Sydney Morning Herald – Feb 17, 2011
by Elizabeth Farrelly
I have an acquaintance who, apart from being a practising professional, successful academic and author of several important books, is a pianist capable of rendering entire Bach cantatas as casually as you or I might plunk out Chopsticks. He also has seven equally accomplished children, an undisclosed number of complex relationships, a flourishing side-career as a magician and a personal presence so intensively entertaining that catching up once every few years is enough.
These days, I imagine, he would be diagnosed with ADHD and medicated into normalcy. And it’s this that makes me wonder. Assuredly there are those who benefit from Ritalin, but a fourfold increase in seven years? And five times as many boys as girls, almost all of them pubescent? Surely this should give us pause for thought.
The Ritalin wars are usually treated as just another tussle between the pharmaceutical companies and the rest, but is there something else going on here as well? Is it part of a more generalised, covert war on boyhood?
Thirty years ago Australian primary schools employed five male teachers for every four females. By 2006 there was one male teacher for every four females. This overwhelming feminisation of primary education, and of culture generally, has made boy-type behaviour stuff to frown upon. Are we in danger of seeing boyhood itself as a disorder?
When Christopher Lane, author of Shyness: How Normal Behaviour Became a Sickness, quoted a psychoanalyst saying “We used to have a word for sufferers of ADHD; we called them boys”, he probably did not expect it to become the most famous line of his book.
Lane’s point was more general, about how personality traits that were once tolerated and even celebrated are now treated as disorders.
What was once introversion is now “avoidant personality disorder”, nervousness is “social anxiety disorder” (SAD) or dating anxiety disorder (DAD) and so on. It’s not that these disorders don’t exist, says Lane, a Guggenheim fellow studying the ethics of psychopharmacology, but that our definitions are so broad that the entire mysterious subconscious is reduced to chemical balance, and any deviation looks like disease.
Why, he asks, is ADHD so commonly diagnosed in boys? Is it new behaviour? Or just a new attitude to that behaviour?
A report last year by Dr James Scott and others in the Australian and New Zealand Journal of Psychiatry suggests the latter. Ritalin prescriptions have quadrupled in seven years, which might be explained by the drug being covered by a government subsidy were not the same thing happening overseas.
There’s also this: although, in Australia as elsewhere, the male-to-female ADHD ratio is 2.45:1, Ritalin rates are 5:1. Diagnosis is more than twice as likely in boys, and medication more than twice as likely again.
So the argument is not just about medication or even deviation. It’s also about gender. And as the hetero heart-throb morphs from John Wayne into Justin Bieber, it is worth wondering whether our behavioural expectations show a similar shift.
Consider the following story. There is an opportunity class in a public school that prides itself on nurturing the gifted, and displays the usual oestrogen-heavy teacher ranks. In the class is a boy – not mine – who is 10 years old. Let’s call him Jack. Opportunity classes are known to collect excitable kids, and Jack, even by opportunity class standards, is unusually clever; bright, funny, literary, sporty and artistic but also intensely emotional.
The school is so highly regarded that its roll swells and swells. With the extra classrooms and then, to top it off, one of Julia Gillard’s enormous new school halls, the playground becomes so reduced that lunchtime ball games are banned. Instead, crowded in, the kids play tip.
So when the fight comes it should be no surprise. The only surprise is no one is hurt. Sure, one boy is kicked and another kneeled on, but there is no real damage, no blood. Yet a complaint is made and all hell breaks loose. Violence? In our school? OMG.
There is no physical punishment, heaven forbid. But the substitute, from boy-perspective, is far worse. It’s talk. Regulation department-issue talk, certainly, but it spreads what might have been an afternoon’s pain (and pride) into half a dozen sessions across a week or more.
With various combinations of parents, teachers and child witnesses, Jack endures a heaping-on of emotional pressure, with dark mutterings about Matthew Newton, the actor accused of assaulting his partner, and recommendations of psychological therapy.
Now, I have nothing against talk, or talk therapy. In fact, being female, I like it. But talk is girl stuff. Not only are Jack’s parents made to feel they have a psychopath in their bosom, when it is really just a boy thing and small beer by Tom Sawyer standards, they also come away feeling primary schools in general “expect boys to act like girls”.
Jack has now moved on to an all-boy high school where his tutors say he is a pleasure to teach and they wish there were more like him.
Although there is no suggestion that Jack has ADHD, the attitudes are similar, and disturbing. ADHD, Dr Scott says, is characterised by “immaturity of the frontal lobes” the brain site for planning and organisation. This is why Ritalin, a stimulant, is prescribed for hyperactivity; it stimulates the control centres. It’s also why most ADHD sufferers eventually grow out of it.
But why the gender imbalance, and why now? We know that boys tend to be late maturers anyway, but Scott concedes there are also social and perceptual factors at play. Teachers with “less structured” teaching style and “more distracting” classroom environments, he says, yield many more of his clients than their more disciplined (my word) colleagues.
Whereas ADHD girls “sit quietly in a corner”, the boys are more disruptive and more noticed, more referred, more medicated. And although much the same is true of ”normal” boys and girls, the upshot is that ”girl” is a norm to which boys are expected to strive. Scott sees it as “an unintended consequence of how society operates”.
But consequences this important should be either clearly intentional, if girlifying boys is really what we want, or remedied. Personally, I reckon the crazily creative are types we’ll need more of, rather than fewer of, in the future, even if they are male.