Family Practice Vol. 16, No. 4, 447
© Oxford University Press 1999
Book Reviews |
Ritalin nation: rapid fire culture and the transformation of human consciousness.
Clinical Research Fellow, Department of General Practice and Primary Care, University of Birmingham
R DeGrandpre. (284 pages, £15.95.) W W Norton & Co. Ltd, 1999. ISBN 0-393-04685-0.
An estimated 15% of North American children will at some point be diagnosed as suffering from Attention Deficit Hyperactivity Disorder (ADHD)—on the basis of their exhibiting symptoms such as carelessness, noisiness, chattiness and difficulty waiting their turn. Most of these children will be prescribed stimulants (like methylphenidate—Ritalin) as treatment for their brain disease. This wholesale medication of American youth has caused some anxiety in the US (in blind comparisons, Ritalin is indistinguishable from cocaine), though currently the official consensus amongst US psychiatrists is that ADHD is a biological disease with an effective pharmacological treatment.
Richard DeGrandpre, a North American psychologist, disagrees. In Ritalin Nation he presents an alternative explanatory model whereby "rapid fire culture" has led to epidemic "sensory addiction". Within this model, DeGrandpre sees Ritalin as a substitution therapy—rather like methadone in opiate addiction. He argues that this ‘quick fix’ will ultimately fail as it is directed at symptoms, not causes. His alternative solution advises: "Redefine the bottom line. Spend less time at work; parent more and parent better. Learn more effective life skills and pass them on to your children. Do these things by being less worn out, stressed out, and distracted by the perceived necessity of material wealth."
Whilst it is easy to relate to these sentiments it is also easy to see why most parents would prefer to give their difficult child a pill. Apart from anything else, DeGrandpre presents no evidence for the effectiveness of his therapeutic approach. At times, his views on the current problematic state of US society seem to reflect the "mom and apple pie" nostalgia that characterizes many responses to the current perceived crisis.
There will always be pressure towards collusion between sufferers, doctors and drug makers in the medicalization of social problems. Promised freedom from responsibility and the hope of a technological solution for the former, along with enhanced power and entrepreneurial opportunities for the latter, make a powerful stimulus. Currently, the evidence for the existence of ADHD as a discrete syndrome is tenuous. The evidence for the effectiveness of Ritalin (or other drugs) is equivocal. The Cochrane Collaboration are cautious about the quality of their one systematic review in the area (adult ADHD treatment) and describe the primary research as "extremely poor". The review (by North American psychiatrists) enthusiastically endorses the prescription of stimulants. The fact that this issue is currently much more ‘live’ in the cradle of market medicine than in Europe is not surprising and may make DeGrandpre's book seem less relevant to European family doctors. This may change if our healthcare systems move more towards a US model—as some people suggest they should.
CiteULike 
Connotea 
Del.icio.us What's this?
| ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||