Tuesday, January 29, 2008

If you're not cheerful and obedient, you must be nuts

As I read this article, How Teenage Rebellion Has Become a Mental Illness, by Bruce Levine, I keep asking myself, "where even to begin?" Maybe I'll just start with a few passages that jumped right out at me:
For a generation now, disruptive young Americans who rebel against authority figures have been increasingly diagnosed with mental illnesses and medicated with psychiatric (psychotropic) drugs.
Disruptive young people who are medicated with Ritalin, Adderall and other amphetamines routinely report that these drugs make them "care less" about their boredom, resentments and other negative emotions, thus making them more compliant and manageable. And so-called atypical antipsychotics such as Risperdal and Zyprexa -- powerful tranquilizing drugs -- are increasingly prescribed to disruptive young Americans, even though in most cases they are not displaying any psychotic symptoms.
Many talk show hosts think I'm kidding when I mention oppositional defiant disorder (ODD). After I assure them that ODD is in fact an official mental illness -- an increasingly popular diagnosis for children and teenagers -- they often guess that ODD is simply a new term for juvenile delinquency. But that is not the case.
Young people diagnosed with ODD, by definition, are doing nothing illegal (illegal behaviors are a symptom of another mental illness called conduct disorder). In 1980, the American Psychiatric Association (APA) created oppositional defiant disorder, defining it as "a pattern of negativistic, hostile and defiant behavior." The official symptoms of ODD include "often actively defies or refuses to comply with adult requests or rules" and "often argues with adults." While ODD-diagnosed young people are obnoxious with adults they don't respect, these kids can be a delight with adults they do respect; yet many of them are medicated with psychotropic drugs.
An even more common reaction to oppressive authorities than overt defiance is some type of passive defiance.
I'd like to think that I was a nice-ish teen, for the most part, and that I've been a nice-ish adult (again, for the most part); however I can see how I could easily have found myself stuck with a label like oppositional defiant disorder (I wonder how coincidental it is that the acronym for the "disorder" is ODD. I suppose nonconformists and anti-authoritarians in an authoritarian situation are perceived of as "odd.") due to a persistently stubborn contrarian streak and a tendency to ignore or refuse to follow the demands of those whom I've grown to disrespect. I see a bit of that in my kids as they continue to grow and mature. Personally, I wouldn't want to change that in them - I consider it part of becoming an autonomous adult. As a parent, that means periodically dealing with those inconvenient moments when I have to deal with one or more argumentative kids. That inconvenience of course is only to me of course - for them it is a matter of struggling to learn some of the critical thinking and argumentation skills that they will need later on in life when I'm no longer around to fend for them.

The article goes on to discuss at least one type of passive defiance that often gets titled ADHD. I remember someone with a four year old child whose preschool teacher was saying should be tested for ADHD. I asked a bit about the kid's behavior, and quite honestly, the kid seemed like a regular four year old: full of energy, precocious, short-ish attention span (which would describe practically any small child). My suggestion to her was to wait a few years and see if there really was a problem - in all likelihood her kid was just a normal kid who was probably bored while at school. Kids who are bored tend to get into mischief. Last I heard, the kid was just fine. Fancy that. As you can imagine, my opinion is that our society over-medicates both kids and adults. Why? It's about maintaining control. Sedated individuals don't make waves.

As I've become more and more influenced by the writings of psychiatrist Frantz Fanon, and some of Fanon's followers like Hussein Abdilahi Bulhan, I've increasingly asked myself what is going on in the environment; rather than pathologize the individual, I'm more prone to look toward the dysfunction in one's social and physical environment. Certainly that's a bit of a different outlook than how I was trained (many in my field tend to be primarily focused on the individual, and often in ways that decontextualize their behavioral responses). It seems, if Levine is right, that we also need to look at the environment in which mental health professionals are trained - to the extent that we become conditioned to be good, obedient worker bees (hate to say it, but most of what I learned in grad school amounted to how to jump through hoops, ingratiate myself with those more powerful than myself, and complete paperwork), we become conditioned to see behavior that falls out of a certain set of bounds as aberrant. Maybe we need to radically transform our means of professional training, as the current tradition merely encourages a sort of authoritarianism of thought and action.

Levine also points out that there is a historical precedent for psychiatry to pathologize rebellious behavior:
Two ways of subduing defiance are to criminalize it and to pathologize it, and U.S. history is replete with examples of both. In the same era that John Adams' Sedition Act criminalized criticism of U.S. governmental policy, Dr. Benjamin Rush, the father of American psychiatry (his image adorns the APA seal), pathologized anti-authoritarianism. Rush diagnosed those rebelling against a centralized federal authority as having an "excess of the passion for liberty" that "constituted a form of insanity." He labeled this illness "anarchia."
Throughout American history, both direct and indirect resistance to authority has been diseased. In an 1851 article in the New Orleans Medical and Surgical Journal, Louisiana physician Samuel Cartwright reported his discovery of "drapetomania," the disease that caused slaves to flee captivity. Cartwright also reported his discovery of "dysaesthesia aethiopis," the disease that caused slaves to pay insufficient attention to the master's needs. Early versions of ODD and ADHD?
In Rush's lifetime, few Americans took anarchia seriously, nor was drapetomania or dysaesthesia aethiopis taken seriously in Cartwright's lifetime. But these were eras before the diseasing of defiance had a powerful financial ally in Big Pharma.
I think it is useful to make note of Cartwright's attempt to turn the resistance to being enslaved into a mental illness (it gets mentioned in Guthrie's Even the Rat Was White). These days, the slaves would be administered some form of "happy pill" or sedated in some other form. In a way, we're really not that far from some sort of THX-1138 style society, in which individuals are routinely medicated, and those refusing are detained until they can be "reeducated."

That last paragraph is a must-read:
It would certainly be a dream of Big Pharma and those who favor an authoritarian society if every would-be Tom Paine -- or Crazy Horse, Tecumseh, Emma Goldman or Malcolm X -- were diagnosed as a youngster with mental illness and quieted with a lifelong regimen of chill pills. The question is: Has this dream become reality?
Food for thought.

As a side note, my experience with message boards (e.g., the old Usenet newsgroups and bbs) and more recently blogs is for those who fail or refuse to conform to receive armchair diagnoses from those who are responsible for site moderation. One reason I have mostly left the gated community blogs run by even the so-called "tolerant" progressives was my disgust at seeing others be told to seek psychiatric help over some minor blog-related disagreement, as well as the tendency for quite a number of folks on these same blogs to pathologize dissident politicians and activists such as Cindy Sheehan, Cynthia McKinney, and Ralph Nader. That simply does not sit well with me.

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