Rey & Sawyer ( 2003) ask ‘Are psychostimulant drugs being used appropriately to treat child and adolescent disorders?’ — the answer is no. Like most articles on psychostimulants, they avoid discussion of the fundamental question that needs tackling for their conclusions to have any meaning — is attention-deficit hyperactivity disorder (ADHD) a valid medical disorder? The answer is no (see Timimi, 2002). This disorder is best understood as a cultural creation. Rey & Sawyer illustrate how deeply practice in this area is influenced by cultural dynamics. They show how there are large variations in the way diagnostic criteria are used both between countries (not surprisingly, they only mention Western ones) and within them. They show that there are also large variations in the way psychostimulants are used.
Children are already the losers here. There are reports of some primary schools where nearly 40% of the students were taking psychostimulants ( Runnheim, 1996). Rates of diagnosis of ADHD and subsequent medication use continue to rise alarmingly in most Western countries. This is a massive, dangerous and scandalous experiment in which millions of children are being exposed to highly toxic, addictive and brain-disabling drugs whose medium- and long-term efficacy and safety have not been established ( Breggin, 2002). The only winner is the profit margin of the pharmaceutical industry.
I realise this is emotive language, but then the business of what values we hold when it comes to children is too important to allow us to hide behind dry, detached, academic pretence. We live in a culture that has a deep intolerance for children. This is at the heart of why we are labelling physically healthy children with fictional medical disorders. Doctors become a symptom of this intolerance, not part of the solution.
This is all so unnecessary. For years I have been working with these children and their families using diverse perspectives based on a more humanitarian value system ( Timimi, 2002). Not only are my clients grateful for this, they often recommend others to come and see me.
- © 2003 Royal College of Psychiatrists