More Thoughts on Cultural Inconsistencies

• The Chemistry of Hugs by Jim Brody, 2/26/97
  • Dominance and Too Much Self Esteem by Jim Brody, 2/26/97
    • Tricyclics/SSRI'S/Social Control by Ed Riemann LCSW, 2/26/97
      
      

Responsibility and Happiness; Further Thoughts

There's a persistent contradiction in our treatment goals. Adults are often diagnosed with depression (although not to the extent depression-advocates support); children with inattention. The symptoms can be similar; either disorder can exacerbate the other. Yet, most parents opt first to use a psychostimulant so their child can "do well in school." School performance is such as powerful motivator for parents that they will give medicine "for school" while tolerating inconsistency and impulsiveness in their homes. Physicians are generally comfortable with this decision.

Adults, on the other hand, are treated readily for depression with less consideration for impulse control. It's sometimes difficult (although easier in the past 5 years) to get psychostimulants prescribed for adults despite the likelihood of the stimulant supporting more organized, planned, purposive behavior. It's somewhat easier but still can be difficult to get small amounts of an SSRI prescribed for children. The differing cultural histories of the two classes of medicine result in events that imply we want our kids responsible and working while expecting ourselves to be happy if less driven for excellence. (My adult clients have noted that methylphenidate lets them have a strong surge of "rejection sensitivity" but "put a lid on it"; the SSRIs can often prevent the surge from occurring at all.)

The cultural schism goes further. The Pentagon recently announced it would no longer accept the "Ritalin kids" into the armed services because Ritalin is a "mind altering drug." However, (1) ADHD is such that stimulants are not needed during lively activities such as jumping from planes, or; shooting guns, (2) research might well reveal that 60% of the Marines, 40% of the Navy, and 30% of the Infantry may have qualified for an ADHD label at some point in school. The SEALs and Special Forces may also have qualified for Oppositional Defiant or Conduct Disorders. The same traits that cause a child to have difficulty sitting in class for 12 years sometimes make an exemplary soldier*, (3) a lot of guys refine their skills with tobacco, coffee, and alcohol while defending our nation; these are all "mind altering" substances.

Even though some writers are skeptical, it appears the SSRIs may induce a destructive manic episode in children where there is a family history of mania. It's also difficult at times to distinguish a manic child (driven by Adaptive Systems for dominance) from one with ADHD. Nonetheless, these tools are good; they can be better and we can be better at using them just as we can be better at managing ourselves and our life spaces.

* Brian Goodwin, again. "Find a place to be yourself."

• One Culture at a Time by Ed Riemann, 3/19/97
  • One more reason to slow down by James Brody, 3/19/97