Human Nature Watch 6: Ritalin Gone Wrong

Two days ago, in “Human Nature Watch 5: Is Depression Good for You?,” I reported on a surprisingly level-headed and humane article in The New York Times challenging our newspaper of record’s standard Darwinian-reductionist line on human nature.

Today, I am delighted to report on another recent article that speaks sensibly about medicine and human behavioral problems. I hesitate to announce a new trend on the strength of a couple of articles. But if trend there is, I welcome it wholeheartedly.

Perhaps we should all write letters to the Editor to encourage whoever it was who decided to buck the dominant reductionist narrative line at the Gray Lady by publishing these two excellent pieces.(1)

The new article is called “Ritalin Gone Wrong” (Jan. 29), and was written by L. Alan Sroufe, Emeritus Professor of Psychology at the University of Minnesota’s Institute of Child Development.

As a scientific researcher with long clinical experience with children and adolescents, Professor Sroufe clearly knows whereof he speaks. But in addition, he is also sensitive to the philosophical complexities and conundrums associated with medical intervention into human behavior—and that is a much rarer virtue.

Here are his most important points:

. . . findings in neuroscience are being used to prop up the argument for drugs to treat the hypothesized “inborn defect.” These studies show that children who receive an A.D.D. diagnosis have different patterns of neurotransmitters in their brains and other anomalies. While the technological sophistication of these studies may impress parents and nonprofessionals, they can be misleading. Of course the brains of children with behavior problems will show anomalies on brain scans. It could not be otherwise. Behavior and the brain are intertwined. Depression also waxes and wanes in many people, and as it does so, parallel changes in brain functioning occur, regardless of medication.

Many of the brain studies of children with A.D.D. involve examining participants while they are engaged in an attention task. If these children are not paying attention because of lack of motivation or an underdeveloped capacity to regulate their behavior, their brain scans are certain to be anomalous.

However brain functioning is measured, these studies tell us nothing about whether the observed anomalies were present at birth or whether they resulted from trauma, chronic stress or other early-childhood experiences. One of the most profound findings in behavioral neuroscience in recent years has been the clear evidence that the developing brain is shaped by experience.

This is all excellent good sense.

The mainstream view contends that if we can see a “brain anomaly,” then there must be an underlying physical “cause” that can only be treated by pharmaceutical intervention to restore a neurochemically normal state.

What Professor Sroufe is saying is that this is fallacious reasoning.

Every aspect of our minds is at the same time an aspect of our brains. Of course.

But it simply does not follow from this banal observation that mental problems are “caused” by neurochemical imbalances. Apart from tumors and the like, the causation may be expected as a general rule to run in the opposition direction.

Here is an analogy that may make this point easier to grasp.

I meet a friend on the street, and he says to me: “Hi, how are you?”

I respond: “Great, how are you doing?”

Now, there is not the slightest doubt that when I see my friend, and again when I hear the words, “Hi, how are you?,” my brain chemistry undergoes a series of continuous changes. Similarly, in order for me to produce the words, “Great, how are you doing?,” more neurochemical changes must occur.

So, doesn’t this mean that the one set of low-level changes in neurotransmitter concentrations gives rise directly to the second set? In short, isn’t it all just brain chemistry, which goes to show that Professor Sroufe is mistaken?

No, it isn’t, and no, it doesn’t.

The reason is that the activity of our brains is organized into different levels and occurs across different time and length scales. Much research indicates that higher-order nerve cell assemblies—basically, coordinated action by millions of neurons cooperating across large areas of the brain—are what embody our conscious thoughts and feelings.(2)

These higher-level processes have an autonomy of their own, and are sensitive to the meanings we encounter in the world around us. It is their activities that cause the biochemical changes at the lower level, not the other way around. This is an instance of—to use a philosophical term of art—”top-down causation.”

This alternative, “dynamical” picture of the mind/brain—which at one and same time accords better with common sense and is at the cutting edge of scientific research—is in every respect more plausible than the standard reductive view. It enjoys substantial empirical support. But above all, it better explains how it is possible for our brains to instantiate the persons who we are—persons who are above all responsive to meanings, purposes, and values, and not just driven hither and yon by biochemistry.

Neurotransmitters to not recognize friends or exchange greetings. People do.

This is not just an abstract philosophical point. Rather, it speaks to very important and very tangible concerns.

Professor Sroufe goes on to discuss some of these, as follows:

Putting children on drugs does nothing to change the conditions that derail their development in the first place. Yet those conditions are receiving scant attention. Policy makers are so convinced that children with attention deficits have an organic disease that they have all but called off the search for a comprehensive understanding of the condition. The National Institute of Mental Health finances research aimed largely at physiological and brain components of A.D.D. While there is some research on other treatment approaches, very little is studied regarding the role of experience. Scientists, aware of this orientation, tend to submit only grants aimed at elucidating the biochemistry.

Thus, only one question is asked: are there aspects of brain functioning associated with childhood attention problems? The answer is always yes. Overlooked is the very real possibility that both the brain anomalies and the A.D.D. result from experience.

Our present course poses numerous risks. First, there will never be a single solution for all children with learning and behavior problems. While some smaller number may benefit from short-term drug treatment, large-scale, long-term treatment for millions of children is not the answer.

Second, the large-scale medication of children feeds into a societal view that all of life’s problems can be solved with a pill and gives millions of children the impression that there is something inherently defective in them.

Finally, the illusion that children’s behavior problems can be cured with drugs prevents us as a society from seeking the more complex solutions that will be necessary. Drugs get everyone—politicians, scientists, teachers and parents—off the hook. Everyone except the children, that is.

Obviously, individual children will vary tremendously in their needs, and we ought to take a pragmatic, not an ideological, approach to particular cases. Medication may certainly be indispensable under some circumstances.

But pragmatism involves a judgment as to what the desirable outcome is. For example, is the desired outcome simply make a child sit still? Or is it to uncover the reason why he has trouble doing so? Furthermore, the current mainsteam reductive view of the brain is itself a deeply ingrained ideology. So, it is no simple matter to determine what common sense and pragmatism prescribe, when it comes to the science of human behavior.

We might begin to think through the mess we have gotten outselves into by asking ourselves this question: How did we ever get along without Ritalin for all those years? Why were A.D.D. and A.D.H.D. unheard of, when my older readers were growing up?

Over the past three or four decades, we as a society have become downright schizophrenic in our attitudes towards children.

On the one hand, discipline has become a dirty word, and corporal punishment a crime against humanity.

On the other hand, we make completely unreasonable demands upon young children—particularly boys—who are required to sit still and concentrate for longer periods of time at a stretch than they were designed by nature to do.

Can it be a coincidence that the A.D.H.D. epidemic has occurred at the same time as the abolition of recess?

* * *

There has already been a hue and cry against Professor Sroufe for his article. But scientists like him who have the courage to speak the plain truth—which ought to be apparent to everyone with common sense—are to be applauded.

Some may condemn the injection of philosophical considerations into science. But it is precisely Professor Sroufe’s understanding that the human person transcends neurotransmitters that makes his essay so refreshing—and so important.

At the interface between science and human behavior, bad philosophy is not merely academic. It is not harmless. It can and does lead to bad science, with real consequences for real human beings.

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(1) Lest anyone fear the NYT is going all squishy, I should point out that in the same Sunday Review section (Jan. 29), they published a particularly hackneyed piece by Peter Singer called “Ready for a ‘Morality Pill’?”
(2) See, for example, Antony Chemero, Radical Embodied Cognitive Science (MIT Press, 2009); Walter J. Freeman, How Brains Make Up Their Minds (Columbia UP, 2001); Robert Hanna and Michelle Maiese, Embodied Minds in Action (Oxford UP, 2009); and J.A. Scott Kelso, Dynamic Patterns: The Self-Organization of Brain and Behavior (MIT Press, 1995).