Recently, I was asked by my boyfriend to edit an essay that he wrote on the medicalization of attention deficit hyperactivity disorder (ADHD) in the western world. Honestly, after reading the essay, I was quite taken aback. Never in my life have I ever questioned the medical community. We’re often told that “The doctor knows best” but what if the doctor doesn’t know best? What if the doctor isn’t doing what’s best for the patient but, instead, is doing what’s “best” for society? Before I get started, I want to make it clear that I’m simply expressing my opinion on this subject matter and that I don’t intend to influence anyone in any specific way.
Now, you’re probably wondering what on Earth medicalization even is and how it’s relevant to modern medicine. To put it simply, medicalization is a process in which human conditions and behaviors are defined and treated as medical disorders or diseases. At first glance, this may not seem like a huge problem but, in the long run, medicalization can lead to people taking medicine and undergoing treatment to treat diseases that may not even exist. To put this into perspective, I’ll start with some historic examples.
I’m sure many of you have heard of female hysteria or “The Ladies’ Disease.” First described in Ancient Egypt, hysteria (or the state of having uncontrollable and varying emotions) was believed to be caused by a “wandering uterus” and was thought only to affect women. During the 19th century, French physician Pierre Briquet estimated that 25% of women suffered from hysteria (1) and the symptoms of the disease took up 75 pages in medical handbooks (2). Many of these so-called “symptoms” are simply social behaviors deemed abnormal for women at the time. For example, the following were some of the 19th century symptoms of hysteria:
- Sexual deprivation/Inability to feel satisfied after penetration
- Disinterest in marriage, sex or childbearing
- Erotic thoughts
- Varying emotions
- Back and lower abdominal pain
- Lack of femininity
Essentially, women who didn’t fit the social norm at the time and were categorized as being ill and in need of medical intervention. Doctors prescribed these women with many different treatments including “pelvic massages”, bed rest or, in the most severe cases, exorcism and/or hysterectomies. From a modern perspective, one can easily see that the “symptoms” exhibited by women with hysteria can be attributed to normal female hormonal shifts and the rigid social expectations that Victorian women had to abide by. For example, women at the time were thought to have no sex drive and were expected to feel satisfied living their lives as wives who raised many children. While many women did feel satisfied living this way, the handful of women who wanted to have careers, own property or vote like their male counterparts were labeled as ill and, therefore, in need of medical treatment. Instead of actually addressing the societal problem of gender inequality, these medical treatments simply put a temporary Band-Aid on the problem.
Now, I’m in no way judging the intelligence of the people involved in diagnosing and treating female hysteria. The physicians of the past worked with very limited tools and technology and much about the human mind and body had yet to be discovered. However, I do think that it’s important to look at our history and ask ourselves “How might we be making those same mistakes today?”
In my opinion, attention deficit hyperactivity disorder (ADHD) is the Hallmark of modern medicalization examples. In the States, 9.5% of children aged 4-17 in 2011-2013 have ever been diagnosed with ADHD with 70% of those children being boys (3). When I first saw the symptoms of ADHD as written in the DSM-5, the official handbook for diagnosing mental disorders, I was both amused and horrified. According to the symptoms listed in the DSM-5, almost everyone in my family, including myself, could easily be diagnosed with ADHD. Here are some of the symptoms:
- Failure to finish schoolwork or workplace duties
- Difficulty organizing tasks and activities
- Is easily distracted
- Is often forgetful
- Often fidgets/squirms in seat
- Often unable to play quietly
- Acts as if “driven by a motor”
- Often talks excessively
- Failure to give close attention to detail/makes mistakes
There are 9 other symptoms that are closely related to the ones that I listed above. If you’re interested in looking at the DSM-5 for ADHD, you can click here.
The most appalling thing about these 18 symptoms of ADHD is that, in order for a child or adolescence to be diagnosed with ADHD, only 6 of these 18 symptoms need to be present along with proof that these behaviors negatively impact their social and/or academic life. In my opinion, the vast majority of these symptoms are just normal behaviors exhibited by children. Honestly, have you ever met a child that doesn’t ask tons and tons of questions, plays with other children quietly, stays still for long periods of time and rarely makes mistakes? Of course, the ideal child would be quiet, mature and adult-like but that’s not the way that children naturally behave. Often, children have A LOT of energy and this is simply because both their minds and their bodies are growing. Children are naturally driven to explore, ask questions and move around and I don’t think that it’s okay to label children who display this natural drive as being ill.
Another thing that I noticed about ADHD diagnosis was that 70% of children diagnosed with ADHD were boys. Why is it that boys are more prone to being diagnosed with ADHD than girls? To begin, I looked at how to diagnose ADHD according to the DSM-5. The 6 out of 18 symptoms that children must have in order to be diagnosed with ADHD must be to a degree that is inconsistent with development level. The only problem with this is that, 50% of the children in any development level are girls. Researchers at the University of Newcastle have proven by taking brain scans of 120 volunteers aged 4 to 40, that the brain of girls is significantly more developed than boys during every stage of development (5). If some boys in a 1st grade class can’t sit still during reading time but all the girls can, are we really justified to say that these boys have something wrong with them?
The two main treatments for ADHD are behavioral therapy and medication. Medication is used to treat 69% of children with ADHD (6) and some of the most popular medicines are stimulants, such as Adderall or Ritalin, which reduce hyperactivity and improve focus. The long term side effects of these stimulants include increased seizure activity, stunted growth in children, high blood pressure and damage to the frontal lobes (7, 8). While I do believe that in SOME cases these the diagnosis and treatment of children with ADHD is beneficial to help very troubled children, I don’t think that we should be seeing nearly as high of a number of children with the disorder as we presently do. In my opinion, diagnosing and treating ADHD in the ways that we see today, is a way to mask the impeding societal problem which is that the education system has major faults and doesn’t accommodate children that are naturally hyperactive. Instead of trying to fix its faults and make school more hands-on, the education system labels children that are showing difficulties in school as “ill” which gives them a lifelong stigma of being “bad” and “stupid”.
Medicalization is not unique to ADHD. Many other human behaviors have been classified as diseases/disorders. Take the method of diagnosis for major depression as an example. According to the DSM-5, in order to be diagnosed with major depressive disorder people must experience 5 of 9 symptoms almost everyday for two weeks. These symptoms include depressed mood, disinterest in activities, weight loss/gain, lethargy, insomnia, feelings of worthlessness, diminished ability to concentrate and suicidal thoughts (9).
While I do believe that depression exists as a mental illness and do think that those symptoms are accurate depicters of depressions, I disagree with the fact that someone can be diagnosed with depression after having displayed some of these symptoms for only 2 weeks. Grief is a natural part of being human. There are so many situations in life which can cause us to fall into a state of sorrow: the death of a family member, a divorce, falling physically ill, etc. In my opinion, instead of declaring people who are grieving as ill and giving them medication to numb their sorrows, more effort should be put into helping people understand how to deal with grief on an emotional level. Grieving and feeling sadness is a part of life that will never go away and I think that learning how to properly deal with these feelings is way more valuable than simply masking them with medication. However, in my opinion, if the symptoms of depression still persist after attempting to learn how to deal with grief, I do think that medical professionals should intervene. Depression is an extremely devastating disease to live with and it should be treated accordingly.
I could go on and on about medicalization, but I’ll stop here. I don’t doubt that hysteria (now called conversion disorder), ADHD and depression DO exist but, is it possible that these disorders are not as widespread as we think they may be? While medication is almost always used to help those who are actually suffering, in my opinion, it can so easily be used as a tool to control people. It’s unfortunate, but it’s much simpler to give someone who is deviating from a social norm a pill to stop their deviation instead of dealing with societal problems.