is not what it used to be |
rise of Ritalin has moreto do with shifting social values than advances
in neuropharmacology, argues David Concar
children behave properly within minutes of swallowing it. Books, lawsuits
and websites have been mobilised in honour or horror of its name.
But Ritalin is more than just a noisily debated treatment for young
hyperactive brains. Increasingly, it is being held aloft as a grim
warning of where the new biomedical sciences are leading us.
the latest call for a tighter rein on such research. In Our Posthuman Future,
Francis Fukuyama rates the galloping pace of neuropharmacology and the
brain sciences as even more threatening to human dignity and freedom than
the prospect of designer babies. "Virtually everything that the
popular imagination envisions genetic engineering accomplishing is
much more likely to be accomplished sooner through neuropharmacology,"
he writes. And for a taste of the kind of "mind engineering"
that might flow from this, he suggests we look at the impact of Ritalin.
there are worries with this pill and its long-term effects on the brain.
What Ritalin has neverbeen, however, is a high-tech product of the new biomedical
sciences. The suggestion that it is overlooks its true history and the real
lessons it holds.
first synthesised Ritalin, or methylphenidate, in Switzerland in igq~,
and the first clinical trials using it to treat hyperactivity ran some four
decades ago. Far from being a precise clinical tool, it interferes
messily with the brain's chemistry. It is the product of oldfashioned suck-it-and-see
science. To this day, nobody is exactly sure how it works.
how did it get to be the pin-up pill for a scary new age of revolutionary
neuroscience? Like Monty Python's hapless Brian, this run-of-the-mill
amphetamine acquired its reputation only because it caught the eye of an
expectant crowd. Demand for Ritalin took off in the early i99os, a time
of much breathless talk about neuroscience.
were starting to expose the genetic and biochemical roots of human
personality, supposedly turning the mind into a machine ripe for fixing.
Yet real examples of high-tech mind engineering were scarce, so when
commentators needed evidence of the revolution they held up Ritalin,
endowing it with a more sophisticated image than it deserved.
triggered the soaring demand? As psychiatrist David Healy points out
in The Creation of Psychopharmacology: "The psychiatric
treatment of young childrenwith drugs had until the i99os been all but
taboo...mass treatment on the scale that developed by the mid-rggos indicates
a profound cultural shift:' The rebranding of hyperactive behaviour
as ADHD (attention deficit hyperactivity disorder) in the ig8os helped
create that shift, as did a huge marketing effort by Ritalin's manufacturer.
But neither could have succeeded if doctors and patients weren't themselves
becoming more open to viewing problem behaviour as an abnormality
serious enough to be fixed through drugs.
of this change have been widely debated. One favourite suggestion
is that harried parents and teachers prefer to blame brain chemistry rather
than bad parenting or teaching for their charges' troublesome behaviour.
But there are other, less obvious factors. One is the development
of psychological rating scales for measuring mood, behaviour and personality.
Healy argues that just as the spread ofbathroom scales in the ig6os
laid the ground for anorexia nervosa, so the arrival of psychological
checklists did the same for conditions such as ADHD. Without them, drugs
manufacturers would struggle to design trials, and to identify children
who deviate sufficiently from behavioural norms to require treatment.
merely measuring and naming a behavioural deviation cannot spark a giant
epidemic. What else was going on? It is probably true that before Ritalin
took off, a lot of damaging hyperactivity was overlooked. It might
even be true that hyperactive behaviour is increasing. But no psycho-medical
condition spreads as fast as prescriptions for Ritalin have in the
past decade. If hyperactivity is now diagnosed so often it is because it
matters more to parents and teachers than it did.
isn't surprising.In today's super-competitive and super-protective
world, childhood is not what it was. The idea has quietly taken hold that
we're all prisoners of our early years. Children's behaviour, what
they learn and when they learn it have taken on unprecedented significance.
What was once a fluid time of discovery has been reinvented by cognitive
psychologists as a succession of neuralphasesforlearninglanguage,
social skills, number concepts and the rest. Grab these chances and your
child prospers; miss them and supple synapses might ossify. Poisoning
young minds with bad experiences is seen as a sure-fire recipe for
a blighted life. Childhood has become something that has to be normal
and got right-even if, paradoxically, that means using psychiatric drugs.
and technologies are not simply dumped into our laps by scheming scientists.
They emerge because of a complex web of forces. If we want to control
their impact, we ignore this web at our peril.