ADHD: Medicate or Meditate?

Some years ago, I was working with a colleague on a crisis management audit of a Michigan hospital. As often happens in the course of conducting research, we discovered something we weren't looking for. The head of the Neonatal Intensive Care Unit told us that the county of Grand Rapids had the highest per capita usage of Ritalin in the country. I was surprised ... and curious. What was it about the Grand Rapids area that would account for such widespread use of a drug to treat ADHD? Did they really have more hyperactive kids than anywhere else in the US? Or was there some other factor at play here?

In the course of interviewing other doctors, nurses, and staff at the hospital, the likely answer became clear: it was the influence of their religion, Dutch Reformed Church, which has a large following in the area. Folks of this faith place a high value on harmony, order, and everyone getting along peaceably. They do not like conflict, confrontation, and disharmony.

The answer to why so many parents medicate their children was the same answer as to why this Grand Rapids hospital was rarely sued in cases of "poor patient outcomes" (ie, amputating the wrong leg, medication mistakes, mastectomy on the wrong breast, etc). If a doctor made a medical mistake, the patient's family practiced forbearance and forgiveness – they said "doctors are only human and they sometimes make mistakes." Patients and families did not pick up the phone and call malpractice attorneys. The good folks of Grand Rapids did not want conflict with their doctors ... any more than they wanted conflict with their children.

In this Midwestern community, people's religious beliefs determined their social values – forming the paradigm through which they viewed interpersonal behavior. Nothing unusual in that. Religious values always exert significant influence on how we define social problems and how we respond to difficult, annoying, and/or hurtful actions of others. Sociology has revealed the profound influence of religion on human behavior since the founding of the discipline in the late 19th century. Even today, with the influence of mainline churches in decline, many originally religious values are now secularized into generally cultural values.

It didn't surprise me that the good people of Grand Rapids didn't sue their doctors for malpractice when mistakes are made. But it did surprise me that they viewed their children's behavior as so problematic as to require pharmaceutical remedy. However, in reflecting on what I had learned about the religious and social values of the Dutch Christian Reform tradition, it began to make sense. If you believe that everyone should "go along to get along" – and you place a high value on social harmony – then anyone who demonstrates poor impulse control, has an inability to focus attention for very long, and behaves in an unruly manner is seen as having a behavior problem that needs a solution. Doctors and families concur that it must be a medical problem – requiring a medical solution.

About ten years after working on this hospital project in Michigan, I had the opportunity to look at human behavior through the paradigm of a different religion – Buddhism. I was reading Buddha's teachings in preparation for a business book I planned to write, my first foray into Eastern wisdom. As I read, I was struck with the accuracy of his insights into human nature. Everything he described I could verify in my own experience and that of the people around me. I recall thinking, “Human nature hasn't changed much in the 2500 years since Buddha's time!" Craving and desire, the nature of suffering, the impermanence of all things – these core teachings and many more had me nodding in agreement as I turned the pages of ancient texts. Buddha was the smartest psychologist I've ever read!

Buddha saw himself not as a god or a savior, but rather as a physician who dispensed "medicine" in the form of wisdom to help people alleviate their own pain. He didn't heal anyone – he made it clear that we are each responsible for our own healing. He pointed the way to the path of enlightenment – freedom from suffering – but he emphasized that you have to walk the path yourself.

One of the most helpful of Buddha's teachings was that of "monkey mind." He explained how the human mind is active, noisy, busy, and easily distracted – as though filled with a bunch of "drunken monkeys" all screeching, jumping around, clamoring for attention. This is normal, not abnormal. We all have voices in our heads, 24/7. Some people call it "the committee." Others call it ADHD. Buddha would say that it doesn't matter what you call it – those impulses, those nonstop thoughts and feelings darting through your consciousness – everybody has them and everybody has to live with them.

“Ah, that explains it," I thought to myself. "I've got a monkey mind ... and so does everyone else. It's just a normal, active human mind." I learned that my task is not to drug the monkeys, but to accept them, work with them, and gently tame them so that they serve me instead of causing me problems. Understanding the true nature of my monkey mind – and the nature of my child's monkey mind – proved to be a very helpful understanding of human nature.

Of course, we each get to choose the paradigm through which we view the world and our lives within that world. Some prefer a Western medical paradigm, while others prefer an Eastern wisdom paradigm. Still others choose to have a foot in both Western and Eastern traditions. We each have the freedom to come to our own understanding of the nature of our experience and existence.

But I do have serious concerns about the skyrocketing use of Ritalin and other behavioral modification medications by American families. Labeling kids can damage their self-image for a lifetime – leaving them thinking of themselves as "defective," "broken," "sick" and incapable of succeeding in life. In addition, labeling a kid as having ADHD can give him an excuse for acting out. ("I can't help my behavior ... I'm sick.")

Equally worrisome is the implicit message that we convey to kids by medicating their behavior: Interpersonal problems can be solved simply by popping pills. This message sets a dangerous precedent in the minds of impressionable youngsters: "When the going gets tough, take medication."

Experts estimate that one out of every ten 10-year-old boys takes an ADHD drug daily. But I find it encouraging that some Western psychiatrists are beginning to question the accuracy of their own medical paradigm. Dr. Leon Eisenberg, the distinguished Boston psychiatrist widely credited as the scientific "father of ADHD" acknowledged in a 2009 interview that he was concerned at the widespread over-diagnosis of ADHD, "... a fabricated disorder. The genetic predisposition to ADHD is completely overrated."

Harvard psychologist Dr. Jerome Kagan, in a 2012 interview in the German magazine Der Spiegel, concurs, stating ADHD “ ... is an invention. Every child who's not doing well in school is sent to see a pediatrician, and the pediatrician says, 'It's ADHD; here's Ritalin.' In fact, 90 percent of these 5.4 million kids (displaying symptoms of ADHD) don't have an abnormal dopamine metabolism. The problem is, if a drug is available to doctors, they'll make a corresponding diagnosis."

I am a single mother who raised an active, curious, adventurous boy, so I understand the frustrations of parenting and the search for a effective solution to a child's behavioral problems. My boy made his share of trips to the school principal's office ... and later to traffic court. I hated it when he got into trouble. There were plenty of times I felt at my wit's end, desperately wishing my son would "just behave."

But deep down inside I knew that he was just a normal kid engaging in normal kid behavior. “It's just a phase," I would tell myself. "It'll pass." And I understood that I was a normal mom, too – experiencing all the stresses and strains of trying to be a good parent in a complex, difficult world. Dealing with my own monkey mind was challenging enough. Dealing with my son's monkey mind was one of the hardest things I've ever done.

We would do well – as a society and as individuals – to look beyond the customary Western medical paradigm and seek out wisdom from other quarters. Perhaps our children are better served by practicing meditation, the cultivation of mindfulness, or the slow development of personal discipline in yoga, the martial arts, and other Eastern practices than by reaching for a bottle of pills.

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