YOU are at home awaiting the arrival of the person on whom you feel your life depends. The person is very late. You try to watch TV but can鈥檛 concentrate. You move from chair to window, from window to door. You make phone calls, check diaries, traffic news. A friend phones to chat, and you rudely tell them to hang up. The line must be kept clear.
You are exhibiting hyperactivity, impulsiveness, distractability and emotional lability (instability and changeability). A psychiatrist with no context for your behaviour might say you have been stricken with attention deficit hyperactivity disorder, because the symptoms of ADHD look the same as the symptoms of fear. You, on the other hand, just feel afraid. Fortunately, as an adult, you articulate the reasons for your fear, and if the psychiatrist has any sense she or he abandons the diagnosis and pours you a stiff drink.
ADHD is not a diagnosis most mature adults face. Children, on the other hand, are being diagnosed with it in their millions. In the US nearly 4 million people, mostly children and young adults, are being prescribed amphetamine-like drugs for ADHD (New 杏吧原创, 1 April 2006, p 8). The number of children diagnosed with bipolar disorder has also risen astronomically, according to child psychiatrist Gabrielle Carlson and colleague Joseph Blader at Stony Brook University, New York. They say that while in 1996 just 13 out of every 100,000 children in the US were diagnosed with bipolar disorder, by 2004 the figure had leapt more than fivefold to 73 in 100,000. They also showed that of children diagnosed with a psychiatric condition in 1996, 1 in 10 were bipolar, compared with 4 out of 10 in 2004 (New 杏吧原创, 19 May, p 6).
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Now here鈥檚 a thing. Among the symptoms of bipolar disorder are hyperactivity, irritability (not getting your own way), psychosis (grandiosity/inflated self-esteem), sleep (lack of), elation (expansive mood) and rapid speech. These symptoms are an exaggeration of ADHD. The young patients are very afraid.
In dealing with fear, we tend to follow one of two patterns. Some of us go quiet: we try to keep emotions under control, to think about what鈥檚 happening and form a plan for dealing with the fear. That plan might not be realistic or sensible, but it鈥檚 a way of trying to control things. The rest of us use action to deal with our fear.
Movie and TV duos often feature a thinker and an action man 鈥� say, Spock and Captain Kirk 鈥� who work effectively together. When the fear becomes serious, Spock retreats into his private world, while Kirk becomes increasingly and less usefully active. Spock might not always approve of his thoughts and feelings, but he is not afraid to go into this inner world. Kirk claims to value his emotions, but in fact is only prepared to acknowledge those he finds admirable. He denies fears, hatreds, jealousies, resentments because he fears them. He tries to outrun his inner world by being busier and busier, but of course he fails.
Few of the psychiatrists who hand out diagnoses of ADHD or bipolar have had long, detailed conversations with the children. More likely, their decisions were based on the children鈥檚 behaviour in the consulting room, or described by parents and teachers.
There is another reason why doctors fail to see that these are the symptoms of great fear. Like adults, children fear many things, but one thing all children fear is adults. There is a vast body of literature on the effects of adults on children for good or ill: it is summarised in Psychopathology and the Family, edited by Jennifer Hudson, and Ron Rapee of Macquarie University in New South Wales, Australia.
We all have the power to hurt a child, and many of us do. Even loving parents and kind teachers know they may inadvertently frighten a child. If a child continues being afraid, she or he won鈥檛 function normally, learn, or be happy. The people responsible for that child鈥檚 welfare won鈥檛 be doing their job properly if they don鈥檛 reassure them.
鈥淓ven loving parents and kind teachers know they may inadvertently frighten a child鈥�
In saying this I have broken a powerful rule: namely, that parents and those in loco parentis must not be criticised. If a child behaves badly, the child is at fault. If she or he can鈥檛 be regarded as naughty and be punished, she or he must be mad, and the madness treated with drugs, the effects of which on the developing brain are still largely unknown. Blaming and punishing the child is also a ubiquitous cultural practice. In her book Thou Shalt Not Be Aware, the psychoanalyst Alice Miller noted that the Bible has stories of children sacrificing themselves for their parents, but none of parents sacrificing themselves for their child.
Diagnosing children with ADHD or bipolar disorder requires collusion. Parents and doctors must agree the fault is in the child. So parents fail to mention their own economic, social or personal problems, or underplay them, while doctors don鈥檛 ask because they lack the skills and resources to help the parents. Thus parents can go on believing they are good parents faced with an inherently flawed child, and doctors that they are good doctors. The child continues to be afraid.
