Last semester in psychology we stopped to have a full class discussion on ADD and ADHD. We were studying psychological disorders and had watched a movie about medicating children who are diagnosed with having either Attention Deficit, or Attention Deficit Hyperactive Disorders. It's one of those disorders that seem to be more and more common in the last couple years. Psychologists are getting worried about the increase in these disorders, and people are saying that television and video games are giving our kids ADD, and that the excess amounts of sugar in everything we eat is giving the ADHD. They blame society for an increase mental health problems. They do the same with depression, bipolar and other mood disorders, blaming career and money driven worlds that push us to strive for standard of living instead of quality of life. Surely this is the reason that so many more people suffer from depression.
But is it really a case of more people suffering? Or just more people coming forward with their problems and in turn being diagnosed. There is a difference after all.
Three hundred years ago a person with bipolar or schizophrenic would be told that they were possessed. This was the common diagnosis for hundreds of years, where exorcisms would be attempted and if that didn't work, they could be killed. As little as seventy years ago, the only treatment for depression, bipolar, and schizophrenia was electroshock therapy (ECT). An electrode was attached to your head and you were zapped with a very powerful current. The patient suffered muscle spasms, memory loss, broken bones, and sometimes even death. If that didn't work, lobotomies were common. These weren't the types of focused biopsies we do today to check for brain diseases. Doctors went through your eye with an icepick and removed brain tissue. This was post WW1, and today would be deemed completely barbaric. But we didn't understand psychological problems back then the way we do now.
So you can imagine how many people would confess to having a depressive mood disorder. How many people do you think would seek help if they knew there was a chance of being electrocuted, or something even worse.
Then the first anti depressants came out. Medications altered brain chemistry, changing the way that our hormones were released and absorbed. Trust in the psychological community who seemed to have been experimenting on our brains without truly understanding what was wrong. The first antidepressants and antipsychotics had the side effects of being "mentally numbing" and people said "killed their soul". Mood stabilizers like Lithium made people feel like zombies, and the side effects were brutal. And for what? To feel a little more happy? It didn't seem worth it.
So chemists and biologists and psychologists got together and started looking at better ways of dealing with depression. They figured out possible reasons for what was causing these disorders, and learned about serotonin and norepinephrine and dopamine, the hormones that make us happy. They started to figure out how the brain worked, how it made these chemicals and how to make sure the brain was making enough of them.
Once we figured out it wasn't the patients fault that they were unhappy and that they couldn't just "snap out of it" we were a lot more sympathetic. there was less of a social stigma to step forward and say "I have a mental illness and I am not going to let it control me."
The problem changed. Now if you were unhappy there was a drug for that. It did become widely over diagnosed and people have became completely over medicated. The number of depressed people rose drastically and the reason was two fold. First, more people who were actually depressed felt they could come forward and seek help without fear of harsh treatments or social isolation. The number of people who suffered from depression didn't increase, but the number of people willing to admit they had this disorder did. Secondly, the availability of a "quick fix" for life's problems was so great that people who may not be clinically depressed started telling their doctors they were. With the widespread use of the Internet as a tool for self-diagnosis and you have an abuse of antidepressant drugs.
What people didn't realize was that the side effects hadn't vanished. People with depression would deal with the side effects of an upset stomach, nausea, and even the thoughts of suicide if it meant not feeling like you'd been hit by a truck every morning, and that you were beyond worthless in society. People with major depressive disorder (MDD) would take the risk if it meant a normal day, waking up happy, and the potential to live a normal life. Normal people taking these drugs probably don't like that too much, but I can't speculate there.
The fact that you can log onto google, list your symptoms and get a list of diseases and disorders you might have is a problem. The fact that if you present this list to a doctor, the doctor gives you medicine is just as big. Which brings us to someone else diagnosing a disorder.
Teachers.
Sixty years ago a kid who was hyperactive, unfocused, unable to pay attention, disobedient, easily bored, or overly talkative was a brat or a bad kid. Then psychologists and psychiatrists figured out that dopamine, one of the hormones that make us happy, was all off in some of these bratty kids. While increases in sugar consumption and TV watching in today's society does play a huge role in the energy level in today's children, this chemical unbalance is also important. Together you have the prevalence of ADD and ADHD.
So now there was a disorder that could explain bad behaviour and there was a cure of sorts. Put them on Ritalin, or some other drug, and they'll behave, learn better and be overall better kids, right? Wrong.
A quick psych lesson here, kids with ADD and ADHD are not mentally over stimulated, but rather under stimulated. They act out because their brains are seeking stimulation on an emotional and physical level. Ritalin has occasionally been dubbed "kiddie Cocaine" and it's in effect similar. It's a stimulant that gives stimulates the brain so that they can focusing instead of seeking out stimulation in their environment.
So teachers were informed that not all the bad kids in their classes were just bad kids, but some of them had a genuine disorder and could be treated. So teachers started diagnosing ADD/ADHD in their classrooms. You can imagine that giving a stimulant to a kid who doesn't have a chemical imbalance would be very counter intuitive, and you'd be right. The same way giving cocaine to someone does not fix their behaviour.
So is it worth it? Does medicating anyone help these people or does the availability of a drug to "cure" psychological disorders simply lead to over diagnosis and medication of "normal" people and kids. Surely not every sad person has depression, and not every bratty kid has ADD/ADHD.
Here's another quick psych lesson which is based on the definition of a disorder. According to the DSM (diagnostic and statistical manual of mental disorders) mental condition becomes a disorder when it causes significant interference with daily life. So depression is only a disorder if it is causing you significant problems in your daily life. You stop going out because you think people hate you, you stop working because you think "what's the point?" and you stop living your life because of the depression.
A bratty kid is just a bratty kid unless it's a significant disruption and nothing can be done to change the behaviour. If a kid is acting out to get attention that's one thing, but if the child honestly cannot focus no matter how hard they try, and cannot sit still no matter how much they might want to, that's a disorder.
For example:
A young boy is starved for attention at home. His parents both work and don't seem to have time for him, don't help him with his homework, don't even notice he has any. He is allowed free run of the house and is not under any significant rules at home. In school he continues to act out, reveling in the attention of teachers and peers. He doesn't understand the work because nobody takes the time to teach it to him, and so he doesn't do the work, falling further and further behind in school until he eventually gives up entirely. The teachers can't deal with his acting out and suggests to the parents he has ADD or ADHD.
The teacher here is probably wrong. With some attention and help he could probably begin to put school as a priority again. With time he might catch up on what he has missed and integrate into middle and high school with few problems. Without help from parents and teachers, he will continue to struggle. I wouldn't say it's bad parenting, in today's world it's common for both parents to work just to make ends meet. But someone needs to lay down the law, set rules, help with homework and make sure that education is important. Seven year old boys would rather play in the sandbox or ride their bikes then do math.
Example 2:
A young girl with older siblings and a single mom struggles with school. She hides her homework, but each night is required to sit down with someone and do the work. Her mom tries to get her interested in reading, talks to the teacher about her poor grades and attends parent teacher interviews. Despite the parent and the teacher's best efforts the girl is unable to focus in class, struggles with her work and has problems with friends. By grade four she struggles with reading and writing, basic math and science, and has been told she has a learning disability.
A teacher finally suggests to the girl's mom that the girl has ADD and should see a psychologist. The psychologist prescribes her medication and after a few weeks she is able to not only focus, but understand her work.
The difference? The second child actually has ADD. She also happens to be my sister. She struggled with school for years; teachers refusing to say she had ADD because it has become over diagnosed and teachers get in trouble for suggesting it. No matter how hard her teacher, my mom, my brother and I tried, we could not get her to focus. She was always high energy and never seemed to be able to focus on anything for any length of time. She would come home in tears because she wasn't doing well in school, but just could not seem to understand it, and more than once told us she thought she was stupid.
After she started taking Concerta, a once a day medication for ADD, her behaviour changed rapidly. Within weeks she was sitting down to do math and science of her own accord. She still hated homework because she still didn't understand it, but she could focus better and actually wanted to learn. The day she got 100% on a math test her teacher called my mom in tears to tell her. That year she got an award for most improved student of the year. In fact, after she started taking the Concerta it was discovered that my wonderful little sister is actually a Gifted student. She's incredibly smart when she puts her mind to it.
With a lot of students it's diet. The fact that we live on pop, candy and other goodies that are bad for our health does lead to 'sugar highs' and difficulty focusing. Over stimulation can be just as dangerous as under stimulation. The school system is not designed for children. Hours a day in a desk does not make it easy for kids who would rather be playing. But sometimes there is a deeper issue.
My last example is a name you might recognize. Ty Pennington, the carpenter from TVs Trading Spaces and Extreme Makeover: Home Edition grew up with undiagnosed ADHD. It was undiagnosed because the diagnosis didn't exist when he was seven. But he was able to apply his energy to something that made him happy; carpentry. He built, created, designed and drove his mother nuts. Now when you see him, you can tell he's got lots of energy but is in control of it.
While disorders do exist, it is important to understand their causes and effects. They are usually caused by a chemical imbalance, and they affect the way we live our lives. Medication corrects these imbalances, so when given to someone without the chemical problems, they don't have the same effect and can actually do more harm then good. You can't just disregard their existence and tell people to "get better", but you can't generalize either.
There is an increase in how many people are diagnosed each year with these disorders, but it could be because the stigma is decreasing and people are able to seek help without fear of being deemed "Crazy". There is also an increase in misdiagnosis because we want a quick fix for all our problems. Before medication, cognitive behaviour must be considered. Medication shouldn't be a first response, or even a last resort, but a tool with which real problems are dealt with. And that's my psych lesson for the day. Closing thoughts:
Disorders are real, and help for them is available.
Just because a disorder exists doesn't mean every person with a single symptom of it, has it. Sometimes attention, and a little bit of help are all it takes to help a person out.
Normal is just as much a spectrum as a disorder is. People are different, and we need to be accepting of that.
Somethings we cannot change, but until we try we'll never know.
No comments:
Post a Comment