. Different country, different wars and different people, does that make the difference or it's again unawareness on my part?

  17. zebbidie Says:

    When I was little the population of the earth was 3.5 billion. It is now 7 billion and most are concentrated in urban centres. Is it so surprising that this is having an effect on our young, when they having to cope with numbers of people far beyond anything we evolved with?

  18. zebbidie Says:

    Middle Seaman

    You cannot seriously be telling me that you don't believe PTSD exists and that war is a terrible cause of it. Read Spike Milligan (the original Goon) who succumbed to shell-shock in Italy in WW2. More to the point look at the all the children who were terrorized and scarred by angry, distant fathers in the 50s and 60s. We are only just getting over the legacy of defeating Germany and Japan now.

  19. Major Kong Says:

    I'm sure if they knew about ADD back in the 1960s I would have been diagnosed with it. I had a terrible time paying attention in grade school.

  20. lofgren Says:

    Middle Seaman

  21. Anonymouse Says:

    I have some anecdata to share. I'm the parent of a high school senior/college sophomore (dual enrollment situation) who sounds very much like Tim in Tim's early paragraphs. Very academically capable but didn't give two hoots about school.

    It started for us in kindergarten: 30 kids, 1 teacher, 2 hours and 15 minutes a day of class plus three hours of homework nightly to make up for the fact the kids only had half a day of class but needed to learn the material to pass BushCo's mandatory "no child left untested" school-destroying pogrom. Thanks to an excellent preschool and a love of reading and number games, my "special little snowflake" came into kindergarten already reading Dr. Seuss and PD Eastman and the rest, and starting to explore the world of single-digit multiplication. Some of his fellow kindergarteners weren't even potty trained, much less knew their colors, shapes, or how to count to five.

    The school's solution? Ritalin to zone my child out. We had an excellent pediatrician whose diagnosis was to engage the child's mind. Sadly, that didn't happen in public school, where more and more and more resources were being thrown into mainstreaming uncontrolled, unprepared children and getting them to pass "No child left untested". To quote my son's principal when I met with him about his gutting the gifted & talented program: "Your child aces the test–what MORE do you want?!?" His solution: Ritalin to zone the child out and get him to tolerate the classroom.

    We supplemented at home, but what we got was a child who was bright and eager at home, but bored and unmotivated at school. We ended up pulling the child for ninth grade and dual-enrolling in college classes for the things he was interested in (math, science, history) and online high school for the rest (foreign language, English) and paying for guitar lessons separately.

  22. lofgren Says:

    Whoa, my comment didn't show up above.

    What I said was:

    Middle Seaman:

    It's lack of awareness on both counts.

    Although I have no doubt that PTSD manifests in dramatically different ways depending on culture and experience. It's not going to look the same for a guy who was shipped across the world to machine gun people he knew nothing about as it will for a guy who marches to his nation's border to stab his neighbors in a trench, and it's going to look different in for somebody who was drafted vs. somebody who volunteered, etc. We in America hear the most about the symptoms experienced by Americans who served in the last two Gulf wars. Those symptoms won't necessarily be representative of the symptoms of veterans of other wars or from other places.

  23. Trapclap Says:

    I have ADHD. I have wondered whether I was misdiagnosed as a kid and the drugs (yep, that's a plural) meant to fix my ADHD ultimately caused it. It really seems to me that it should be way harder to get those drugs prescribed to kids. At such a young age, I seriously question whether one can effectively diagnose the problem with enough certainty to justify the damage that the drugs will almost surely cause.

    Either way, I definitely know I have ADHD now. I stopped taking all my meds when I turned 16. I wish I'd actually looked at my coursework at the time; I was definitely enjoying my life more, but holy crap did my grades tumble, hard. There are varying degrees of ADHD – some people only have to be more rigorous with keeping their thoughts on track and it's more or less mitigated. Other people just won't reach their potential without some kind of medication, and will struggle in daily life to do the simplest shit you can think of.

    I know my life as improved immensely since I decided to try Adderall again. I'm taking 20MG 3x a day. Some people are on 10x that, but 20MG is enough for me (more than enough at times). There are definitely some down sides, but managing the side effects(dry mouth can get out of control pretty easily) is an easy price for me to pay.

    I'm pretty unhappy with the way Adderall is distributed. I have to go back every 3 months to my doctor for more prescriptions. Meanwhile, I knew someone that was getting 3-month prescriptions every month and selling the excess for more than the cost of the prescription. Then he crushed and snorted the rest.

    It's infuriating because people like that make the rest of the society smirk at the idea of ADHD – with so many taking it recreationally, the idea of someone having a legitimate need for Adderall is unheard of in some circles. Which leads to awkward conversations when you have to explain to your boss that why an Adderall shortage is to blame for your wandering around on the job. Some of them might not take it as lightly as mine did.

  24. Trapclap Says:

    You can actually have PTSD without having gone to war. Participating in war is just the most common way to get it. Mental illnesses in general are poorly understood in this country, and I wish it weren't so.

  25. Buckyblue Says:

    Great comment thread. As a long standing high school social studies teacher with two high school aged kids,and one middle schooler, I'm not sure that I can add anything to what has already been said. The pharmaceuticals are a God send for many, as already attested, and misused/misprescribed by almost the same amount. The pharmaceutical industry has a huge stake in making sure they're prescribed. They're even advertising for these things. You can't advertise cigarettes but you can run ads for some powerful new anti-depressant. Where's the sanity in that? My fear with the ADHD and adderal and Ritalin over prescription is two things. One, we have a lot more kids going to high school and college than we ever had before. A lot of those kids that we now diagnose or Identify as special Ed would not have even been in school when I was in high school. They 'fell through the cracks', or some other such euphemism. But what also goes along with that is the realization by parents that if there kid doesn't get a diploma, or even a college degree,their life will probably suck. So special Ed departments are booming in high schools and more and more of these kids are then going on to college. Secondly, I fear that our educational system has not kept up with the changing society. When I was in school the way school was taught made sense because we, for the most part, lived in a literary world, one in which information was communicated through reading. So, for the most part, people actually read. We pretty much teach our classes to the 1970's student, and the current student is light years away from that. Which then gives a double whammy of more students than before, most of which are completely bored or unengaged in the typical academic class. But Xboxes are not going away and kids are not going to suddenly sit down and read The Rise and Fall of the Third Reich, like I did in high school. We can adapt and create something that really does meet the needs of the students that we currently have. Or we can muddle through for awhile until we become so obsolete some crazy politician will thankfully put ourselves out of our misery.

  26. c u n d gulag Says:

    Almost everyone in the world who was alive in the 1930's and 1940's had/has PTSD.
    The people from that era, self-medicated, usually with booze – at least until "Mother's Little Helper's" came along.

    Having said that, I was an Adjunct Professor in College, and a corporate trainer, and in America in the past 30-40 years, and there are new, and different, stresses – and more so, every few years.

    I, for one, never expected to live to my soon to be 55 years, because of nuclear weapons.
    Now, I face a probably jobless future.

    So, if a Doctor offers me something to help me cope with living a life of virtual poverty in the future, I'll be more than happy to take it.
    Unfortunately, I'll probably have to take the pills with some food.

  27. Arslan Says:

    You know what's worse than your mother(as opposed to a qualified medical professional) telling you that you have ADHD for years and putting you on medication? Your mother telling you that you have ADHD for years and not doing a damned thing about it. I mean this shit actually happened, in more or less this fashion.

    Mother: Your almost non-existent behavioral problems in school and your love of avoiding homework is probably due to ADHD. I think I have it too. Also it's due to your no-good dad. (Rant continues)

    Me: So, like, should I go to the doctor and get that Ritalin stuff?

    Mother: No. Also, your teachers say the reason why you don't do homework is because you're actually gifted(based on standardized test scores!) and you want a challenge.

    Me(thinking): Why would I want a challenge? I just want to play video games.

  28. Trapclap Says:

    Arslan: That's kind of a mindfuck. You might not have ADHD and your mother might've just been crazy. Or you could actually have it because of some kind of fucked up placebo effect. Ever tried going to a pysch for a diagnosis?

  29. pb Says:

    At first we were overloaded with commercials for medications treating any kind of ailment you can think of. Now these commercials are interspersed with commercials for lawyers willing to sue on your behalf over the unforeseen side effects of all of these medications. I think it makes sense to talk about the problem of doctors throwing pills at you immediately after you describe certain symptoms.
    I also wonder about all of the unused medication and pills. Its a pain to get rid of the stuff if you don't just want to flush it or toss it in the garbage. I'm sure most people don't bother with trying to find a place that will take unused meds. What sort of chemical soup are we making of our environment by doing this?

  30. pb Says:

    At first we were overloaded with commercials for medications treating any kind of ailment you can think of. Now these commercials are interspersed with commercials for lawyers willing to sue on your behalf over the unforeseen side effects of these medications. I think it makes sense to talk about the problem of doctors throwing pills at you immediately after you describe certain symptoms.
    I also wonder about all of the unused medication and pills. Its a pain to get rid of the stuff if you don't just want to flush it or toss it in the garbage. I'm sure most people don't bother with trying to find a place that will take unused meds. What sort of chemical soup are we making of our environment by doing this?

  31. Paul Says:

    Parent of a school-age child here.

    I definitely DON'T think we as a society are freaked out enough on this subject. Whatever moral panic exists has not expressed itself in policy. Maybe people complain that everyone's on DRUUUUUUUUUGS but until anything is done about it that's all mere wind. Until the number of kids actually on pills dwindles, we should be freaking out more.

    Go to a Dow Jones page and click on the link for "most widely held" stocks. At any given time, 5 of the top 10 are pharmaceuticals. It's a vastly profitable industry with unrivalled PR & advertising resources. Obviously their end game is the same as every other corporate seller's: make a customer out of every possible candidate (i.e., everyone who's breathing and has a buck in their pocket).

    This is not to deny that ADHD is real. I just don't think that's the real issue here.

  32. Radical Scientist Says:

    Of course, when the baby boom generation was in college (and before), amphetamines were readily available as diet pills, over the counter or as an easily obtained prescription. And of course they were used off-label as study- and party-aids.

    My mom has some real horror stories about what happens to you combine amphetamine-induced paranoia when an entire sorority house is trying to make it through spring finals and lose a few pounds before beach-and-wedding season.

    So the question is less 'What's going to happen with the kids are all taking these drugs?!' than 'What's going on now that the kids are being prescribed these drugs in limited but readily available ways, as a treatment for learning disability, instead of just buying them at Woolworths?'

  33. ec Says:

    As a former elementary school teacher, in a low-income, low-performing and 99% African-American school, I dealt with some students who truly needed medicine to control ADHD.

    But, I also dealt with the pressure to medicate the "bad" out of children. I generally encouraged parents to not medicate their children unless the child could absolutely not function without medication.

    This was both for me and for the kid. Kids need to be allowed to mature and develop without medication–an eight-year-old boy just might not be able to sit still for 3 hours. It was for me, because I, for one, did not enjoy teaching little robot children that basically seemed stoned into submission. I would rather see their personality and creativity than watch them act like a little robot.

    I don't know how you would ever regulate it, but there are days when I think that ADHD drugs (taken without prescription) should be treated in academics like steroids are treated in sports.

  34. Jacquie Says:

    I wonder if one factor might be that the kids that really need pharmaceutical intervention to succeed in the college environment would not, in past generations, have been considered suitable for college in the first place. The same kids that might have gone into a skilled trade, or worked their way up from the mailroom, are now getting MBAs. By requiring a college degree for even shitty, low-level jobs, we're basically corraling kids into higher learning that have no real reason or desire to be there. Then when a student falls behind, instead of suggesting that college maybe might not be the right path for that student, we just give them a scrip for something to help them study.

  35. Elle Says:

    @Middle Seaman

    I had PTSD (if you can use the past tense about something which is thought to have periods of remission, rather than always have gone away forever) and a couple of acute depressive periods in college.

    I didn't discuss it with anyone at my university until I had failed one exam, and had to. My psychiatrist wrote to my individual advisor, and she wrote to the head of the course to which I was applying for my first honours year. I had a meeting with my head of course, who didn't mention it, other than to tell me if I didn't get above a certain GPA he would have my head on a stick. (I did.) I assume other people got told about it, because one of my tutors asked me a load of questions about why I was depressed which completely skeeved me out. I was evasive, and short, and he never mentioned it again. I didn't discuss it with anyone on my course, or anyone at all except for my very close friends.

    It's possible to hide mental illness that is shattering, and draining, and immiserating, and which affects every part of your life. I don't believe that engineers or pre-med students are more resilient. It's entirely possible that the culture on such programmes may be even less open to frank discussions about individuals' mental health than others. Heaven knows that the worst profession in which to have complex mental health needs is medicine.

  36. Heidi B. Says:

    As a college employee, on antidepressants, I notice one issue not addressed much here: LIABILITY. Colleges bear a huge responsibility in taking children straight from mommy & daddy helicopterland and trying to turn them into adults. If meds and counseling can keep that one student from having a violent episode (omigod what will the newspapers say?), then it's worth it to prescribe the meds. (In my case, counseling is an expensive, time-consuming mess that I avoid. I've gotten some BAD counseling advice. If I'd been diagnosed in college, though, I'd probably be a different person.) The college kids I work with are adorable, fun, creative people. I'm sure a significant number are on antidepressants just like me.

  37. Nicholas Says:

    Ed,
    Would you say you have a "Plethora" of pseudo-science pinatas?

  38. bb in GA Says:

    @graham

    "All religions have noted that distraction is the enemy of thought and enlightenment,…"

    @zombie rot

    Well, if you want to believe fairy tales, that's your choice. But "All" religions? Is there a source for that claim?

    How about we grant graham a little room on hyperbole? You atheists can be as big buttheads as any religious people.

    The total number of people who claim to be influenced by:

    Christianity 2.1 billion
    Islam 1.5 billion
    Hinduism 900 million
    Buddhism 375 million
    ———————————-

    Around 5 billion out of about 7 billion total population

    Secularists/Atheists/Agnostics 1.1 billion

    All of the religions on my list teach that the noise up in your head is the enemy of getting in touch w/ [peace, serenity, enlightenment, Jesus, Allah, etc. etc.]

    Whether or not that all the adherents (nominal to devout) get it or practice it is beside the point.

    And really, are you gonna make me cite texts? This is well known stuff zombie.

    And to understand this fact does not turn you into an obnoxious Bible banger on the street corner or a wild-eyed Hare Krishna at the airport (do they still exist?)

    //bb

  39. Tacoface Says:

    I have little patience (most of the time) for general squawking about how all the kids are on the drugs now. However, overprescription is not one of those times. I have seen a lot of good come from psychiatric medication and even those in the Mad Pride movement that i know (people who believe that there is a lot of good to be found in what they call "dangerous gifts") believe that the proper course of medication can be helpful. The part that disturbs me isn't the idea that it is easy to get these prescription stimulants. Talking to middle aged people now, almost everyone they knew was using weight loss supplements and blow for pretty much the same party/study purposes as Adderall and it's brethren are now. What i think is a problem is the fact that we have started to view kids as units of production. We pump them through standardized schooling and try to standardize them as we go. We view any deviation from standard behavior, whether it is a danger to them or others, as a blemish to be wiped out as soon as possible. This doesn't mean that their aren't kids out there that have these problems. i have known several people who absolutely would not have made it into college without the medication and are now 4.0 students preparing for grad school in hard sciences that need their kind of talent and intelligence. That said, I've known people who were just "problem kids" reacting to overbearing parents who were drugged into submission. There is a similar problem in the diagnosis of depression. I want to be perfectly clear: depression is real and medication for it has saved many lives and lives that I care about personally. But I fear that we are losing the highs and lows of the human experience to a degree. Suffering has produced much of our best thinking and thinkers. How do we find a balance where we help people in pain find healing without trying to mold our country into a grey people sludge with a narrow, bland range of thought and experience? I have no answers. The answer isn't "kill the psychiatrists and their dirty mind drugs" but it certainly isn't what we're doing now.

  40. mel in oregon Says:

    a lot of stuff you talked about. first tom cruise, most would agree his roles are simply limited to a short tough guy who is always hyper & very dogmatic. his views are nonsense, & thus can be ignored. next is the epidemic use of prescribed drugs in america from cradle to grave. it's a subbranch of capitalism, namely the american way of medicine which is not cost effective & in most cases isn't even effective. of course prevention doesn't have the potential to make a pill pusher very wealthy, so it's ignored. it isn't just college students with a prescription drug problem, look at the elderly, they can't function without a box of many pills. the elderly also are on the front line of future evolution, different body parts to replace worn out hips, hearts, & livers. in the fairly near future this will expand to brain enhancing technologies, implants to solve memory loss, faster problem solving ability, etc. of course as computer intelligence doubles every 18 months or so, a hybrid from of machine-human will almost surely come to the conclusion that humans are destructive & waste all our resources, thus the mayan end of the world. don't worry that's decades if not centuries away. finally the words of the elderly always longing for the past. there is a lot of truth in the fact that america was a fairer society a half century ago at least if you were a white, straight male. for probably at least 150 million americans, the loss of home equity, credit card debt, student loan debt & un/underemployment is a tremendously difficult problem for them which isn't addressed on gin & tacos or any other mainstream corporate entity. as far as ptsd, it's a real problem whether some who have fought in wars will admit it or not. look at all the veteran suicides, & homelessness. what it really boils down to is if you invade countries that have done nothing to us, you reap what you sow. the truth is, many veterans feel like suckers & criminals. they also know unless you've served in combat, you have no idea what the hell they go through.

  41. Patrick Says:

    "are there any students left who aren't chemically altered by the time they get to me?"

    There were never any students who weren't chemically altered. I guess the difference now is that they're being altered deliberately and artificially. But all sorts of stuff in our environment enters our bloodstream and alters our brain chemistry. An easy example: Forty years ago the brain chemistry of most students was being altered by inhaled lead from leaded gasoline.

    Is it better now that it is happening with prescription drugs? We probably won't know the consequences for another 40 years, but it isn't really an epidemic. Humans are exceptionally good at maintaining homeostasis during shocks to their brain chemistry. We'll muddle through.

  42. Arslan Says:

    "Trapclap Says:
    December 10th, 2012 at 10:17 am
    Arslan: That's kind of a mindfuck. You might not have ADHD and your mother might've just been crazy. Or you could actually have it because of some kind of fucked up placebo effect. Ever tried going to a pysch for a diagnosis?"

    Personally I don't think I had ADHD, and the only thing I was ever diagnosed with was depression, one time, when I was still under 18.

  43. amil666 Says:

    The problem with most psychiatric disorders is that just about everyone can relate to their symptoms. What most people fail to understand, or at least often overlook or forget, is that it is not a disorder until you have those symptoms to such an abnormal degree that it is severely inhibiting you from leading anything resembling a normal life (like, for example, keeping you from getting or keeping any job). The rampant self-diagnosis of Asperger's Syndrome is the clearest example of this; also, the way the term "OCD" is commonly used to describe acts which are miles away from actual OCD (though in the case of OCD-term-abuse, I suspect most people know that's not really OCD). If these were merely physical ailments that people suspected themselves of having, a doctor could check up on them and with some certainty tell them that no, don't worry, you're alright. The problem with psychiatry and psychiatric disorders is that, in most cases, the psychiatrist has to take your word for it. Moreover it is much easier to fake anxiety or even ADHD than it is to fake appendicitis. There may be some extremely conscientious psychiatrists out there who refuse to prescribe any psychiatric medication without running the patient through a whole battery of tests or whatever, but any patient knows that if the psychiatrist they're seeing doesn't believe them, they can always find another psychiatrist who will just take their word for it and prescribe the medication they seek. So, until we make all psychiatrists institute strict diagnostic tests or whatever (on pain of malpractice), I don't see this problem going away; and yes, there are other problems with forcing some standardized test upon psychiatrists, and no, I don't know how to get around those problems while handling the former problem. Something definitely needs to be done though, because this abuse of psychiatry is delegitimizing those who actually suffer from these real disorders. It's bad enough having (real) ADHD without having your teachers roll their eyes when you say you have it.

  44. amil666 Says:

    P.S. Tom Cruise may be a piece of shit and all around terrible human being, but I can watch him act all day.

  45. fasteddie Says:

    I have an 18 year old who has been on Adderall ( and Prozac ) since he was 14. He won a large (40%) scholarship to a prestigious music school at a Big Ten University. Once out of sight of Mom and Dad, he stopped taking his meds, self-medicating with alcohol. We had to pick him up and withdraw him from classes due to crippling depression. Back home and on his meds, he is bright, pleasant and capable. I hope he has learned his lesson. He will attend community college for a few semesters, and we will give it another try. It's not fun and it's not frivolous.

  46. Purple Platypus Says:

    I was one of those bright but unmotivated kids, breaking the needle on aptitude tests yet achieving only average grades in school. I don't think I heard anything about ADHD until high school, and it never occurred to me that it might apply to me. I never failed anything but I came frighteningly close in many classes that everyone concerned, myself included, knew I could have aced. I just barely got into university, but having done so my grades actually took a sharp turn *upwards*, especially after I admitted to myself that physics (my strongest subject in high school) wasn't for me. At that point I could take only things I was actually interested in, a freedom I'd never had before.

    I actually thought I might be mildly autistic in some way, and started seeing a psychiatrist at around the age of 30 for that reason. She quickly concluded that, while I showed some characteristics of (say) Asperger's, that I was nowhere near the point of being diagnosable for that – but that there was a simpler, more elegant explanation for a lot of the problems I'd had throughout my life. Obviously, this was ADHD (primarily inattentive type, so basically without the H). Lack of motivation interspersed with episodes of hyperfocus when it came to topics that especially interested me, to make a long story short. but there was enough more to it than that to convince her that this was a medical problem and not just a personality quirk.

    While much of what we hear about this topic is about how easy diagnosis is and how psychiatrists are basically pill dispensers, blah blah blah, mine was (and I consider this a good thing) downright paranoid about these subjects. She made me get a second opinion even though she had convinced me, and having done that we still had to make a case to her boss. Having gone through all that to get a Ritalin prescription, I then proceeded to not bother taking it (again, the exact opposite of all the cliches). It was only ever going to be an occasional thing, but between being somewhat squicked at the idea and knowing that I do have relatively good, if by no means perfect, coping methods, I've used the drug maybe four times. (Also, freaky but totally coincidental things keep happening whenever I do. One time my left side went numb right after I took it – this was later determined to be a result of minor nerve damage totally unrelated to ADHD or Ritalin, but it scared the hell out of me at the time!)

    I don't really have a big point I'm leading up to, but this stuff seems relevant. I suppose one thing my case does show is that the usual stereotypes are a long way from being the whole story. I was diagnosed as an adult, not a child; had a hard time getting access to the medication; and ended up hardly ever taking it.

  47. sluggo Says:

    Isn't ADHD just the natural state of all children? (and a bunch of adults?)

  48. sluggo Says:

    @ Purple Platypus

    Parts of your story sound very familiar, I actually got pulled into my high school councilor's office and questioned about cheating on the ACT!

    ADHD is actually a gift, it is almost a second sight, those long periods of disinterest, followed by intense activity are exactly the traits that hunters need to be successful.

  49. what the karp?!? Says:

    I was diagnosed with ADD in like third grade. I never knew if ADD was the same as what they now call ADHD or if it was something else. All I knew was that I wasn't normal, but the pills would make me normal. I was prescribed Ritalin, but I rarely took it throughout elementary and middle school. In High school I was forced into taking it more strictly. I hated the way it made me feel, I didn't get anything more done in school, I just got angry and frustrated with everything. Eventually I started pocketing each dose throughout the day and taking all of them at once before going to my Mcjob. My problem was much more likely depression, hell, I'm still depressed a lot of the time, but that goes undiagnosed and unmedicated. It's just who I am, and I'm cool with that.

  50. jon Says:

    This is one half of the discussion. The other half is the self-medicating that goes on. Caffeine, nicotine, alcohol, pot, coke, and other drugs are over- and underused as well. I know many people who would be better off with some pot. I know many people who need to use it less. Drinking has been both a helper and a problem for me. I've considered risking addiction to nicotine patches, because I don't want to smoke and the gum supposedly tastes awful. But I am too cheap to try that.

    Between occasional depression and my usual Asperger's-ish, I have quite a few crippling things going on in my life. But like most people, I handle it well enough on my own. At least I get by, while others want me to see professionals so I can thrive.

    And that's another part of this problem: most people don't want to thrive. They don't all want to be a leader and stand out. Most of us just want to be able to support ourselves, have a stable future, and provide for those we love and want to support. Nothing makes me need a drink more than to hear how disappointing I am to my mom, ex-wife, girlfriend, friend, or myself. I'm doing okay. And that's enough.

  51. Andy Brown Says:

    I think our current levels of medication are probably overdetermined. And I think there is a lot going on there, from corporate profiteering to indulging anxious parents. But here is another way to think about it: an overarching push toward Standardization. It is one thing to standardize textbooks, institutions, curricula, etc. It is an entirely different thing to standardize the student body (and I mean that in multiple ways). Yet I think that's what this pressure is toward. Even a couple of generations ago, only a minority of students was expected to make their way through 14 or 16 years of academic, classroom instruction. Not everyone is cut out to find that a satisfactory existence for thriving within. Hence the effort to set our growing repertoire of chemical adjusters to the task.

  52. Andy Brown Says:

    In a complementary process, education is being molded into something that can process this much less differentiated mass. The reason that so many teachers dislike grade inflation is that they experience it as pressure to give everyone essentially the same grade. Paa(ABCD)aasssss.

  53. JohnR Says:

    Interesting. W/regard to the question of "kids today", I suppose there are two schools of thought on that. Changes may be real or imagined; we may over-react to real change and miss it because we're using a particular label promiscuously. Autism used to be very rare; now it's extremely common, and that doesn't even include Asperger's. Is that statement accurate, or have we started looking and diagnosing better? Beats the hell out of me. I do know that my wife's cousin has a boy with Asperger's, one of my two colleagues in the lab has twin boys with severe autism, and almost everyone I know has or knows someone who has an autistic kid. What does this mean? Is it mercury in sodas from the HFCS processing? Is it mercury-compound thimerosol in various things? Is it anything to do with mercury? Is it rising age of father at conception? Is it something else? The advent of Reaganomics, maybe? I haven't seen any clear indications. How about depressive disorders, including bipolar Type I and Type II and all the other varieties of depression. Are they more common than 30 years ago? 50 years ago? Beats the hell out of me. It wouldn't surprise me – overcrowding is associated with various stress-related problems in various other animals, but I don't know. Is the huge increase in diagnoses a function of a huge increase of psychiatrists needing patients? Beats me. So a lot of college kids are goofed up on one thing or another. Is that actually different from 30 years ago, or are we just talking about another in an endless string of "kids today" stories? Hell if I know. Anecdotal evidence is evidence, but what does it actually mean? I was diagnosed as bipolar 2 after college, and for a while used one of two different medications. One worked really great. One screwed me up very badly, and it took a long time to get over the side-effects. Back in college, I developed a pattern of delaying assignments because as the stress level increased, at some point I would go into a 'creative frenzy' where the stuff just poured out onto the page, and I couldn't stop writing. I had tunnel vision, couldn't sleep, couldn't not write. When I was done, I crashed for a day or so to recover. It felt great; it felt wonderful and when it stopped happening in my first year of grad. school I was devastated. I was suicidal for a while, but managed not to pull the trigger. Eventually I was diagnosed and put on a medication that was amazing – it was like the lights went on and the color came back; a lot like the first cup of coffee on a Monday. Anyway, medications wear off as you habituate to them; diagnoses are often less than accurate, as most docs aren't mind-readers, and even depressed people aren't always completely forthcoming. People use useful medication for unintended or unanticipated purposes. What a surprise! We're most of us screwed up one way or another; life's a pile of crap sometimes, and sometimes we just seem to want to make it worse. So? Human nature; we've been doing that for millennia if not longer. You can't help everybody, and a lot of us don't really seem to want to be helped anyway. Do the best you can to help the ones who want and need it the worst, and try not to get overwhelmed. Platitude, platitude, all is platitudes.

  54. DocAmazing Says:

    I'm a pediatrician, so I see a lot of this. First problem: kids whose behavioral problems might not be an issue in a classroom of 24 kids are going to be a problem in a class of 32. Teachers are overworked, and lean heavily on us docs for a chemical fix to the behavioral problem. Insurers won't pay for complex psychiatric testing to get to the root of the specific behavioral problem that the kid has, so they lean on us to make the ADHD diagnosis and begin stimulant treatment. Even getting a referral to a psychologist is an uphill battle.

    When easy, less-expensive chemical solutions are available, they will be used, appropriately or otherwise, unless someone's riding herd on the insurers and providing other options.

  55. JazzBumpa Says:

    I need to run so I'll get back to read comments later. It's absolutely a question we should spend more time thinking about. And not just in that demographic.

    My mother in law is 84 and in an extended care facility. We recently changed her doctor and he reduced her drugs dramatically. She had become psychotic, paranoid and aggressive – on anti-psychotics, anti-paranoics, and trancs. Her turn around was miraculous.

    How many old people are in that condition – over medicated and left out to dry? It's a damned good thing my lovely wife has been a staunch advocate for her mother.

    There are a few lessons here. One is to not simply think MD's have any god damned idea what they're doing when they throw meds around. Another is that 3 drug interactions never get studied and lots of people are on a dozen or more, so nobody has any fucking idea what that does to anyone. Another is that drug reactions are individual – it might not o to me what it does to you.

    Most importantly – if anyone you care about is in an institution or hospital, you have to watch like a hawk, ask every question you can think of, get advice from others, and don't think anyone there is going to give a shit about outcomes. [Even though some of them do, obviously - but they also have 100 other patients to think about.]

    This is literally life and death, and you can make a huge difference.

    JzB

  56. mothra Says:

    I don't know a thing about this, but I do know that there is a woman I work with who needs medication. Woman probably has some kind of personality disorder in addition to having severe ADHD. God, she's impossible.

  57. protected static Says:

    @lofgren & Middle Seaman – country of service makes a difference. The Brits have much lower rates of all kinds of psychiatric complaints among combat troops coming back from Afghanistan compared to their American counterparts.

  58. Strangepork Says:

    Cool thread, and everyone has been pretty cool and respectful. It's always interesting to hear other's experiences with psychiatry and meds, etc. I was diagnosed with MDD as a teenager in the 90's and institutionalized for a bit. When I was inside, I met a little kid named Mike H., or Mikey Hyper. He talked so fast you could only make out every other word. He literally couldn't look you in the eye for more than 10 seconds while you were talking to him before he was staring at the crack in the ceiling, or your shoes, or that bird over there. You learned to talk in 3 word sentences to him, because he'd be gone down the hall by the end of a 4th. Alternatively, if you really needed to make sure he processed what you were saying, you could hold onto his cheeks and touch your forehead to his while you talked so that you were the only thing he could see. He was also the most excellent human cannonball — a "game" where you ran down the boy's wing as fast as possible and jumped at the grate over the windows, which would bounce you back down the hallway…we were bored.
    Anyway, whenever anyone suggests that ADHD doesn't exist, my memory of Mikey begs to differ.

  59. Trapclap Says:

    @Mothra, There's an old saying that's appropriate here: Mental illnesses have a tendency to come in threes. Browse around some ADD communities and you'll see an alarming tendency for people to have AD/HD along with bipolar and even autism. As someone with ADHD, I can't imagine a worse combo.

    The drug cocktails these people take are the craziest thing. Mixing antidepressants with stimulants and who knows what else in a lifelong struggle to find some kind of balance in your life must be a bit of a nightmare. On the one hand, it's easy to wonder whether they really need the drugs. On the other hand..Can you imagine being unable to focus on any one thing at a time while also having a tendency to rapidly shift emotions? Have some sympathy and respect for those with mental illnesses. They can be hard to work with, but you get to be away from that for most of your day. They don't.

  60. hardcastle Says:

    Given the NIMH statistics (~8% for 18-29yo) regarding the prevalence of attention deficit disorders, I find the "overmedication" hype to be incredibly overblown, self-satisfied dick waving by the same type of people who get all wigged out about "sexting."

    My mom runs a counseling agency and views on AD[H]D and medication in general vary widely between different counselors, but they frequently deal with people taking various medications for mental health issues and thus have to remain pretty neutral in their practices. Growing up around this might have skewed my view a little, but I think the perception that drugs are just casually doled out all the time is extremely flawed. It happens, obviously. But it certainly does not represent the majority of cases.

    Most of the clients who are on some sort of medication did not get it by walking into a doctor's office and saying "I have trouble focusing." The prescription usually follows a history of behavioral problems/trauma/emotional upset/etc that eventually leads the person to see a counselor. The counselor will try to help them process through their issues without medication, but will refer them to a psychiatrist if it becomes apparent that meds might be needed. The client, the counselor, and the psychiatrist all communicate about the process the entire time and everything is documented and monitored.

    Maybe I'm harping on something that's beside the point, but I really hate the "overmedicating" perception because it has led some clients to avoid medications that they probably need. It CAN be easy/effortless to get psychiatric drugs to abuse, but promoting that image just compounds the mental health stigma. I liken it a little bit to the image of the Welfare Queen, because yeah, we all have a fuckload of examples that fit the stereotype, but in the end it's just anecdotal evidence and is not a good representative of the broad picture.

    I know tons of people who have gotten Adderall when they really didn't need it. It's certainly a thing and it probably should not be happening, but I honestly do not believe that there are enough of those people to represent anything close to an "epidemic of overmedication." It might seem that way because A) we are saturated with advertising for prescriptions, which is really screwed up, and B) confirmation and memory biases make the Adderall addict stand out in our minds over the other, much larger group of people who really need it to function and acquired it legitimately.

    As far as the increase in diagnosis of learning disabilities, I would guess that's just a side effect of us figuring out that there is no one-size-fits-all when it comes to human learning and development. Slapping a diagnosis on a kid in a society that heavily stigmatizes mental illness is probably one of the shittier ways to deal with it, though.

  61. matthew Says:

    Here's a blog post that goes deeper, if you want to get past anecdotes.

    Here are some headings:
    Progressive Increase in Required Dosage
    THE PATIENT WANTS STABILITY TOO
    The Short-Term vs The Long-Term
    Drug Withdrawal as Proof That It Works

  62. Elle Says:

    The Brits have much lower rates of all kinds of psychiatric complaints among combat troops coming back from Afghanistan compared to their American counterparts.

    Given the culture around mental health in the UK, and the relative inaccessibility of mental health services, I think that underdiagnosis should be considered as a likely cause of at least some of that difference.

  63. Anonymouse Says:

    @Strangepork ("Anyway, whenever anyone suggests that ADHD doesn't exist, my memory of Mikey begs to differ."): absolutely, and just in my neighborhood, I know two children who absolutely need ADHD meds. They're fine when on them, completely unable to focus when not.

    @DocAmazing ("kids whose behavioral problems might not be an issue in a classroom of 24 kids are going to be a problem in a class of 32. Teachers are overworked, and lean heavily on us docs for a chemical fix to the behavioral problem. Insurers won't pay for complex psychiatric testing to get to the root of the specific behavioral problem that the kid has, so they lean on us to make the ADHD diagnosis and begin stimulant treatment. Even getting a referral to a psychologist is an uphill battle.") I couldn't agree more. In my child's case, just getting material to learn that he hadn't mastered 3 years before did the trick. Engage the mind, and the child stops fidgeting. But the overworked teacher couldn't engage the mind of one child out of 32 when she had to get the Down Syndrome child to pass the No Child Left Untested debacle every year. Every other child's needs came last in the face of the one who was never going to pass anyway.

  64. Ed Says:

    I had one of those 'angry and distant' fathers in the 50s and 60s. Got 3 brothers and two of them are broken, can't say for the third, he abandoned the family. Pharmacology can help, but it also destroys and distorts. Pills without additional treatment are a tragic mistake. You'd think that with as much mental illness as we have, it would be better treated, but no. Big Pharma rules the day. Roll those pills, patient turn over is the goal in medicine, not healing. Doc has to see 50 patients today, no time for humans, just hustle the bodies and file those claims.

  65. Kate Says:

    Ivy League law student here.

    I really enjoyed reading this discussion thread. While I have nothing other than anecdotal evidence of observations from the law library to add to the discussion, I would guess that at least a third of my classmates are on some kind of study-drug. Mostly prescribed.

    I think a big part of it is stress… we all know that there's not a much of a market for the JD we're sinking ever-deeper into debt for. If you see everyone else working 12-hour days to beat the curve, there's a lot of motivation to find something that lets you do that too. And you need drugs for that – humans simply aren't meant to sit at a desk and read for 80+ hours a week.

  66. protected static Says:

    @Elle – it seems to have far more to do with how the UK rotates their troops out of combat zones, as these screenings are being done by the MoD. At the end of a deployment, the entire unit is given leave, together, but not in the UK. The entire unit gets to decompress together, away from their families and friends and stressors of everyday life. In the US, we typically just dump our troops back into their daily routines and expect them to instantly transition back to 'normal' as soon as they return.

  67. Elle Says:

    @Protected Static

    I don't mean to do down the measures that the UK forces take to maximise the mental wellbeing of servicepeople, and it's entirely possible that the decompression you describe is enough to process the trauma of combat. I haven't read the paper referenced on this page on the armed forces and mental health, but it seems possible that the higher incidence of alcohol misuse than the general population might be attributable to self-medication for otherwise underdiagnosed mental health problems.

    Of course, I could be quite wrong.

  68. amil666 Says:

    A propos: http://www.psychologytoday.com/blog/dsm5-in-distress/201212/dsm-5-is-guide-not-bible-ignore-its-ten-worst-changes

    Professor of Psychiatry and Chair of DSM-IV Task Force complains that DSM-V is just going to exacerbate the over-diagnosis problem.

    Choice quotes:

    "This is the saddest moment in my 45 year career of studying, practicing, and teaching psychiatry. The Board of Trustees of the American Psychiatric Association has given its final approval to a deeply flawed DSM 5 containing many changes that seem clearly unsafe and scientifically unsound. My best advice to clinicians, to the press, and to the general public – be skeptical and don't follow DSM 5 blindly down a road likely to lead to massive over-diagnosis and harmful over-medication. Just ignore the ten changes that make no sense."

    "The history of psychiatry is littered with fad diagnoses that in retrospect did far more harm than good. Yesterday's APA approval makes it likely that DSM 5 will start a half or dozen or more new fads which will be detrimental to the misdiagnosed individuals and costly to our society.

    The motives of the people working on DSM 5 have often been questioned. They have been accused of having a financial conflict of interest because some have (minimal) drug company ties and also because so many of the DSM 5 changes will enhance Pharma profits by adding to our already existing societal overdose of carelessly prescribed psychiatric medicine. But I know the people working on DSM 5 and know this charge to be both unfair and untrue. Indeed, they have made some very bad decisions, but they did so with pure hearts and not because they wanted to help the drug companies. Their's is an intellectual, not financial, conflict of interest that results from the natural tendency of highly specialized experts to over value their pet ideas, to want to expand their own areas of research interest, and to be oblivious to the distortions that occur in translating DSM 5 to real life clinical practice (particularly in primary care where 80% of psychiatric drugs are prescribed)."

    He then goes on to list ten problematic changes that will lead to over-diagnosis (including of ADD).

  69. Eric Titus Says:

    There's two issues. The first is that while medication will do many people a lot of good, there's a tendency to see normal productivity (i.e. the ability to do 12hours of schoolwork, not have occassional days lost to lethargy, etc) as the goal rather than the more difficult task of figuring out how drugs can make you more well-adjusted and happy on your own terms. It's healthy to have a dialogue about whether psychopharmaceuticals are too tied up to some cookie cutter version of productivity and normalcy.

    There's also plenty of problems with the drug-based approach to treating mental issues. As @Trapclap points out you end up getting multiple diagnoses and "bizarre drug cocktails." The problem is the diagnostic tools: since disorders are not so clear-cut as the DSM makes them out to be, chances are that a disorder+some "normal" personality quirks will leave you with multiple potential diagnoses. On the less serious side, periods of reduced productivity are not unusual, but can easily result in an ADD diagnosis if you are (consciously or subconsciously) predisposed in that direction. The thing is, it's also not "natural" to be in school from 8-4 for 12 years of of your life (or more). So I do think that the diagnostic tools we have definitely make for plenty of "false positives". Psychiastrists know that it's somewhat discrediting them, but the problem is that most of them don't have the expertise to exit the diagnose-prescribe framework.

  70. protected static Says:

    @Elle – my understanding (which is as a layperson married to a researcher in this field) is that cultural norms and expectations play a greater role in drinking to excess than does self-medication. In the US, that's been difficult to study because active duty military personnel have few rights to privacy even as research subjects.

  71. Elle Says:

    @ Protected Static

    The cause of the alcohol misuse rate in the UK armed services being twice that in the general population isn't known. The defense select committee of the House of Commons recommended to the MoD in 2011 that it needed to do more work to explore this.

    The Committee itself, having heard evidence, posited that it might be a response to combat stress, or not.

    I guess at this point, we don't know.

  72. Jane Says:

    Parent of a 22 year old here. She and her friends take less "medication" than I did at her age.

    It seems that more young people are seriously unhappy now than they were in the mid 1980's, at least here in Sweden. There are excellent statistics available. (http://www.fhi.se/PageFiles/12031/R2011-9-Kartlaggning-av-psykisk-halsa-bland-barn-och-unga-2.pdf) – mostly in Swedish, sorry.

    This is serious and real and a large effect, and doesn't have to do with overmedication or competition with drug enhanced peers.

  73. mclaren Says:

    Clearly from the tone of your post, you suffer from affective disorder and need to be prescribed massive amounts of ritalin, chlorpromazine, risperidone, aripiprazole, olanzapine, quetiapine, and ziprasidone. If improvement is not visible within 10 to 14 weeks, stereotaxic surgery to burn out the affected areas of the brain may be indicated.

  74. Robert Says:

    I can speak from my experience as a parent. My husband and I adopted our two sons (now 15 and 11) from foster care. Each were five when adopted. They have both been receiving psychiatric AND psychological counseling since, along with medication for multiple psychiatric diagnoses. The meme of 'mommy says you're ADHD, so let's drug you into catatonic submission' truly chaps my hide. It took professional evaluation by multiple mental health professionals before either of them were given 'drugs'. I am convinced that they would have had to have been institutionalized without the care they've received.

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