The Normalization of Productivity: A Philosophical Investigation into the Proliferation of ADHD and Stimulant Drugs

7/30/2019 The Normalization of Productivity: A Philosophical Investigation into the Proliferation of ADHD and Stimulant Drugs

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The Normalization of Productivity:

A Philosophical Investigation into the

Proliferation of ADHD and Stimulant Drugs

By: William Adamowicz

Advisor: Professor Michael Kelly

In Partial fulfillment of the Perspectives Honors Sequence


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Table of Contents:

I. Introduction.......................................................................................................... 3II. Postmodern Power............................................................................................... 5III. What is ADHD? ................................................................................................ 10IV. The Birth of Normality...................................................................................... 17V. The Power of Seeing.......................................................................................... 25VI. The Rise of Production...................................................................................... 33VII. ADHD and Capitalism....................................................................................... 40VIII.

America in the World......................................................................................... 45

IX. A New Framework............................................................................................. 54


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I - Introduction

In order to understand the proliferation of attention-deficit hyperactivity disorder

(ADHD) and stimulant drugs, one must examine how complex relations of knowledge

and power manifest themselves in modern capitalist society. While it is possible to

independently frame the current debates surrounding ADHD, contextualizing them in

relation to Michel Foucaults general critique of modernity will allow us to understand

the ADHD construct in a more profound way. At the same time, such an approach will

reciprocally contextualize Foucaults work within contemporary society, thereby

providing us with an empirical basis upon which one can understand his complex and, at

times, abstract descriptions of how knowledge-power relations actualize themselves.

Largely drawing on Foucaults body of work as well as the latest medical

research, this investigation will elucidate the various disagreements within the ongoing

debates regarding the pharmacology and pathology of ADHD. The purpose of clarifying

these debates is twofold. Firstly, it will reveal that most of the controversy surrounding

ADHD is precipitated by moralized judgments that are both relative and specific to

contemporary society. Specific because they are contingent upon the contemporary

power relations in America; and relative because they are created by patterns of thought

that only arise from the knowledge produced by modern capitalist power relations.

Secondly, the clarification of these debates will allow for a prognosis of how ADHD and

stimulant drug use will be viewed in future generations, both in the US and on a more

global scale.

As it stands, ADHD is a highly controversial and, at times, taboo subject. The

debates range anywhere from: disagreements about the medical legitimacy of the


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condition, the ethics of using stimulants for educational gains, and the cultural

implications of its highly endemic proliferation in the United States. These debates are

largely the product of an amalgamation of ways of thinking that are produced by the

current knowledge-power relations. At the most basic level, the currently established

framework is grounded in a duality between abnormality and normality. It propounds a

belief that individuals with personality types that diverge from established social

normsor deviantsare abnormal in the sense that they cannot function within society

without some form of intervention. From a sociocultural perspective, the current

framework is also grounded in a belief that normality entails productivity. In modern

America, unproductive personalities are not only undesirable due to their comparatively

limited potential for social and material success, but are also considered anomalies that

can be remedied through medical treatmentmore specifically, through the

prescription of stimulant drugs.

Given that the current understanding of ADHD is responsible for these manifold

debates, an investigation of the arguments within the ongoing disagreements will reveal

that most of the controversy is derived from moralized judgments that are both

theoretically and empirically avoidable. By exposing these complications within the

context of Foucaults critique, one may arrive at a more comprehensive understanding of

this condition. Such an investigation will potentially provide an explanation for why the

proliferation of ADHD and stimulant drug use is so highly endemic to the US, thereby

allowing for a more accurate prognosis of the pharmacology and pathology of this

condition in years to come.


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II - Postmodern Power

The term modernity is not merely a description of how an event or a

phenomenon is temporally situated. It is also contingent upon an understanding of the

symbolic departure from classical or traditional thought, and a movement towards the

thought of contemporary society. What ispostmodern, therefore, represents a departure

away from contemporary thought. When we think of power in the modern age, one might

look to the large corporations as the epitome of a new manifestation of power that did not

exist in the classical age. Yet for Foucault, such a form of power is still measured in

relation to the traditional conception of power. What Foucault is primarily interested in is

an entirely conception of power that actualizes itself through new techniques. Postmodern

power, therefore, is different from the modern power of corporations, which are still

examples of traditional power in the modern age. For Foucault, postmodern power is a

modern form of power that is not symbolic of contemporary thought, it is an altogether

new understanding of power that bears no relation to traditional power in terms of how it

actualizes itselfit differs from traditional power in three fundamental ways: it is

ubiquitous, invisible, and inclusive.

On the first point, Foucault understands postmodern powers ubiquity in relation

to Jeremy Benthams panopticon. In Benthams panoptic prison system, the cells are

organized in a cylindrical structure with a guard tower in the center, whereby the

prisoners in the cells can never know whether they are being watched by the guards. On

the surface, Foucaults analysis of the panopticon is meant to illustrate how observation is

a technique through which postmodern power exercises itself, but the analogy primarily

serves to illustrate how the guards and the prisoners are both subject to the disciplinary


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power of the system that they are part of. In other words, while Foucault grants the notion

of power as a nonegalitarian force, he deviates from the traditional conception of power

as a force that is held to dominate a particular group from a strictly top-down

relationship; rather, Foucault claims that power is multidirectional, that it is a general

matrix of relations at a given time wherein power is exercised upon the dominant as well

as the dominated (Dreyfus & Rabinow, 1983, p.185). In the panopticon, Foucault claims

that the guards may think that they are in control and, therefore, in the possession of

power, yet Foucault contends that power is not something that is held. In fact, just as

corporations are shaped by the exercise of postmodern power, the guards may feel that

they are the oppressors, yet they are invisibly oppressed by the control of the prison

system that they are a part of. Inherent to this conception of postmodern power is the

notion that we are all subject to this form of coercion, the source of which is an invisible

sovereign that is inherent to the modern capitalist system.

This brings us to the conception of power as an invisible exercise of oppression.

The invisible manifestation of postmodern power is precisely the reason why the

oppressor is unable to see that he is oppressed. Foucault claims: Traditionally, power

was what was seen, what was shown, and what was manifested and, paradoxically, found

the principle of its force in the movement by which it deployed that force (Foucault,

1991, p.199). Unlike traditional power, our modern form of power is unseen. Through

various techniques, which I will elaborate on in the context of the medical discipline

viz., hierarchization, examination, and normalizationpostmodern power is exercised

through its invisibility. This dimension is closely related to the implication that there is

this aforementioned third party, the invisible sovereign, driving the exercise of


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postmodern power. These invisible techniques, finally, bring us to the third dimension of

power that I will discuss: inclusivity.

Foucaults thesis identifies the trends towards normalization not as an incidental

byproduct of modernity, but as a deliberate effort to control the population through this

new form of power. For Foucault, postmodern power is not an instrument of exclusion,

but a pervasive pressure towards ever greater inclusion. It does not serve to objectify,

exclude, coerce or punish, but rather to order and enhance life (Dreyfus, 2004).

Although power is typically regarded as a violent force, Foucaults understanding of

normalization as the oppressive force in postmodern power seems comparatively tame.

But it is precisely this unintuitive aspect of his conception of power that serves to

illustrate how the oppression of power in modernity is clandestine. In modern America,

the process of normalization is a leveling force that shapes individuals in order to make

them fit within the culturally accepted behaviors of society. The modern capitalist agenda

is one that seeks to organize the population through a coercive exercise of normalization,

which, in turn, enhances life by making individuals more productive.

Lastly, we must understand that postmodern power is not an institution, and not

a structure; neither is it a certain strength we are endowed with; it is the name that one

attributes to a complex strategical situation in a particular society (Dreyfus, 2004). In

order to arrive at a conception of power that will help us understand the current ADHD

construct, one must examine the strategical relations of knowledge and power not as a

way to arrive a specific definition of power, but as a way to analyze these relationships

and uncover how postmodern power manifests itself. This is precisely why the aim, for


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Foucault, is to move less toward a theory of power and toward a determination of the

instruments that will make possible its analysis (Dreyfus & Rabinow, 1983, p.185).

Through an investigation of ADHD, Foucaults analysis will come to life. While

it is difficult to grasp Foucaults conception of power in the abstractwithout seeing

exactly how it actualizes itself in the real worldthe current ADHD construct provides

us with a canvas upon which Foucault philosophy can be grounded with empirical

observation. By analyzing these phenomena in tandem with Foucaults schema of

postmodern power, we may begin to see that the proliferation of ADHD and stimulant

drugs is not only a model example of how such power manifests itself within society, but

is also the most advanced example to this day. While Foucault identifies institutions and

disciplines that exercise power in order to breed productivity and normalize individuals,

the ADHD construct has gone a step further: it has created an internal drive for

productivity and a framework wherein individuals are not passively normalized, but seek

out normalization of their own accord.

First, I will endeavor to draw out a basic genealogy of ADHD and trace out how

the modern conception of the disorder has come into being. I will then discuss the

changing conceptions of normality and productivity in the modern age in relation to the

development of the medical discipline. I will examine these developments in relation to

the ADHD construct by drawing a parallel to Foucaults understanding of postmodern

power as an inherent aspect of the rise of modern capitalist society. Finally, I will situate

the proliferation of ADHD and stimulant drugs within the discussion of what defines the

modern capitalist agenda in order to understand why the ADHD construct is endemic to

the US. The discussion will end with a prognosis of how the condition may be considered


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through a new framework in the years to come, and whether its proliferation will remain

circumscribed to the US, or if it will spread to other countries as well.


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III - What is ADHD?

The authority on mental disorders, the American Psychiatric Association (APA)

classifies ADHD in the Diagnostic and Statistical Manual of Mental Disorders, Fourth

Edition (DSM-IV), as a: Persistent pattern of inattention and/or hyperactivity-

impulsivity that is more frequently displayed and is more severe than is typically

observed in individuals at comparable level of development (APA, 2000). The DSM-IV

provides a list of nine symptoms for inattention:

(a)often fails to give close attention to details or makes careless mistakes inschoolwork, work or other activities

(b)often has difficulty sustaining attention in tasks or play activity(c)often does not seem to listen when spoken to directly

(d)often does not follow through on instructions and fails to finish schoolwork,chores or duties in the workplace (not due to oppositional behavior or failure to

understand instructions)(e)often has difficulty organizing tasks and activities(f) often avoids, dislikes, or is reluctant to engage in tasks that require sustained

mental effort (such as schoolwork or homework)

(g)often looses things necessary for tasks or activities (e.g., toys, school assignments,pencils, books or tools)

(h)is often easily distracted by extraneous stimuli(i) is often forgetful in daily activities

and nine symptoms for hyperactivity-impulsivity:

(a)often fidgets with hands or feet or squirms in seat(b)often leaves seat in classroom or in other situations in which remaining seated is

expected

(c)often runs about or climbs excessively in situations in which it is inappropriate (inadolescents or adults, may be limited to subjective feelings of restlessness)

(d)often has difficulty playing or engaging in leisure activities quietly(e) is often on the go or often acts as if driven by a motor(f) often talks excessively(g)often blurts out answers before questions have been completed(h)often has difficulty awaiting turn(i) often interrupts or intrudes on others (e.g., butts into conversations or games)

It then divides ADHD into three subtypes: (1) Combined Type; (2) Predominantly

Inattentive Type; (3) Predominantly Hyperactive-Impulsive Type. Those who meet six or


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more criteria within the list of symptoms for inattention are classified as type (2)

Inattentive, those who meet six or more for hyperactivity-impulsivity are classified as

type (3) Hyperactive-Impulsive, and those who meet six within both categories are

classified as type (1) Combined.

If we examine the criteria for this current definition of ADHD more closely, we

can see that the diagnosis is in fact socially relative. In other words, the diagnosis of

ADHD depends on behaviors that are more frequently displayed and more severe

than is typically observed; accordingly, it is classified as a behavioral disorder (APA,

2000). Although many conditions in the DSM depend on symptoms that are relative to

socially accepted norms, it is important to note that such a category of disorders contains

an inherent value judgment. In other words, the behaviors described by the symptoms

that are higher than average, in this case, inattention and/or hyperactivity-impulsivity,

are socially and medically regarded as undesirable qualities. While the symptoms

described above do not necessitate medical attention in the way that a physical ailment

might, they have been medicalized by both the medical discipline and society.

The categorization of the ADHD subject as an individual that demands medical

attention, therefore, directly implies that the values of modern American society reflect a

judgment that impulsive and inattentive behaviors are not merely able to be changed, but

that they oughtto be corrected. This value judgment contained within the categorization

of ADHD as a behavioral disorder not only denotes a societal belief that impulsive and

inattentive personalities are undesirable, but also contains a belief that the behavior of the

corrected individual reflects the norm. In other words, it would be ridiculous to assume

that if it were not 16%, but 84% of the population exhibiting symptoms of persistent


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inattention, that there would then be a condition known as attention-surplus disorder. We

must necessarily understand the importance of the relation of the norm to the ADHD

subject. In the case of a newly discovered physical disorder, there is no judgment that

needs to take place; the minority of individuals affected by a physical ailment will seek

out medical attention on the basis that they do not reflect the norm of how a healthy

human being ought to function. In the case of ADHD we do not find a minority that seeks

out medical attention, but a majority that defines the norm in relation to its own

personality, and thereby imposes a belief that any deviations from this personality are

undesirable, abnormal, and correctable. Should its diagnostic growth carry on at a similar

rate, though, one would hope that these questions are addressed before ADHD prevalence

reaches an integrity-threatening 50%. These are, quite clearly, purely speculative

remarks, but their intention is to illustrate that ADHD, according to its definition,

depends both on a majority that exhibits a pattern of symptoms, as well as a general

opinion that the symptoms of inattention and hyperactivity-impulsivity are undesirable.

Yet this was not always the case.

It is widely accepted by historians of ADHD (e.g. Lange, Reichl, & Tucha 2010;

Advokat, Baumeister, Henderson, & Pow, 2012) that a Scottish physician named

Alexander Crichton first identified the condition in his work titled,An Inquiry into the

Nature and Origins of Mental Derangement(1798). His early diagnosis, albeit

surprisingly accurate in arriving at the modern conception of ADHD, described subjects

who suffered damage in areas of the brain responsible for the faculty and the power of

attention (Crichton, 1798). Although many scholars point to this text as the first example

of symptoms of ADHD being described in a medical discourse, Crichtons agenda was


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purely observational; it did not seek out to remedy individuals who exhibited an unusual

lack of attention. In describing a deficiency in the faculty of attention, Crichton makes

no mention of rectifying his subjects. In the modern discourse, however, ADHD is

labeled as a behavioral disorder; it deals not with the observation of brain damage, but

with the treatment of social behavior. According to the APA, an emotional or behavioral

disorder (EBD) is diagnosed according to: A behavioral or psychological syndrome

or pattern that occurs in an individual which is the first of five categorization of what

can constitute a mental disorder. Our modern understanding of ADHD contains the

inherent notion that behavior can and should be modified in subjects that exhibit these

symptoms. This distinction primarily separates Crichtons reflections from the concept

that behaviors can be medically treated.

Thus, ADHD did not begin with the observation of inattention, it progressed to it

only by way of attempting to remedy the hyperactive-impulsive personalities, which itself

was only recently considered as a category of individuals that can and should be

remedied for the betterment of society. In fact, while there is a long tradition of treating

children with particularly high levels of hyperactivity, it is only until very recently that

high levels of inattention have also constituted the need for medical intervention. One

must, therefore, turn to the causes for behavioral control of individuals with hyperactive-

impulsive tendencies in order to account for the shift in medical knowledge from a purely

observational science to a discipline that can remedy unwanted personality types.

It was only until the 20th

century that the denomination of deviant was attributed

to individual who exhibited such socially obtrusive behaviors. As society recognized that

there may be a way to correct, and not merely confine these individuals, the problem of


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deviants captured the attention of the medical community. As Edward J. Comstock notes

in his genealogy of the ADHD subject, George F. Stills Defect of Moral Control

(1902) may be considered the first identifiable work that proposed medical intervention

for hyperactive personalities. From the title itself, one can see that Stills account to

correct deviant social behavior inherently contains a dimension of judgment. Still referred

to his subjects as moral idiots, all of whom were children who had committed actual

crimes or habitually transgressed clear moral boundaries, exhibiting reckless disregard

for command and authority (Comstock, 2011). Although Stills subjectssome being

criminalswere far more problematic to the well-being of society, his account represents

the first initiative to medically rehabilitate deviant individuals. On the one hand, the

criminal and the deviant can be differentiated by the fact that the former reflects a

transgression of the law, while the latter reflects a transgression of social norms. On the

other hand, while this distinction is important in considering Stills study in the modern

context, we find that criminalitys dependence on the legal system makes it relative in the

same way that deviant behavior is purely relative to what is considered socially accepted

and desirable behavior. On the surface, it would seem that these behaviors are

differentiated by the fact that criminality entails a transgression of a written law. Yet if

we consider the behavior of a deviant child in a classroom, we find that the childs

transgression of the rule that delineates proper classroom conduct in the schools

handbook is analogous to the criminals transgression of the law. While the criminal

transgressor may not be analogous to the modern ADHD subject in terms of the severity

of the transgression, it is important to see how Stills study laid the foundations for an


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understanding of scientific study as a method for changing social norms by moralizing

unwanted behaviors and equating them with criminality.

While Stills attempt provides us with an account of how medical knowledge

changed in its self-estimation as a field that could uncover the primary causes for certain

behaviors, it relies on a moralized premise. The proliferation of ADHD, in the modern

context, was only enabled through a shift from the deviant subject being viewed as a

morally or legally reprehensible individual to the deviant subject being viewed as an

abnormal individual. Thus, Stills account can only be considered quasi-scientific in

modern medical discourse; no modern scientific journal would seriously consider Stills

study on the basis that it explicitly states its intentions as an examination of moral

control. Yet when we consider how the diagnostic criteria for ADHD are moralized in the

sense that they inherently consider hyperactive-impulsive and inattentive behaviors as

abnormalities, we can see how the medical discipline, since Stills time, has learned to

hide such moral judgments behind a veil of objectivity. While the modern medical

discipline does its very best to stay away from any mention of morality, one should not

be so nave as to assume that it is devoid of moral judgment. The fundamental difference

between Stills description and that of the latest version of the DSM, therefore, is merely

the fact that the former describes the ADHD subject as an individual that exhibits a lack

of moral control, while the latter places the subject within the abnormal category. For this

change to a occur, a new concept had to be introduced within the medical discourse,

which would treat deviant subjects not as morally devoid individuals, but as exceptions to

the rule: It was no longer the offence, the attack on the common interest, it was the

departure from the norm, the anomaly; it was this that haunted the school, the court, the


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asylum or the prison (Foucault,1991). This shift to the concept of normality would allow

society to moralize deviants without dismissing them as incorrigible cases, to use

Stills language, but rather, as anomalies. The deviant child was no longer primarily

considered a problem to his peers. He became, above all, a problem to himself; one that

could potentially affect society in a negative way; and one that, finally, could and should

be reeducated and rehabilitated.

Normality does not merely represent a lexical change. It was a new concept that

restructured the medical discipline by making it the voice that defines the identity of the

normal individual and a force that can shape a societys understanding of itself.

Normality was not a concept that previously existed and was simply ignored in the

medical field. It was a new form of measurement and estimation that would change the

way in which humans situate themselves in society, thereby fundamentally undermining

their own knowledge; it transferred the power of self-estimation from society to particular

disciplines. While the conceptualization of the norm has fully integrated itself into the

modern discourse, it bears a disconcertingly unshakable aspect of relativity. For what

does it truly mean to be normal? Is it purely a relative measure, one that has no

inherent meaning? To answer these questions, one must trace the development of the

medical discipline as a body that has redefined social norms by shifting the structure of

knowledge in modern America.


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IV - The Birth of Normality

In any civilization, cultural practices reflect a degree of truth, yet the source of

their legitimacy greatly differs. For the Aztecs, the practice of human sacrifice reflected a

belief in their religion, legitimized by the priest. In contrast, for the Japanese kamikaze

bombers during World War II, the practice of human sacrifice reflected a belief in the

principles of nationalism, legitimized by the emperor. In the case of modern medicine,

the practice of seeking medical assistance reflects a belief in medicine itself, legitimized

by the doctor. What is interesting about the case of modern medicine is that it underwent

a radical transformation with the advent of psychiatry. The practice of seeking medical

assistance was transformed on the basis that the notion of the medical condition was

changing from the visible to the invisible. In other words, medical assistance no longer

merely applied to the remedying of physical ailments; it became a way to evaluate

conditions through the observation of deviant social behaviors that are caused by

dysfunction in the mind. Although the practice of seeking medical assistance changed,

the belief in medicine and the legitimization of the doctor remained. In fact, the advent of

psychiatry gave the medical profession a newfound dimension of power by enabling the

reintegration of individuals who deviate from the norms of society.

It is important to note that this change did not come about fortuitously. The

advent of the medical clinic in the 19th

century, as a space where patients also became the

objects of research for medical students, forever changed the doctor-patient relationship.

This change occurred through a clearly identifiable progression. First, as the medical

clinic develops into a space that educates the young in order to produce more efficient

doctors, it gains a dimension of organization that inherently breeds rank and competition.


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In turn, the organization of the medical discipline and the development of the clinic

changes the way medicine is societally perceived, most prominently, by giving the doctor

an unprecedented degree of legitimacy.

Foucault identifies the root of this transformation as a need for qualification.

When the medical field gained momentum in France during the 17th

century, the

government decided that certain measures had to be taken against malpractice. These

medical reforms, i.e., Cabanis Intervention marked a stage at which ideology was to

take an active, and often determining part in political and social restructuring (Foucault

1973, p. 78). As the need for qualification developed, the medical discipline became

more organized and efficient. One need only look at the medical profession today in

order to see how the qualifications of rank and competition have flourished within this

highly structured discipline. The medical students who get the highest MCAT scores are

allowed to choose the best medical schools. Those who get the highest scores on their

medical exams may then choose the best hospitals to do their rotations. They are

provided the best resources to treat their patients and may perhaps, one day, establish a

practice of their own. In turn, this develops into a hierarchy on the side of the patients; in

other words, the individuals who have the best access and the greatest economic means

notwithstanding the power of having connections are able to see the most qualified

professionals, conveniently ranked for them by the latest issue of: The Best Doctors in

America.1 While the medical discipline is epitomic of the processes of hierarchization

and examination, it is only one example of a process that was by no means specific to

medicine; in fact, it reflects a broader movement in contemporary society as a whole.

1Yearly publication founded in 1989 by the Harvard Medical School: http://www.bestdoctors.com/about-

best-doctors


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One need only look at the educational system in general to see the extent to which

it is structured so as to differentiate and judge individuals based on performance. These

processes give disciplines and institutions a certain degree of fluidity in the

implementation of systematic procedures, thereby enhancing productivity. More

importantly, with the establishment of the examination and the entire system of writing

that accompanies it, every discipline is able to compare individuals by measuring their

abilities according to a particular standardto a particular norm. By the middle of the

nineteenth century, the normal is established as a principle of coercion in teaching with

the introduction of a standardized education and the establishment of the cole

normales2(Foucault, 1991, p. 196). While it may seem overly polemic to describe the

concept of normality as a principle of coercion, Foucault understands normality as a

means to oppress individuals through classification.

The effort to establish a hierarchical system not only gives the medical discipline

a newfound legitimacy; it fundamentally undermined the power of self-knowledge.

Medical treatment is no longer a question of a difference in the object, or the way in

which the object is manifested, but of a difference of level in the experience of the

knowing subject (Foucault, 1973, p. 81). In objectifying the patient, the medical

discipline shifts the doctor-patient relationship away from mutual understanding and

towards the sovereignty of the medical discipline. The conceptual introduction of the

norm gives the doctor a new dimension of power in the estimation of the patient, and the

doctor acts on behalf of the invisible sovereign power that normalizes society. In other

words, the patient no longer measures her need for medical assistance through self-

2Teachers training colleges


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estimation; she simply provides all the information that would be used to decide whether

she needs treatment, and places the ultimate decision in the hands of the doctor. This

change is a microcosmic example of a broader epistemological shift away from the

Cartesian values that placed self-knowledge at the apex of human understanding during

the Enlightenment. Self-knowledge is gradually undermined in the face of the more

complex and inaccessible knowledge of a body that grows and expands through

collective, disciplinary knowledge.

Despite the fact that we apply the concept of normality systematically in

contemporary society across various disciplines and in everyday language, the

introduction of this term represents much more than an expansion of vocabulary. The

advent of normality as a perspectival change in knowledge, as a new method of self-

understanding, is what places it at the crux of the transformation in medical discourse.

Eighteenth century medicine related much more to health than tonormality; it did not begin by analysing a regular functioning of the

organism and go on to seek where it had deviated, what it was disturbedby, and how it could be brought back into normal working order; it

referred, rather, to qualities of vigour, suppleness, and fluidity, which werelost in illness and which it was the task of medicine to restore

Nineteenth century medicine, on the other hand, was regulated more inaccordance with normality than with health; it formed its concepts and

prescribed its interventions in relation to a standard of functioning.(Foucault, 1973, p. 35)

In terms of power relations, the transformation from health to normality gave the medical

discipline an unquestionable power of estimation. This shift in power was only possible

through the accompanying epistemological shift that led the patient to understand illness

not as measure of ones self-estimation, but as the measure of an organized body that

decides on the individuals behalf whether medical attention is needed.


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With the birth of the medical clinic, the doctor-patient relationship loses its

reciprocity; it was no longer a matter of mutual effort, of the physician working with the

patient to arrive at the goal of healing: It was no longer the gaze of any observer, but

that of a doctor supported and justified by an institution, that of a doctor endowed with

the power of decision and intervention (Foucault, 1973, p. 89). The patient, as the object

of medical examination, no longer has any role in dictating the terms of his recovery;

rather, he is analyzed by a doctor whose sole intention is to bring the patient back to what

is considered normal. With introduction of psychology and its subsequent medicalization,

the patients self-understanding is fundamentally undermined. While a person with a

physical ailment may have a better grasp on her condition than the doctorfor example,

in describing areas of her body that may be causing pain but that have no discernible

injurya subject with a mental ailment is fundamentally undermined by virtue of the fact

that the information she provides is subject to her mental deficiencies. While this is not

necessarily the case, the psychological and psychiatric disciplines are structured in a way

that gives the doctor complete autonomy in the process of diagnosis.

This ideological shift allowed for the possibility of a constantly changing

definition of normal. While the norm as defined in the 19th

century represents physical

suffering, psychiatry circumscribes the normal individual into a progressively tighter

space. With every discovery of a new mental condition, the patient is exposed to an ever-

expanding world of seemingly endless classifications that gradually decreases the

possibility of her being normal. It is this very circumscription that Foucault admonishes

on the basis that it establishes a system that subordinates those who are outside of it. The

creation of the normal type forms a hierarchy between normality and abnormality, which


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thereby denies certain personality types an alternate form of reality. As processes and

behaviors are normalized, Foucault fears that they are not merely considered medical

judgments, but that they become more profoundly engrained within society as natural

truthsas inevitabilities of human existence. Perhaps, humans are predisposed to

transport their own cultural beliefs and practices from their status quo of how things are

into a broader schema of how things ought to be. In any case, the tendency to place

phenomena into this latter category inherently creates artificial conflicts and divisions. Be

that as it may, the more society develops, the more complex and clandestine these

judgments become. While most developed societies would unilaterally agree that it is

irrational to persecute left-handed people on the basis that they are evil because humans

ought to be right-handed, when we discuss whether society ought to correct inattentive

individuals using stimulant drugs, opinions become divided.

The modern conception of ADHD, on the one hand, normalizes the individual by

proclaiming that inattentive and hyperactive-impulsive personalities are abnormal. While

there is a primary concern that inattentive and hyperactive-impulsive personalities are

stripped away the freedom to exist in their uninhibited mental states, the effort to

rehabilitate them is simply the result of their inability to integrate themselves into society.

The more profound concern is that the rest of society will generally accept ADHD

personality types as anomalies, and will believe that qualities such as calmness,

lawfulness, and productivity are not simply ways in which individuals have to behave in

order to be accepted in contemporary society, but that they are ways in which human

beings are naturally meant to be.


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The semantic consequences of the perspectival change in medicine can also be

observed in the etymology of the word physician. The term bears anachronistic

nuances, precisely because traditional medicine related to a concept of medical

professionals as healers of physical ailments. Since then, the term no longer carries the

same weight in everyday language; this is because medicine no longer merely applies to

physical processes. Instead, the term doctor has found its place in our modern discourse.

The root of the word doctor comes from the Latin, docere, to teach. This denominative

change directly reflects the primary designation of the doctor not as a healer but as a

teacheras a member, de jure, of a medical clinic that is designed to educate and

discipline its students. Likewise, the use of the term clinician has broadened its scope to

describe psychologists, thereby reinforcing the professions medical legitimacy. The

psychologist, previously confined within the space of theoretical studies, now retains the

same stature in the clinic as a surgeonnot merely by virtue of her denomination, but

also by that of her influence in the medical discipline.

When we consider ADHD in the modern context, we are faced with the notion of

a behavioral disorder as a list of symptoms that constitute unwanted social behaviors. The

medicalization of social behavior that began with George Stills experiment is now

ingrained within the discourse of modern medicine to the point that behavioral disorders

have become just as important to medicine and to society as physical disorders. They are

both identifiable, in some way; they can both be treated; and they can both be remedied

in many cases. Yet the concept that unwanted patterns of behavior may constitute a

medical condition was only possible once deviant or abnormal behaviors could be

contextualized in the same way as physical ailments. This shift was only made possible


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with the advent of psychiatry; it represented a new way of seeing, a new way of

identifying illness and defining normality, as a result of which the relations of human

knowledge to what is visible and what is invisible would be radically transformed.


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V - The Power of Seeing

The paradoxical nature of the power of normalization is that it imposes

homogeneity by encouraging certain behaviors in terms of a new standard; yet at the

same time, it individualizes by making it possible to measure gaps, to determine

levels [introducing] all the shading of individual differences (Foucault, 1991, p. 197).

Yet the birth of normality not only highlighted minor differences, it also created a new

standarda benchmarkwhich was not previously understood. Inherently tied to the

restructuration of various discipline through the processes of hierarchization and

normalization is a change in what we consider visible.

Aside from the movement towards greater organization and efficiency, the

development of the medical discipline also had the secondary effect of shifting what

Foucault calls the medical gaze. It should be noted that the original French term,

regard, implies both visual gaze, but also the English term, regardas in estimation.

This ambiguity, which is lost in translation, serves to illustrate how the medical

discipline, underwent superficially identifiable changes regarding its increasing

organization, but also made certain things visible in the sense of new ways of

understanding. For example, the process of hierarchization renders qualifications visible

in the first sense of the word: it establishes over individuals a visibility through which

one differentiates and judges them (Foucault, 1991, p. 197). Yet in the second sense, it

also indicates how through the process of hierarchization the medical discipline

underwent broader and more complex changes in perception, both in terms of how

society regards medicine, as well as the way in which medicine regards itself in relation

to society.


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The changes that constitute the reorganization of the medicinal discipline

represent a change in power relations that, in turn, redefined our knowledge. Yet we

should not understand such relations of power and knowledge as causally distinct

phenomena; we should admit, rather, that power produces knowledge; that power and

knowledge directly imply one another; that there is no power relation without the

correlative constitution of a field of knowledge, nor any knowledge that does not

presuppose and constitute at the same time power relations (Foucault, 1991, p. 175). The

power that the medical discipline gained in its discernment and estimation of patients

undermined the previously established framework of the Enlightenment. Self-knowledge,

in the Cartesian tradition, stood at the apex of human understanding, but the changes in

the medical discipline gave the doctor was only possible through an accompanying shift

in the relations of visibility and invisibility in medical gaze. The establishment of the

concept of normality in medicine precisely reflects such a change in what is visible, not

in terms of observation but in terms of conceptual understanding. Likewise, one could

understand the examination in the same sense as a process that makes visible the

shading of individual differences, and thereby changes the way we measure ourselves

and one another.

At the earliest stages, the medicalization of psychoanalysis represents a shift from

the visible to the invisible. Unlike the physician and the surgeon, both of whom are

concerned, above all, with conditions that manifest themselves in visible ways, the

psychoanalyst primordially operates in a domain that is inaccessible to the faculty of

human eyesight. Medical treatment is, thus, no longer merely an empirical, quantitative

science; it gains a dimension of qualitative measurement. Psychoanalysis is a discipline


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that is discrete in its cyclicalityit is the human brain working to understand itself; the

analyzing subject is the analyzed object and the analyzed object is the subject herself

thus, the subject brings into question its own validity. Above all, psychoanalysis is a

bottomless endeavor: [It forms] an undoubted and inexhaustible treasure-hoard of

experiences and concepts, and above all, a perpetual principle of dissatisfaction, of

calling into question, of criticism and contestation of what may seem, in other respects, to

be established. For the first time, the medical field would delve into a domain of

empirical uncertainty. While other sciences construct and reconstruct themselves through

representation, psychoanalysis advances and leaps over representation (Foucault, 1970,

p. 373-374).

Yet with the technological advancements of the last several decades, the shift is

reversed once more. By giving human eyesight the power to observe neurobiological

processes, the causes for the conditions that were previously considered invisible became

visible. This shift was not merely empirical; it was not simply that a veil was lifted with

regards to the observation of physical processes in the brain; rather, the change was also

fundamentally epistemological in the sense that the concept of understanding

psychoanalysis through visibly identifiable procedures was not even a theoretical

possibility.

If we look back to Freuds conceptions of instinctive drives, we find that it is far

removed from the conception of pleasure in contemporary medicine as a release of

neurotransmitters. In fact, Freuds time not only reflected a lack of understanding, but an

embracement of this uncertainty. One need only look at the concurrent Surrealist

movement to see that human self-understanding operated in a domain of darkness and


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uncertainty. In these early stages, though perhaps not explicitly stated, psychoanalysis

represented a rejection of normality and an embracement of deviancy. Following in the

footsteps of the Surrealists, the Dadaists subsequently mocked social convention, instead

emphasizing the illogical and the absurd. Without the process of medicalization,

psychoanalysis could only reveal truths that fundamentally questioned normality. As

these movements came to an end, however, the empirical uncertainty of psychoanalysis

was progressively demystified with every discovery in the field of cognitive science. The

uncertainty that grounded the Surrealists and the Dadaists was undermined by causal and

observable scientific explanations.

Be that as it may, there is an extent to which the visibility of certain mental

disorders still remains invisible to human understanding. In other words, the debates

currently surrounding ADHD in the medical community are fundamentally rooted in the

relation between the visibility of certain biological patterns in the brains of ADHD

subjects, and the invisibility of the link between social behaviors and the increased

activity of certain parts of the brain. Most of the debate surrounding ADHD in the

medical community arises from the idea that visible brain activity constitutes a mental

disorder.

On this front, the medical community is highly divided: Despite being unable to

point to a definitive link between specific biological regions or neurologic components,

there is a strong foothold of individuals in the medical community who posits

neurobiological dysfunction as the cause for behaviors said to indicate [ADHD] and

psycho-pharmaceuticals as the solution (Graham, 2006). There is a clear discrepancy

between the individuals who posit this model outlined by Graham, and the reality of the


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matter; namely, that there are no specific cognitive, metabolic or neurological markers

and no medical tests for ADHD (Timimi & Taylor, 2004). Because it is clear that there

is a substantial lack of evidence for this model, there are many individuals who work to

oppose such medical falsities. In a letter signed by sixteen Ph.D.s, all members of the

American Psychological Association, certain concerns were raised to the attention of Dr.

Alice Rubenstein, Director of The Brochure Project, a joint effort of Division 29

(Psychotherapy) of the APA and Celltech Pharmaceuticals to publish and distribute

brochures on Attention Deficit-Hyperactivity Disorder (ADHD). The brochures

supported by Dr. Rubenstein made three controversial claims: 1. ADHD is generally

considered a neuro-chemical disorder. 2. Most people with ADHD are born with the

disorder, though it may not be recognized until adulthood. 3. ADHD is not caused by

poor parenting, a difficult family environment, poor teaching or inadequate nutrition.

Citing an abundance of information as evidence, the doctors proceed to adamantly deny

each claim, and conclude: As a body of practicing psychologists, we acknowledge

before the public and one another that what we believe about ADHD is based on neither

adequate nor established scientific fact but is instead a reflection of cultural and societal

forces that have influenced our theoretical, research, professional, and practicing

agendas (Galves & Walker, 2002).

Thus, the ongoing medical debate regarding the etiology of ADHD can be broadly

summarized as a case of the age-old correlation proves causation fallacy. In other

words, researchers recently have discovered genetic, neurobiological correlations

amongst patients diagnosed with ADHD and this data, in turn, is used to substantiate the

claim that ADHD is a neurobiological disorder. This is precisely the sort of reasoning


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that the sixteen psychologists in the letter referenced above are fighting against on the

basis that one cannot use correlative brain functions to substantiate the causation of a

dysfunction in the brain. Their counterproposal correctly argues that finding correlative

links between patients does not validate the claim that ADHD is a neurobiological

disorder. While there is an extent to which correlations of this type may indicate the

existence of a neurobiological disorder, there must be a link between the evidence and a

biophysical ailment in the brain. Alzheimers disease is a considered a mental disorder

not because there is similar activity in parts of brain among various patients, but because

the negative symptoms of the condition can be traced to an activity that is visibly and

physically harmful to the brain. It is clear that the correlation of higher than average

activity in parts of the brain for ADHD subjects is not analogous to the deterioration of

the brain observed in Alzheimers patients. The same way that investigators from

Harvard Medical School (McGreevey, 2012) recently identified similar activity in the

response of the amygdala, a part of the brain that controls emotion, in a group of people

who underwent meditation trainingweeks later even when they were not in meditative

statessuch a correlation does not imply that meditation constitutes a neurobiological

disorder. Likewise, the fact that inattentive subjects share similar activity in certain parts

of the brain does not mean that ADHD is a neurobiological disorder.

For Galves & Walker (2002), the cultural and societal forces represent a threat

to the integrity of the medical discipline; yet these forces are more profoundly indicative

of how the power relations in the modern American capitalism system engender the

cultural value of production throughout society. Power, in this sense, not only reflects the

knowledge of a society, but also defines certain cultural values and practices through that


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very knowledge. Indeed, as Foucault tells us: Power produces; it produces reality, that

is, it determines what it makes sense to believe and to do (Dreyfus, 2004). As the power

to change how ADHD diagnosis functions in the medical discipline is exercised, the

general view of ADHD in society is shaped to reflect the medical practices. The more

doctors systematically prescribe stimulants for ADHD diagnoses, even in cases of mild

inattention that may not necessarily demand drug-treatment, the more society believes

that such cases of inattention warrant drug-treatment. This changing shift in knowledge is

precisely why Foucault believes that postmodern power produces reality. It begins by

changing the way we view certain personality traits, and eventually changes the way we

treat the individuals who exhibit those traits. The power acquired by the psychiatric

disciplines in the 21st

century shapes the reality of a society by defining new beliefs and

practices without its constituents having any awareness of it.

The early conceptions of ADHD began with an effort to curb deviant behavior,

yet at a broader level, the process of normalization represents a deliberate attempt to

control the population in order to breed more productive individuals and enhance the

conditions of life. As the diagnostic criteria for ADHD become more structured, the

inattentive individual is led to believe that normality entails production, and that his lack

of attention and focus is an anomaly. At the same time, one must also ask whether

production enforces normalization. Although we may understand how the desire to

enhance social order by leveling deviant behavior enables a more productive society,

there is also an extent to which the value of productivity instills within society a desire to

be normalized. Thus, we must contextualize the value of production within the

development of modern American society, and in tracing the relationship between


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production and normalization, we may understand how and why the modern framework

of ADHD not only enhances productivity through normalization, but also normalizes

productivity in itself.


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VI - The Rise of Production

According to the National Institutes of Health, a government agency, ADHD is

the most commonly diagnosed behavioral disorder of childhood (NIMH, 2012); their

latest reports reveal that the syndrome also affects 8.1% of the American adult population

(NIMH, 2005). But more so than its prevalence, the rate at which ADHD diagnoses have

increased in recent years is unprecedented. The Center for Disease Control and

Prevention reports that ADHD prevalence rose from around 5% of the total U.S.

population in 1976, up to 16% in 2000, with diagnoses increasing by 22% from 2003 to

2007 (CDC, 2012).

The main courses of treatment for ADHD-diagnosed subjects are methylphenidate

(Ritalin

) and amphetamine (Adderall

), both of which are psychostimulants. Data

gathered by the Drug Enforcement Agency reports that prescriptions for both of these

medications increased from less than 3 million in 1991 to over 15 million by 1999, with

the U.S. producing and consuming 85% of the worlds methylphenidate (DEA, 2000).

From these statistics, it is apparent that the proliferation of ADHD is correlated

with a significant increase in diagnosis as well as in prevalence of stimulant drugs. But

long before the advent of these drugs, there were various changes in the perception of

how society should deal with deviant subjects. When George Still studied his patients he

had the intention of rehabilitating them for their own sake. His intentions, while perhaps

passively looking to the general well-being of society, were primarily intended to

reeducate and understand moral idiocy. But as previously noted, there was already a

shift in the social perception of the deviant subject that strayed away from moral

character and its relation to the criminal act, instead, directing itself towards


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understanding the subject in relation his or her deviation from the norm. At the same

time, another shift occurred away from the seclusion of the deviant subject, and towards

an interest in assimilation and social inclusion.

It is important to note that the shift in the social perception of the deviant subject

occurred long before the advent of stimulant drugs, and was actually initiated by a shift in

the utility of confinement. During the seventeenth century, confinement acquired a new

meaning. On the one hand, it maintained the repressive function that Still was

concerned with, in terms of rectifying moral character, yet it was no longer merely a

question of confining those out of work, but of giving work to those who had been

confined and thus making them contribute to the prosperity of all work was not only an

occupation; it must be productive (Foucault, 1991, p. 132). In this sense, it would not be

irrational to consider ADHD diagnosis a method of psychological and behavioral

confinement that is designed to enhance social order. In order to maximize general

prosperity, in order to gain a return on the investments that society makes by dealing with

the problem of deviants, the changing practices of prisons, penitentiaries, and detention

centers alike represent the birth of a utilitarian drive that would continue to spread

throughout various institutions and disciplines. This changing notion of workno longer

as an end in itself but merely a means to the end of productionreflects an underlying

agenda towards social order by way of increasing utility. This perspectival change is

precisely the result of an exercise of modern power that seeks to include rather than

quarantine deviant behaviors.

While the shift in the social perception of the deviant subject may seem logical, or

even natural, it is the result of a deliberate exercise of power that seeks to dominate


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societynot through oppression, but through docility. Foucaults thesis identifies the

trend towards normality and productivity not as incidental byproducts of modernity, but

as a deliberate effort to control the population. Although he grants the notion that power

is non-egalitarian, he deviates from the traditional conception of power as a force that is

held to dominate a particular group from a strictly top-down relationship; rather, Foucault

claims that power is multidirectional, that is a general matrix of relations at a given time

wherein it is exercised upon the dominant as well as the dominated. In capitalist society

the modern form of power is a complex strategical relationship; it is characterized by

increasing organization of population and welfare for the sake of increased force and

productivity (Dreyfus & Rabinow, 1983, p. 7-8).

The modern capitalist agenda operates through power relations that control the

population by normalizing the archetype of the modern American and by maximizing

productivity through a process of ever-increasing organization. As this agenda gains

momentum, the conception of productivity as a socially useful act converges towards the

notion that productivity is a social norm. These changing knowledge-power relations,

thus, redefine the objective reality of the modern capitalist society, culminating in a

redefinition of self-understanding. In other words, the power that is tied to the control of

deviant subjects produces reality by changing the societal understanding of production;

this shift in knowledge, in turn, creates more productive individuals and a more

productive society. Finally, at the most profound level, this process ingrains within the

identity of the modern capitalist a belief that production, as a norm, is also a means to

achieve a greater endthat is, happiness. Thus, the eudemonic drive that stands at the

crux of human self-understanding is redirected.


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In the context of ADHD, the normalization of productivity could only actualize

itself into its current state through the medicalization of stimulant drugs. It was only until

the mid-twentieth century that the benefits of using stimulants to reduce deviant

behaviors would be observed more closely. Charles Bradley famously performed a series

of Benzedrine Experiments in hopes that stimulants would supplement psychotherapy

and work to reduce hyperactivity and other behavior problems, improve schoolroom

adjustment and academic performance, and improve psychometric test scores. Yet

Bradleys experiment also represented a shift in the intentions of rehabilitating deviant

subjects. While rehabilitation was once, for Still, an attempt to understand the subjects

reckless disregard for command and authority (Comstock, 2011), it soon became

apparent that were various other advantages that go beyond the attempt to rectify moral

character: namely, societal benefits. With regards to the benefits of ADHD diagnosis, few

have summarized its advantages as well as Lawrie Reznek:

Such a mental illness has many advantages. First, it enables us to treatsuch deviant behaviour with drugs millions of children have been

sedated with methylphenidate. Second, the classroom disruption is cured teachers can now devote their time to more rewarding pupils. Third, the

parents can avoid the guilt associated with producing an inferior child orwith failing to raise their child correctly. They can explain away his or her

poor school performance by reference to a disease that needs treatment.Fourth, the other children are able to benefit from the decrease in

classroom disruption What started offas being a problem for parents,

teachers, and other children, ends up benefiting everyone except those who

end up being sedated and depressed on the drugs. (Reznek, 1991)

Reznek does well to illustrate the extent to which the ADHD construct responds to

various utilitarian motives. His summary shows us how the diagnosis and the use of

stimulants resolves disruptive behavior and enhances the classroom environment for the

teacher as well as for the other students. But Rezneks observations also capture another,


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more nuanced form of utility. With respect to the parents being able to avoid guilt, we

find an indirect motivation that comes from self-interested intentions. In other words, it

makes sense that the teacher has a responsibility to maintain an ordered classroom vis--

vis the school and the parents of the children; likewise, the children in the classroom

should be entitled to an education without having to be disrupted by another child; thus,

the parties involved are all directly affected by the deviant child.

In the case of the parents, though, we find motivations that are neither conducive

to social order nor directly affected by the behavior of the child. Were it socially

acceptable to have an inattentive or impulsive child, the parents would not feel guilty in

their being associated with the childs behavior. Rezneks observation thereby capture a

surreptitious form of utility that depends more on social pressurein terms of how he

parents social lives and social standing are indirectly affectedas opposed to the

societal pressure associated with the correction of directly problematic behavior. While it

would be unfair to assume this these observations reflect every case of ADHD diagnosis,

we must recognize that this is a realistic characterization of how such a diagnosis may

benefit the various parties involved. From the perspective of productivity, the efficiency

of stimulant drug treatment for the treatment of deviant behavior is unparalleled. It is not

merely that the deviant is no longer a problem to societyquarantine would achieve the

same endrather, the deviant can now be assimilated into a society and made to

contribute to the productive workforce.

The utilitarian motives in Rezeks description are directly correlated with the

evolution of ADHD with respect to its gradually expanding scope in diagnostic criteria

over the last century. What started out as a the Hyperkinetic reaction of childhood


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disorder in the 1968 publication of the DSM-II, would soon become attention deficit

disorder (with or without hyperactivity) in the 1980 publication of the DSM-III (Lange

et al., 2010). As ADHD developed into the condition that it is today, the diagnosis would

no longer merely be used to maintain social order, but would represent a way to make

inattentive individuals into productive ones; by the end of the century, deviant and

antisocial behavior was no longer the sine qua non of the disorder maladjusted social

behavior is a sufficient but by no means necessary diagnostic principle (Comstock,

2011). The intention of ADHD diagnosis, thus, gradually shifted away from a primary

concern for social order, and towards the general breeding of more productive

individuals.

On the one hand, there is a superficially identifiable cause that accounts for the

proliferation of stimulants. With respect to Rezneks observations, there is an

underlyingyet unspokenargument that the ends of diagnosis justify the means. In

other words, doctors begin to regularly prescribe stimulants on the basis that, even in the

case of a misdiagnosis, the effects will generally be positive. While it may seem like this

approach is socially accepted, the latest research reveals otherwise. In a survey3

conducted by Harold Koplewicz, MD., president of the Child Mind Institute, 32% of

parents said they believe that ADHD is sometimes more a result of insufficient or absent

parenting rather than a true medical condition, and 72% said they believe that doctors

and parents are too quick to put kids on medication for ADHD rather than looking for

other solutions (CMI, 2012). It seems odd, to say the least, that despite this apparent

awareness and reluctance to prescribe stimulants, there should still be a rapidly increasing

3In a sample of over 1,000 people


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rate in diagnosis. Likewise, the evidence that Galves & Walker (2002) provide reveals

that the medical community, while perhaps not unilaterally, is also opposed to the

understanding of ADHD as a neurobiological disorder from the very same concern that

the systematic prescription of stimulants can be harmful to children and adults alike.

As we begin to trace the various sources for the proliferation of ADHD and

stimulant drugs, it becomes apparent that while there is, on the one hand, a trend towards

increasing diagnosis, which naturally entails more drug treatment, there is also, on the

other hand, a motivation to seek out stimulant drugs that entails ADHD diagnosis. In

other words, the rapid increase in diagnosis of ADHD and the proliferation of stimulant

drugs should also be considered from the desire to acquire stimulant drugs for social and

recreational endeavors, thereby suggesting that healthcare professionals are prescribing

stimulants in cases that do not necessitate drug treatment but are, nonetheless, beneficial

to the diagnosed subject for other reasons. These ulterior motives for ADHD diagnosis

fundamentally rely on the capitalist drive towards productivity that is instilled in modern

American society.


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VII - ADHD and Capitalism

The desire to assimilate the ADHD subject and breed productive individuals for

the general prosperity of society is not an incidental occurrence; it results from a

deliberate exercise of power. While one may understand this exercise of power as the

product of modern capitalist society, in the case of ADHD, the question is whether we

should attribute its proliferation to the modern capitalist agenda alone, or if it is also

caused by certain values that are specific to American society. If we are able to answer

this question, it may be possible to understand why the proliferation of ADHD and

stimulant drugs is so highly endemic to the US.

In attempting to unearth the underlying causes of the medicalization of the

inattentive personality and the use of stimulant drugs, one must turn to the network of

economic and political institutions within modern American society.

When considering the perspectives outlined above in relation to the statistical

data, one necessarily wonders whether the proliferation of ADHD can be attributed to

over-diagnosis. However, recent scholarship reveals that there does not appear to be

sufficient justification for the conclusion that ADHD is systematically over-diagnosed,

yet, this conclusion is generally not reflected in public perceptions or media coverage of

ADHD (Sciutto & Eisenberg, 2007). Be that as it may, the studies that examine over-

diagnosis measure prevalence in relation to the criteria outlined by the DSM-IV. In all

likelihood, this discrepancy between the public perception and the actual prevalence

comes from a discrepancy in the interpretation of over-diagnosis. Unlike Sciutto &

Eisenberg (2007), the public perception of over-diagnosis is rooted in a belief that

symptoms of the inattentive-type ADHD subject do not constitute a medical disorder.


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Of course, there are still many publications that consider the entire ADHD

construct a fraudulent enterprise. In his best-selling book, The ADHD Fraud(2006), Dr.

Fred Baughman argues that ADHD is an epidemic driven by economic profit motives.

While there is something to be said about understanding the proliferation in terms of

social and cultural influences, Baughmans skeptical account propounds the belief that

the entire ADHD construct is a lie. Instead of trying to understand and resolve the

ongoing debates, such accounts ignore the historically situated meanings we give to the

behaviors that constitute this disorder, and tend toward a false dichotomy whereby we are

forced to imagine the disorder as medical and real or socially constructed and unreal

(Comstock, 2011). One must, therefore, evaluate the economic dimension not as a

corporate conspiracy, but as a combination of social and cultural forces. While these

skeptical accounts only reinforce the debates that prevent a new understanding of this

condition, they are still right to point out that there is a clandestine system of economic

motivations that enables and reinforces the rapid proliferation of ADHD. If we try to

consider this notion of a cultural construct as not merely a fictitious construct in the sense

that the aforementioned skeptical accounts proposes, we may begin to see that the source

for the motivations behind the proliferation of ADHD goes beyond the corporate profit

motive.

A recent investigation of the financial ties between the pharmaceutical industry

and panel members responsible for the revisions of the DSM revealed that 56.7% of

panel members have financial ties4

to the pharmaceutical industry, and in the category of

4Financial associations of interest for this study include: honoraria, equity holdings in a drug company;

principal in a startup company, member of a scientific advisory board or speakers bureau of a drug

company; expert witness for a company in litigation; patent or copyright holder; consultancy; gifts from

drug companies including travel, grants, contracts, and research materials.


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disorders that includes ADHD, 61.9% have financial ties to the pharmaceutical industry

(Cosgrove, Krimsky, Vijayaraghavana & Schneider, 2006). While there are certainly

financial ties between the pharmaceutical companies producing stimulant drugs and those

in charge of revising the diagnostic criteria for ADHD, one must acknowledge that there

is an underlying motivation that brings us back to the normalization of the American

population. In other words, the corporate motive is merely one component of a network

of complex relations between the educational, the medical, the social, and the economic

spheres of society, all of which can be chiefly attributed to a reevaluation and a

normalization of values.

If we attempt to frame the process of normalization in relation to the modern

medical system, Foucaults conception of postmodern power as a clandestine method to

order and enhance human life becomes all the more apparent. One of the fundamental

aspects of Foucaults conception of power in modern capitalist society is that it is

exercised through its invisibility (Foucault, 1991, p. 199). On the surface, we find that

the financial ties described here are invisible in the sense that it becomes increasingly

difficult for the medical discipline to identify and expose cases of doctors being

influenced by economic agendas. While the letter referenced by Galves & Walker (2002)

provides us with one example of such a case, there are many factors working against

these doctors. Broadly speaking, what we find is a profit-dependent pharmaceutical

industry and a high-status profession looking for new roles, both of which establish the

ideal cultural preconditions for the birth and propagation of the ADHD construct

(Timimi & Tayor, 2004). However, many people are even aware that the medical system

is structured in this waythat pharmaceutical companies providing research grants to


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doctors who control the diagnostic criteria for the conditions that allow for prescription of

certain medications is neither illegal nor frowned uponin fact, it is so commonplace

that more than half of the revisers are identified as having financial ties. While this

system is invisible both in the sense that is becomes increasingly difficult to identify

instances of unprofessional medical practices, it is also invisible in the sense that it occurs

without the public being aware of its existence.

That being said, there is a another, more pernicious, form of invisibility, which

occurs as an exercise of postmodern power through the relationship between medical

knowledge and the knowledge that defines the cultural values and beliefs of modern

American society. This is precisely how we may contextualize Foucaults claim that

power produces domains of objects and rituals of truth (Foucault, 1977). In modern

America, the medical system self-propagates its power by establishing a reciprocal

relationship between economic power and medical knowledge. In other words, the

medical system has become structured so that the economic agenda of pharmaceutical

industries producing stimulant drugs first affects the medical understanding of the

conditione.g. (Galves & Walker, 2002)but it also begins to affect how society view

the condition. In this sense, we find that the agenda that drives this modern capitalist

productivity does not stop at the pharmaceutical company. Rather, the company is part of

a broader system wherein the oppressor that is exercising visible powerviz. the medical

financial tiesis unable to see that they are being oppressed by an exercise of invisible

power; one that is pervasive throughout the entire modern capitalist system. This

precisely reflects the multidirectional power structure that is described in Foucault

analogy of the panopticon. The pharmaceutical company may very well believe itself to


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be the oppressor, yet it fails to see that its agenda is not merely driven by financial gains,

but by a systemic drive that engenders an agenda of normalization and productivity

throughout modern American society.

While it is possible to see how the modern medical system is a product of the

form of postmodern power identified by Foucault, this would still fail to explain why

ADHD is endemic to the US, for many other countries have adopted capitalist economies

that are also driven by production and normalization. Considering that the US currently

represents the most capitalist society in the world, it may be difficult to truly distinguish

between modern capitalist values and American values. Despite the fact that the two may

be intertwined, if we are able to roughly distinguish between the two, it may be the case

that many of the stereotypes of American society may, in fact, only be

contemporaneously specific to American culture by virtue of the fact that it is the most

advanced capitalist societynot due to any primordially cultural differences. While this

may seem like a debate about what we should label these values, if we understand

particular aspects of modern American culture as inevitabilities in the development of

modern capitalism, it would follow that other capitalist societies will begin to resemble

and adopt these very same values. In fact, one need only look at the influence of

American culture throughout younger generations around the world to see the extent to

which capitalist societies may be predisposed to resemble contemporary American

society.


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VIII - America in the World

The 21st century marks a period of great technological leaps in the United States,

and with it comes a strong reinforcement of capitalist values. However one may choose

to define the character of this nation, it would seem that one value stands above all the

others: few would debate the contention that industriousness is at the cornerstone of the

American identity. In the most general sense, industriousness has a goal; success, in all

its complexities, whether it is defined through wealth, happiness, love, or good heath, is

measured in terms of prosperity. And to achieve such prosperity, one must value

industriousness as the fundamental ingredient, as the quintessential means to the

proverbial end that is The American Dream.

But what of industriousness, per se? The notion of hard work must necessarily be

complemented by the object that is being worked on; and as such, it would seem that the

object of industriousness is just as, if not more, important, than the act of exertion. Yet in

our modern age, this view is quickly decreasing in popularity. As the value of

industriousness continuously grows within the undercurrents of the modern American

identity, it no longer becomes an ingredient, but rather, resurfaces as the recipe itself. It

denies its own identity as a means to an end and seizes the opportunity to become the

coveted end in and of itself.

While this concept may not seem particularly striking, one need only look at the

latest research comparing the success rates of intrinsic and extrinsic motivators to see

how this ideology manifests itself. The extrinsic constitute material gains, like cash

rewards, while the intrinsic constitute qualitative gains, like increased self-worth. In

recent years, psychologists have

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