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by Kathy O’Brien & Anne Eisner
This article is important not only for the information it provides, but also for the presentation of a plan of action which has helped people to organize. In so doing these people have taken control of the decision-making power which was initially denied to them.
Drugs In The Schools
Frank, an attractive but rather thin sixth-grader, sits quietly in an examination room of the Learning Disabilities Clinic at the Kaiser-Permanente Medical Center in Oakland, California. A clinic doctor checks Frank’s cumulative record from the urban school he attends. Then he checks the boy’s eye movements. Frank has a slight reading problem-a bit below grade level. But the main trouble, according to his mother and teachers, is that he has trouble concentrating. He’s not one to sit still, his mother says. Still, he’s doing better in school this year. He’s on traffic patrol, an honor student, and he’s even done some independent projects. At home, his mother says, he’s kind of lazy and can sit and watch TV forever. Frank explains that he doesn’t like school, and that’s why he won’t sit still.
The doctor tells Frank: “It’s not that you won’t sit still. You can’t sit still.” “No,” Frank insists, “I won’t.” “I don’t believe you,” the doctor says, and continues to question Frank, but the boy stubbornly holds his ground: “I won’t because I don’t want to.” His grit in the presence of two white-coated doctors and his mother is impressive.
Frank has been on Ritalin in every grade but the fourth, when the teacher said he was fine without it. He doesn’t take it in the summer because he doesn’t need it when he’s not in school. “Do you know what the Ritalin does to him’?” the doctor asks. The mother says no, she just knows he doesn’t eat much when he’s on it, that’s why he’s so thin. And the school says he’s a little better on it. The doctor talks rapidly to the mother about hyperactive and hypoactive children, about low-arousal and sleep-deprived and seemingly lethargic children. Frank’s mother nods as the words go over her head. “Keep him on Ritalin,” the doctor concludes. “He seems to need it.”
It is the first time he has seen the boy and the visit took fifteen minutes.1
Such incidents are occurring more and more frequently with children across the United States being treated with drugs for “hyperactive” behavior in the classroom. That this is a fairly recent phenomenon is indicated by the absence of “hyperactivity” as a subject in the Education Index from July 1966 to June 1967; but the July 1971 to June 1972 issues list 25 articles under that heading.2 This new concern with hyperactivity cannot be explained by any break-through discoveries in the fields of medicine. education or psychology. None of these areas offers a more clear-cut explanation than was offered in 1937. when “the problem” was first identified by Bradley.3
The behaviors that experts say characterize hyperactivity range from what are thought to be manifestations of neurological damage. to performance on psychological tests or behaviors deviating from normal (read “desired”) in the classroom. Here is a typical list of “indices of hyperactivity”: excessive rocking; wiggling and climbing; the rapid wearing out of furniture. toys and clothes: experiencing close calls repeatedly; being overactive, easily distracted, excitable; talking out of turn in class; telling tall stories to create an important impression; not getting work done in school; acting rather silly and immature; having trouble sitting still; not getting along well with all classmates; being impatient; looking for companionship; showing marked ingratitude.4
There simply is no objective test (neurological, intelligence, or behavior observation) to positively determine the existence of hyperactivity. Though classified medically in the category “Minimal Brain Dysfunction” (MBD), the symptoms (e.g. an increase of purposeless physical activity or an impaired span of focused attention) are not necessarily manifestations of physiological disorders that can be identified through medical testing.5 Psychological and educational theories of hyperactivity are not any more scientifically verifiable than the medical theories; accurate definitions and better-than-guess diagnoses are lacking in all fields.
Despite the ambiguous, subjective medical psychological definitions and the lack of accurate and reliable diagnostic tests, hyperactivity is said to exist and is treated with an objective medical tool—amphetamines, specifically Ritalin and Dexedrine. The medical profession, however, seems to know as little about the drugs as they do about the behavior. Some researchers and doctors say that the drugs, which usually work to stimulate the average person, actually have a calming, slowing down action on the children with “true hyperactivity” (cases believed to have cerebral malfunction). It is claimed in this case that the drug raises the activity of the cerebral cortex where thinking functions occur. When this happens, there is at the same time a lessening of activity in the part of the train where Jilysical (motor) activity is said to be controlled.6 That is why, they claim, the child “calms down and concentrates.” Others claim that amphetamines generally excite the entire brain. Since “these children” have low thinking activity, the drug in exciting the whole brain, also excites the part where thinking takes place. This creates an increase in alertness along with an increase in the ability to focus attention.7 A third explanation postulates that the drugs act the same for anyone who takes them, children and adults. Given the same dosage per body weight, hyperactive children focus with abnormal (high rates) concentration on unpleasant, boring and repetitive tasks. For example, the schoolroom tasks that many of these children would not concentrate on before are now performed routinely. If we go back to the opening quote in this article we are left with the uneasy feeling that Frank will be performing tasks he once considered boring and this, as has been the case in our history of education, will be considered good learning. It is interesting to learn that athletes and performers often use Ritalin to help them practice tedious routines. Several teachers have stated that they use Ritalin and Dexedrine to face tedious work of their own, e.g. grading papers.8 It appears then, that the action of amphetamines is not understood, but what is a result is that the user will perform with rapt attention the tasks put before him-her. Perseverance, rather than active, interested participation can be had.
Just how does a child come to be included in the nebulous category of “hyperactive child?” The major part of the “discovery” process starts within the classroom, and usually proceeds as follows: The teacher notices that a particular student exhibits one or more of the behaviors mentioned in the beginning of this article. This child is then discussed by the teacher and the school psychologist or principal, who then suggests to the parents that the child be seen by a medical professional, usually a pediatrician. He will check the child for a physical-psychological disorder. The pediatrician, with anxious parents at hand, then finds that the easiest thing to do, given a lack of diagnostic tools, is to prescribe drugs.9 It is important to underline here that the lack of specific medical information and the prestigious position of professionals in our society, allows the psychological and medical professions to exercise control in this situation—not in the sense of actually helping the child, but in the sense of telling people what they “should do.” The relationship between the professional and the parents and child is dependent on the socio-economic group from which they come.
In some urban areas the parent is told bluntly that unless the child receives treatment (i.e. medication) he will face suspension or be transferred to a speciaL program for the emotionally disturbed. At this point, more affluent parents may transfer their child to a more flexible public school or to a private school. But, most parents cannot afford these alternatives.10
Ritalin causes complex changes in the central nervous system which result in observable behavior changes. But, it also causes a host of side effects which can result in severe consequences to the child: nervousness, insomnia, hypersensitivity, loss of appetite, nausea, dizziness, skin rash, irritability, depression, tackycardia (uneven, rapid heart beat), abdominal pain, weight loss and stunted growth.11 Children have been known to hallucinate or to enter catatonic states on Ritalin. Because of the possibility of indiscriminate use and potentially dangerous side-effects Ritalin cannot be sold either in Japan or Sweden.12 These drugs are prescribed for many children in America; with support for use coming from material published in medical and educational journals. These articles place emphasis on changes in behavior which are vital to a “smooth” running school. The journals, with this bias, therefore, place the drug use in a favorable light. However, a critical look at these studies suggests that their findings should be viewed skeptically. Most of the controlled studies are short-term, and could not possibly examine the potential problems a child might encounter after being on the drugs for a year or more. In addition, experiments conducted to test the drugs use school children as subjects, with testing procedures that can endanger the child’s health. These studies often use a double blind design. That means nobody, the child, parent, teacher or family doctor has any idea which of many drugs are being used. If a child has a severe reaction, none of the people immediately available (and the researcher doesn’t know either—that is why it is called double blind) in an emergency could identify the drug that is being employed. The side effects of the drugs are consistently played down in most of the studies, if mentioned at all (the side effects are consistently played down by the drug companies who profit from their use). If the pediatricians prescribing these drugs are relying on these studies, even they might not be aware of the severity of the side effects.
Another problem with the studies is that they recruit candidates from the schools by asking teachers to refer children they think are hyperactive, thus relying heavily on individual teacher prejudice. The teachers are provided with a behavior rating scale upon which they base their decisions. The scale consists of 39 items which describe “abnormal” (undesirable) behavior.13 The range of behavior for which the drugs are tested is quite broad and in many cases non-specific. Once the child has been selected as a subject by the teacher and experimenter, he-she is put on the medication and allowed to return to the classroom. The effectiveness of the drug is also determined by behavior ratings of parents and teachers. However. these ratings are questionable because both parents and teachers expect some change in behavior. and their ratings are, therefore, likely to improve independently of the real effect of the drug.
In addition, there are wide discrepancies in results of drug treatment within and between studies. In looking at specific behavior, drug effects are found to vary among different groups of children. Some studies show changes in IQ, others do not; some show changes in many behaviors, others in just a few. These discrepancies are attributed to poor experimental design by the experimenters. Yet, it has never been suggested that these experimental in· consistencies result from the vague and arbitrary description of “hyperactivity.” “Hyperactivity,” as defined by “the experts” has a wide range of symptoms, which, of course, makes it useful for labeling many children and then doing something about them.
A Community Fights Drug Research
Recently, an attempt to carry out a study in Boston encountered heavy community opposition and was consequently thwarted. The research project, under the direction of a member of the Psychopharmacology Department of the Massachusetts Department of Mental Health, was to be carried out through the facilities of Boston State Hospital and administered through Tufts University School of Medicine. Funding for the project was provided through the National Institute of Mental Health (NIMH).
SEXISM AND PSYCHOSURGERY
1. After a provision preventing psychosurgical operations on men had been passed in a Canadian hospital, 17 women were operated on.
2. Dr. Baker, a Canadian psychosurgeon, reported operating on 44 cases of which 61 percent were female. (Canadian Medical Journal, January 17, 1970, Vol. 102, p.37.)
3. Peter Lindstrom, now at San Francisco Children’s Hospital, wrote in 1964 about operations on 60 psychotics and 154 neurotics, and 72 percent of the psychotics and 80 percent of the neurotics were women.
4. H.T. Ballantine, of Massachusetts General Hospital, operated on 40 patients, 40 percent of whom were women.
5. M. Hunter Brown and Jack Lighthill, of Santa Monica, state that out of 110 cases, 72 were female. (See Congressional Record, February 24, 1972 for documentation of points Nos. 1, 3, 4, and 5.)
The initial proposal, which was to be funded by NIMH for $250,000, was designed
…to examine the effect of psychotropic medication on a variety of symptoms in functional behavior disorders in children… (defining functional behavior disorders as)… those disturbances that appear to have resulted from early childhood training or from experiences traceable to grossly inadequate and unfavorable environments rather than from some demonstrable neurophysiological, genetic or metabolic abnormalities.14
This definition, encompassing a wide range of vague problems, describes “functional behavior disorder”— the same term which the Food and Drug Administration forbade the drug company C.I.B.A. to use in advertising the effects of Ritalin, because of its vagueness.15
The research design provided for a double-blind comparison of three drugs, D-amphetamine (Dexedrine), theoridazine (Melaril), and diazepam (Valium), to be administered to 160 boys over a twelve-week period. The children were to have been initially selected on the basis of enduring behavioral or emotional disturbances that had been, in the teacher’s opinion, “affecting the child’s capacity or motivation in his school work” during ten weeks of observation.
Initial identification of potential study candidates will be made by school teachers from their observations of the behavior of children coupled with the knowledge of their intellectual potential and achievement. Basis for referral will be observations of persisting and disruptive classroom behavior and- or emotional disturbances.16
Those children who showed significant improvement would be given the opportunity to be continued on medication through the services of the Boston State Hospital Child Guidance Center.
Opposition to this program began after the investigators had received the approval of the School Committee to have a nurse involved with the research project administering the test drugs to the subjects in the schools. On December 5, 1972, the Task Force on Children Out of School. along with their community representatives, went to the School Committee to ask it to reconsider its decision of May, 1971. A hearing followed, during which community representatives and social service agency representatives presented their specific objections to the Boston State Medication program. These objections were as follows:
- The drug program is an experiment on children which is not designed to provide needed services.
- The drugs being given are experimental in that their effects upon children range from unknown to potentially harmful.
- Because the program is designed to study drugs rather than to serve children, no clear-cut standards exist for determining which children will be medicated.
- No adequate follow-up procedures exist to evaluate the long-term effects of the drugs on the children.
- The drug program raises serious ethical and policy implications which public officials have yet to address. We are deeply concerned about the ethical and policy questions raised by the School Committee’s cooperation with the drug program. There are no rational ethical grounds to support an experimental research program of questionable service values which may carry negative consequences for children. The program is designed to experiment with drugs to control classroom behavior while neglecting educational, social, and psychological factors. The long-range implication of relying on drugs to control the behavior of school children is alarming.17
The manner in which the program was presented to the community was obviously one-sided and misleading. Because of the professional status of those involved in the research project, it was possible for them to control the extent of the community’s knowledge about the study. It just so happened that some community people were aware of the consequences of this sort of study.
Why is it so important to do studies showing the positive effects of drugs treating hyperactivity’? The medical and educational institutions in the U.S. have a vested interest in defining hyperactivity as a disease, as do the drug companies. The kinds of behavior noted as hyperactive are consistently those of children who are not conforming to the norms of the classroom. These norms are concerned primarily with obeying authority, keeping order, and not being creative; in underfinanced and understaffed schools, with obsolete principles of education, the child who does not obey authority poses a real threat. So what better way to cure this problem than by putting the child on drugs that transform him-her into an obedient subject and a ready vessel for “knowledge”? These considerations lend even further significance to the community protest against the drug project.
The community was successful in halting the proposed study in Boston. The associated program at Boston State Hospital was terminated, and legislation was passed to ensure that similar projects would not be allowed in the state. Knowledge of the tactics the community used in this case may help others fight similar projects. Three routes were taken by those people opposed to the continuation of the program. In the first case, one of the members of the Task Force on Children Out of School discovered the project by hearing about it from an acquaintance on the Boston State staff. He went on to alert others working directly with the community, and they, seeing through the rhetoric of the proposal to the contradictions and implications of this research project, formed a pressure group to act on behalf of community interests. This group attempted to reverse the decision made by the School Committee and to make the Committee aware of the consequences of such a decision.
The second route taken was a future-minded one, working through the established channels: the Task Force and the Massachusetts Black Caucus sponsored legislation which would prohibit any person from administering (or causing to be administered) in Massachusetts’ public schools any kind 1.i behavior modification drug appearing on a list of restricted drugs at the Public Health Department, unless verified through this Department as needed for medical reasons. This bill was passed, and will preclude any kind of medical research of this type in the schools.
A third approach was to confront the persons directly involved in the research project. Members of the Task Force and some mental health associations went to speak with the research director to raise various objections concerning the referral process involved, the side effects of the drugs, the methods of testing their efficacy and the availability of services promised for participants in the program as of June, 1973, when the funding was to run out.
In light of these objections from professionals involved with community work, the investigators revised the protocol. The revisions dispensed with the specific concerns; the more general problems still remained, e.g. the drugs to be used were not specified. The original research design provided for subjects to come from three schools, all of which are located in low-income areas. Note here the implications of giving drugs to children in poverty areas, to prevent and control resistance and uncooperativeness. These schools were the only ones falling within the district designated in the research design. This could mean that, in order to have the desired number of subjects, five percent of the population in each of these schools could have been taking the test drugs.
Because of objections voiced by community spokespeople, a different method for supplying subjects was proposed. The children would be referred to take part in the study through the Boston State area mental health centers, which cover, among other areas, Roslindale, Hyde Park and West Roxbury. The children would be ongoing clients of these clinics. This plan would involve children from 14 schools, not all located in poverty areas. If the staff of the mental health center felt that medication was indicated, they would inform parents of the study. Parents could then choose to use either the services of the mental health center or explore the medication treatment study. Parents had to initiate contact with the program themselves.18 The community pressure, forcing the revamping of this program in light of its implications of social control, made it more difficult to recruit subjects. So difficult, in fact, that the program was stalled long enough for legal restrictions in the form of the bill mentioned above to be passed.
It is unusual for community opposition to prevent research from being carried out as planned. The degree of secrecy surrounding these kinds of projects makes it difficult to find out essential information. An examination of the differences between the presentation of the project to the community and the actual intent as written up in the protocol illustrates the difficulty. The presentation to the community emphasizes the service aspects of the project over the research aspects. The investigators knew that there was a conflict between providing needed service to children and meeting their own research goals. The presentation to the community also states that participation in the program is voluntary, and that the medications in use are not experimental. Yet, Ritalin has been substituted for Dexedrine, and neither the parents nor the physician would know which type of medication the child was receiving. The presentation to the community stated that only those children who would benefit from the medication would be treated. Yet, the medication and the placebos were to be distributed randomly. The presentation also places little emphasis on possible side effects, mentioning only drowsiness, irritability, allergic reactions or other such problems, and pushing them as being easy to clear up. There is no mention of the loss of appetite and insomnia caused by Ritalin.
It’s important to note that the medical profession’s labeling “hyperactivity” as a disease ensures that this diagnosis will not be questioned. For who feels competent to argue with a doctor? The fact that doctors prescribe drugs for treatment of the “disease” is also significant. In a capitalist economy, where industry is oriented toward profit, it is not surprising that C.I.B.A. (the drug company producing Ritalin) grosses $13 million yearly, or 15 percent of its total, from Ritalin sales.19 Promotional materials from the drug companies advocate helping children with school problems through drug treatment.
This relatively new “disease” of hyperactivity has to be seen in the context of social control in order to fully understand its implications. The increasing use of medication for control is a logical outgrowth of technological advancement within a capitalist system. And we are seeing ever increasing acceptance of chemical solutions to social and political problems. The stress of the Nixon administration on law and order is not unrelated to the upsurge in the use of these particular drugs on children. The use of drugs and other forms of behavior modification has increased dramatically in the years following the rise of the anti-war movement, prisoners’ movement, and demands from minority groups for control over their communities. The technology provides a way to control the movement activity without making any changes in the system. The use of drugs to control the children makes it appear that their behavior is the result of an individual psychological am physical problem, and precludes the possibility that attention be focused on society as the source of the problem; it also helps to control any collective movement which might arise from the people’s recognition of the social nature of problems.
The medical profession legitimizes this control by defining hyperactivity as an illness and treating it with drugs; the educational system provides the space within which this control is executed. It does not appear however that this control is random. It is directed most frequently at specific groups within the population. The three schools originally included in the Boston State medication program were located in poverty areas. Who is more apt to manifest active and restless behavior in the classroom than the child who is alienated from the kinds of things that take place there? The Boston State program’s definition of the problem as stemming from “early childhood training” and from experiences ”traceable to grossly inadequate and unfavorable environments” assumes at the outset that hyperactivity occurs more frequently in ghetto children The fact that the researcher is looking for what he considers to be an environmentally-caused problem, which he will later define as a disease and treat with drugs, confirms the hypothesis that “hyperactivity” functions to control the lower classes.
The subjects of the studies on hyperactivity can be numbered among the other victims of experimentation who, due to the powerless position they find themselves in, have no recourse, or legal rights. We refer here specifically to prisoners and mental patients. To the list of psychosurgery, shock treatment and behavior modification, we add drug treatment of hyperactivity as another example of “scientific” involvement in the social control of critics of the system.
- Diane Divosky, “Toward a Nation of Sedated Children,” Learning, March 1973, p. 9.
- Educational Index: A Cumulative Subject Index to a Selected List of Educational Periodicals, Julia W. Ehreureach, ed. New York: H. W. Wilson Company, 1967–1972.
- Stanley Krippner et al., A Study of Children Receiving Stimulant Drugs, February, 1972, p. 2.
- Divoky, p. 7.
- John Hurst and Ann Bernard, The Happy Pill, p. 4.
- Krippner, p. 1.
- Ibid., p. 1.
- Hurst and Bernard, p. 5 and Divoky, p. 13.
- Divoky, p. 9.
- Ibid, p. 10.
- Hurst and Bernard, p. 9.
- Minimal Brain Dysfunction: Social Strategy or Disease?, Medical Committee on Human Rights, May, 1973, p. 1.
- C. Keith Conners, “Recent Drug Studies,” p. 1.
- Research Protocol No. 1 of Boston State Medication Program, p. 2.
- MBD: Social Strategy or Disease, p. 1.
- Research Protocol No. 1, p. 4–5.
- Statement of Community and Social Service Agency Representatives Opposing Drug Study Program on School Children, pp. 1–4.
- Revised Protocol, pp. 3–4.
- MBD: Social Strategy or Disease?, p. 1.