ADD As a Social Invention By Thomas Armstrong, Ph.D.
(Originally published in Education Week, October 18, 1995)
(c) Thomas Armstrong, 1995
In 1851, a Louisiana physician and American Medical Association member, Samuel A. Cartwright, published a paper in the New Orleans Medical and Surgical Journal wherein he described a new medical disorder he had recently identified. He called it drapetomania (from drapeto, meaning “to flee,” and mania, an obsession), and used it to describe a condition he felt was prevalent in runaway slaves. Dr. Cartwright felt that with “proper medical advice, strictly followed, this troublesome practice that many negroes have of running away can be almost entirely prevented.”
In the last 20 years, we have witnessed the birth of a new medical disorder–attention-deficit disorder–which has grown from a relatively rare neurological condition (under other names) during the 1930s, 40s, and 50s to a condition today said to afflict millions of children and adults (a recent Time magazine cover story even suggested that President Clinton may have ADD and could be “only a pill away from greatness”). Attention-deficit disorder (or, more recently, “attention deficit hyperactivity disorder”–the syndrome has changed names at least 25 times in the past 120 years) has the support of thousands of scientific studies, the American Psychiatric Association, the U.S. Department of Education, and many other solid institutions in this country and worldwide. Yet, like Dr. Cartwright’s “drapetomania,” ADD may in fact come clothed in scientific respectability yet have disturbing social overtones which are scarcely acknowledged by the wider educational community.
Social critic Ivan Illich once wrote that “each civilization defines its own diseases. What is sickness in one might be chromosomal abnormality, crime, holiness, or sin in another. For the same symptom of compulsive stealing one might be executed, tortured to death, exiled, hospitalized, or given alms or tax money.” So far, few attempts have been made to analyze the social meaning of “attention-deficit disorder” in our time. However, one does not have to probe too far beneath the surface to discover some interesting-and troubling-features of ADD
Why, for example, does identification Of ADD vary so widely from one social context to another? Studies reveal that up to 80 percent of the time, ADD cannot be identified in the physician’s office, presumably because the one-to-one social context with a (frequently) male authority figure mediates against the occurrence of symptoms. In another study, trained clinicians from different countries were shown tapes of children and asked to diagnose them. In a country with stricter behavioral norms–for example, China–there was a greater likelihood of an ADD diagnosis than in a country such as the United States. On the other hand, in some countries, such as England, a diagnosis of hyperactivity is much less likely (one study on the Isle of Wight identified only two children out of 2,199 as hyperactive).
One has to ask, then, what are some of the underlying social influences that may have served to shape the invention Of ADD as a category of disorder in our culture? The answer to that question, I believe, is complex and many-faceted. On one level, it’s possible to revive some of the concerns that Nicholas Hobbs, a former president of the American Psychological Association, had in the mid-1970s concerning the labeling of children. Mr. Hobbs pointed out that “a good case can be made for the position that protection of the community is a primary function of classifying and labeling children who are different or deviant.” He noted that the Protestant work ethic (as elaborated upon by social theorists such as Max Weber) may be one set of American values which may permeate our nation’s penchant for classifying unruly children. Mr. Hobbs writes:
“According to this doctrine … God’s chosen ones are inspired to attain to positions of wealth and power through the rational and efficient use of their time and energy, through their willingness to control distracting impulses, and to delay gratification in the service of productivity, and through their thriftiness and ambition.” Such a society might well be expected to define deviance in terms of distractibility, impulsiveness, and lack of motivation–the same traits frequently used to describe children suffering from ADD.
Alternatively, ADD may have arisen in our society precisely because of the loss of those same values. As Harvard University professor Lester Grinspoon and his collaborator Susan B. Singer pointed out over 20 years ago, “our society has been undergoing a critical upheaval in values. Children growing up in the past decade have seen claims to authority and existing institutions questioned as an everyday occurrence. … Teachers no longer have the unquestioned authority they once had in the classroom. … The child, on the other side, is no longer so intimidated by whatever authority the teacher has.” Grinspoon and Ms. Singer felt that “hyperkinesis” [the term used in the 60s and early 70s to designate ADD-type behaviors], whatever organic condition they may legitimately refer to, has become a convenient label with which to dismiss this phenomenon as a physical ‘disease’ rather than treating it as the social problem it is.”
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