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Edward J. Comstock “The End of Drugging Children”

Comstock, Edward J. 2011. The End of Drugging Children: Toward the Genealogy of the ADHD Subject. Journal of the History of the Behavioral Sciences 47(1): 44-69.

[…] over the course of the century, through new relations between knowledge, the body, and techniques and technolo-gies such as the drug test and brain scanning, ADHD emerged at the intersection of an ethi-cal knowledge and practice that reflects an emerging psychiatric power, but that cannot be reduced to the terms of social control. (45)

[…] the nosography through which the deviant subject was diagnosed relative to external moral/juridical values or standards is replaced over the course of the century within a shifting discourse on the body built around behavioral norms, where abnormal behaviors of any kind become a potential sign of ADHD. (45)

[…] the valuation of behavior is given a new basis in the “deepest” levels of the individual—where the individual represents the self as a subject of knowledge and rational investment, and where drugs work to establish our true identity. (46)

To begin with, the person with an attention deficit or hyperactivity did not occupy a positive identity as a “human kind” (e.g., Hacking, 1991; Hacking in Wasserman & Wachbroit, 2001); rather, these individuals were understood to have (heterogeneous) underlying psychological conflicts that resulted in antisocial behaviors that the drugs, alongside other therapeutic techniques, were meant to eradicate (deviancy in gen-eral). The focus was on behaviors, conformity, and institutional roles. (52)

The key word here is “adjustment”; Bradley was not anticipating a return to some more inherently normal or ideal self for his subjects, but rather a return to more socially normal (adjusted) behaviors and roles. Ultimately, the drug is used to treat behavior—in the first instance to eliminate socially unacceptable behaviors— providing the conditions under which one can do better in school. But drugs only work in this regard by temporarily eliminating unwanted behaviors, not by addressing an underlying disorder. (53)

Indeed, it was not until the 1950s, and the invention and diffusion of chlorpromazine in psychiatric institutions, that some psychiatrists would begin to claim drugs as something like a cure (or at least a medical treatment) for mental disorders. (53)

But for the purposes of the genealogy of ADHD and the medicating of behavior disorders, the major significance of Bradley’s work is in shifting the nature of the problem from behaviors as a sign of an organic or metaphysical deficiency, to behaviors as the problems themselves. To wit, shortly following Bradley, hyperactivity becomes not a sign of minimal brain dysfunction or organic pathology, but a “disorder” of its own: hyperkinesis. And for the first time drugs are used in processes meant to produce behaviors and identities, rather than solely to eradicate immoral behaviors owing to moral concern.13 As institutionalized practices of power created new possibilities for managing and producing behaviors, the subject of knowledge shifts accordingly. (55)

[…] while Bradley and the experimental psychologists understood stimulant medication to work precisely through the emotional effect of the “drugging” of the child and the “sense of stimulation, well-being, and confidence” that the drug imparts (Bradley & Bowen, 1941, p. 101), now it is understood that the drugs “stabi-lize the brain” and normalize biological “function,” making the most inner and essential mental processes of the child “more normal” (Oettinger, 1971, p. 163). What an incredible reversal! (56)

In part, no doubt, we see here a shift in theoretical models—the passing from behaviorism to cognitivism as the en vogue theory of child development in education and psychology. However, at a more fundamental level, this shift can be attributed to the emergence of a new body—a new human nature made intelligible in part by positing a universal functioning of the individual as naturally self-interested and entrepreneurial. (56)

The difference is that by the time of the Johns Hopkins studies in the early 1960s, “usefulness” and “improvement” are not simply articulated relative to external social norms—norms derived from ethical and institutional custom and law—but instead these developmental concepts are elaborated in relation to norms of behavior itself at the level of the individual. (57)

By establishing the brain as the material cause and principle of intelligibility of behaviors in this way, there is a direct relationship between the brain—which “functions” in knowable ways according to a transcendental human program—and behaviors, rather than anbimplied and generic relationship between a physiological abnormality and behavioral abnormality. In this new configuration, behaviors lose their absolute value and are now only intel-ligible by relating them back to the individual (who is reducible to a brain) and the transcendental economical/rational brain program that caused them. In other words, within this circular and self-confirming system of knowledge, behaviors, given this organic basis, can now be viewed and codified in terms of their functionality at the level of the individual rather than in terms of their institutional/moral quality. (58)

[…] in many “official” versions of knowledge, these technologies would help give ADHD the status of a differentially diagnosed neurological disorder, and thus the hard-science status of pathological anatomy and true illness. (59)

The norm, in this regard, is no longer simply mapped on top of the sovereign and juridical as it applies to a universal trajectory of human development (the social norm). By the mid-century, as the culmination of a discourse on deviancy and the body that had emerged years before, the tech-nique of “the norm” becomes freely applied to any and all human behavior by way of anal-ogy to normal and abnormal physical “functions.” As a result, for example, deficiency in attention can become in and of itself a disorder. (59)

So it was through analogy that the deviant was linked to the pathological, as norms of behavior were assumed to reflect norms of the body and by proxy the inherited code of the species—morality and law were inscribed in the disciplinary body through the inherited human nature (which, of course, the deviant deviated from). (60)

At this point, to be medically abnormal, one had to first be socially abnormal, and the power of moral law and custom always preceded medical power. (60) -> No longer referring to social deviancy  per se, these mental technicians were able link identity to the “normal” or expected response to the drugs themselves, thus making the analogy itself—the major issue psychiatric power had to overcome to insinuate itself in the institutions—invisible. (60)

But perhaps most importantly, because psychotropic drugs replace institutional moral and juridical norms as the test for this behavior disorder, the new disorder could be found in anybody and in any behaviors based no longer on these norms but on the reaction to the drug in relation to a synthetic ideal of behavior. The fact that the drugs “work” in making the individual function better is often enough. And in this process, by bridging the gap between behaviors and the body, psychotropic drugs establish an ostensible  causative relation to appear between brain and behavior, where before (at least in cases where no physical pathology was evident) there was only an analogical relation between behavior and body. (61)

Once it was understood that brain function was at issue with ADHD, the use of medications was given its final justification as the best way to reach the disorder itself. The seeming “paradox” of drug effects on the ADHD-type could be reconciled—without resorting to an explanation that referenced the euphoric dimensions of the drug—by recognizing that stimulants allowed the brain to function more normally, more naturally. (62)

Now, for example, instead of referring to the abstract con-cepts of happiness or discontent, one could reduce these things to the “pleasure center” in the brain and speak of the quality and character of mental representations, and then use EEG technologies as empirical evidence. Hyperactivity, rather than belonging to an organic defect, becomes reducible to the firing of synapses—and therefore can become in and of itself an abnormality. (62)

[…]I believe that normality itself finds its basis in a “pure” discourse (and a tech-nology) that has the effect of opening up all behaviors to normalization techniques. (63)

Drugs become a test of the pathology in question. They work not only through the eradication of behaviors, but in the production of entirely new identities that extend from these tests. We see here a kind of inversion of the relationship between the norm, drugs, and identity compared to the relationship we saw with Bradley. (63) As the basis of the norm shifts from social external standards to the “deep” spaces of individuality, the individual him/herself replaces a universal social reality as the principle of a knowledge of behaviors. (63)

behaviors are now only given value in relation to the complex interplay of the volitional self, environmental context, and the particular biological/developmental needs and limitations of the individual. And whereas before only illegal and immoral behaviors were viewed as symptoms of a developmental disorder, where behaviors themselves were the sign and  the symptom of the disorder, by the late mid-twentieth century all behaviors become potential symptoms of the malfunctioning organism. (64)

Whereas before one was normal with respect to an ontological discourse based on the absolute construct of morality and the universally applicable social contract, now, freed from this discourse, science bases its new mode of seeing and knowing on nothing but a discourse on human behavior itself. I believe that this was the final transformation or rupture in the intelligibility of the human body during the twentieth century. In the shifts within the discourse on the ADHD-type, we can see a compelling example of an entirely new, nonreciprocal, intelligibility or dispotif of the body that emerged over the course of the century around the enterprising and self-interested individual, Homo economicus. (66)

The goal is no longer to identify deviant individuals or to control deviant behaviors—both of which extend from an intelligibility that ascribes absolute (moral) value to behaviors—but to produce new possibilities of behavior and identity bychanging the ethical relationship Man has with him/herself. (67)

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