The podcast: Listen to the podcast here at the audio file below. (Links to Stitcher and iTunes are at the end of this post).
Matthew Smith is Professor of Health History within the Centre for the Social History of Healthcare. He is Vice Dean Research for the Faculty of Humanities and Social Sciences at the University of Strathclyde. He has written many books about the history of medicine, including two about ADHD and Another Person’s Poison: A History of Food Allergy –as well as co-editing the 2016 collection: Deinstitutionalisation and After: Post-War Psychiatry in the Western World (2016).
Audio note: There are a couple of minor dropouts/patchups in the beginning of the interview, but it clears up then for the rest of the interview.
Matthew Smith is an expert on the history of the ADHD diagnosis, which emerged out of the late 1950s, when researchers broadened this area of diagnosis and Americans were living in the era of the Sputnik satellites and the attendant anxiety around the “space race.” This, along with demographic and economic changes, all had a significant impact on education policy priorities in the US. Shifts in the field of child psychiatry and in psychopharmacology also played a big role.
Classroom environments changed dramatically in the 1950s. Kids had to adapt to these changes; some could and some could not. All of these factors came together to create the perfect storm for an “ADHD epidemic,” a further diagnostic expansion and an uptick in prescription for Ritalin and like drugs.
Matthew talks about the trajectory of the ADHD diagnosis in the last half of the 20th century and shifts in child psychology as well as Ritalin marketing and sales. We also discuss the impact of society’s responses to ADHD in kids, as well as the problem of teaching to the test and the current use of ADHD drugs for performance-enhancement or as an “easy fix” replacement for meaningful inclusion. As Matt says: “The knee jerk reaction is to consider that it’s the child that’s wrong and is at fault for whatever reason — ‘something in their brain is not firing correctly’– and we turn to drugs. And I think one very simple change that I would like to see is if we saw Ritalin as the last resort, rather than the first resort.”
I also ask Matt about a program he is involved in: a pilot project in Musselburgh, Scotland where many children had been receiving the ADHD diagnosis. The school principal there chose to “change the ethos in the school” and commit to an inclusion-based model. They modified the school to be inclusive, with a series of 10 projects that the students take on, none of which cost much to do and all of which were sustainable.
As Matt notes: “It [isn’t] a whole bunch of intensive interventions. These were actually quite simple things that the school took on board to make considerable difference”. At the school, children are being taught with more hands-on learning (including producing a podcast series!) As well, the school undertook a popular new program in Scottish schools called the Daily Mile, where kids get more physical play time and breaks. The EAs also took on a radical new role (Listen to learn more about the pilot project!).
As a result of all of these changes, “the school saw a real reduction in referrals to psychiatric services as well as academic improvement.”
Hyperactivity and authoritarianism
While preparing for the interview, I thought about some of the works I had first read about the subject, by the poets Henry Rollins and Jello Biafra. Both Rollins and Biafra identified an authoritarian undercurrent to the hyperactive diagnosis and the use of Ritalin on kids as a form of social control. Biafra summarizes this in the song Hyperactive Child, in which an adult trying to drug a hyperactive child repeats the phrase “wouldn’t you rather be happy?” It’s the perfect leitmotif for the gaslighting at the core of authoritarianism. The lie that conforming and complying at all costs will make you happy –when conformity and compliance are really only making one entity happy: the authority or authoritarian institution. Pledge allegiance to our flag, now you will obey.
That song was written at the height of the cold war: we managed to survive it, but where are we at now? With new world war threats–this time propelled by climate change–the uptick in patriotism and the cultural anxieties have a new hue. We’ve got a bigger problem now. What new forms of social control does our current political environment engender? What’s happening to the kids in all this?
It is always fair–and vitally important–to place the ADHD diagnosis and others like it (as well as the attendant “interventions”) within a cultural context. What is wonderful about the Musselburgh project–and others like it–is that by knowing the history, they transcend some of the bias to get a clearer look at the little people who stand before them. Kids who want to move, kids who want to do. How can we accommodate or facilitate that? And what can we all learn in the process of doing so?
Professor Smith’s blog on Psychology Today
Professor Smith’s book, Hyperactive, The Controversial History of ADHD
New York Times series about ADHD drugs in America