The Drug Ethic Under the Microscope

by Matthew Raley An opinion piece about A.D.D. medications by L. Alan Sroufe was published in the New York Times on Saturday. "Ritalin Gone Wrong" remained on the Times's most emailed list Tuesday. Also published on Saturday was "An Appointment With Dread", one of a series of online pieces about anxiety medications. The article by Alissa Nutting was also still hanging out on the most emailed list two days later.

A third article about meds and behavior was published the same day. "Are We Ready for a 'Morality Pill'?" was written by the well-known (infamous?) philosopher Peter Singer and researcher Agata Sagan.

All of these pieces deal with the predisposition problem: our behavior seems to be determined by factors beyond our control. We would very much like our predispositions to be biochemical, so that we could jump our ethical and emotional gaps with the momentum of dosage.

Singer and Sagan argue that, if biochemistry predisposes our actions, and if one can demonstrate differences in brain chemistry between ethical and unethical people -- the criterion in their article is reduced to empathy -- then free will is not really a factor in human behavior. So why not take a pill to become better?

(Empathy equals good ethics. It's hard to know who was more sophomoric, the writers of the piece or the editors who said, "Yeah, that's a worthwhile contribution to the millennia of Western thought.")

Nutting gives readers a hilarious look at daily life spent inside an anxious mind, and a less funny peek at how to connive the desired prescriptions out of a doctor. The longevity of her article on the most-emailed list suggests that she is hitting more than people's funny-bone. I hear reviews of anti-anxiety drugs in conversation as if they were films or smart phones.

Sroufe's article is substantive, rigorous, and devastating. He has been studying the psychological development of troubled children for four decades, long enough to see how a supposition about A.D.D. led to a 20-fold increase in the consumption of Ritalin and Adderall over the last 30 years.

The supposition has been that A.D.D. is rooted in biochemistry, and that it is therefore treatable with medication. In the early 1970s, children with A.D.D. who took the drugs showed better ability to concentrate than those who didn't. Open-and-shut. Parents and teachers dealing with behavioral problems day in, day out needed no more proof.

But there are problems.

Ritalin and Adderall, Sroufe points out, are stimulants. They do not calm children. The short-term increase in concentration results from heightened excitement. By 1990, researchers had thought to ask, "How do these drugs affect children who don't have A.D.D.?" Srouf surveyed the literature and documented that "all children ... responded to stimulant drugs the same way." In fact, "versions of these drugs had been given to World War II radar operators to help them stay awake and focus on boring, repetitive tasks."

Sroufe writes, "To date, no study has found any long-term benefit of attention-deficit medication on academic performance, peer relationships or behavioral problems, the very things we would most want to improve." Children's bodies simply adapt to the stimulants.

He rejects the idea that A.D.D. is a biochemical problem. He says hard evidence doesn't establish a link. On the contrary, his own studies point to environment as the culprit. He has followed 200 children born into poverty since 1975. "What we found was that the environment of the child predicted development of A.D.D. problems." Policy-makers don't seem too interested in that conclusion.

Young people are taught very few moral principles. The only one that I hear them repeat consistently is the responsibility to "take your meds." If you don't set your brain chemistry right, you make poor choices. To be sure, there is a relationship between the body and the emotions. Treating the body properly changes your outlook. But those insights don't automatically yield moral and spiritual health.

We are not dealing with the predisposition problem seriously. By attempting to solve it with pills, we have created a society that is ethically helpless.