The ADHD juggernaut rolls on… and why science matters

Where to start? The Hungarian-born American psychiatrist, Thomas Szasz had a very simple approach to mental disorder: it’s all a hoax. The patients, he said, are all pretending to be ill or disabled while, by dishing out diagnoses and pills, psychiatrists are playing their part in an elaborate social game. They also have an extra role of locking up public nuisances under the pretext of them being “mentally ill” but, he insisted, everybody involved in the “mental health” industry knows it’s a racket. Szasz didn’t have a shred of evidence for this but in the 1960s and 70s, his line had enormous appeal, especially to anybody who fancied themselves as “counter-culture.”

At the time, psychiatrists definitely felt themselves to be under attack but today, it’s the other way around. The various “media” are awash with stories of (a) how common, and (b) how dreadful, mental illness is but, three cheers, (c) here comes modern scientific psychiatry riding to the rescue. Szasz died in 2012 and it seems hardly anybody in the younger generations has heard of him, but now everybody is clamouring to be given a diagnosis. The “mental health” industry is laughing all the way to the bank.

So the new “position statement” by the Royal Australian and New Zealand College of Psychiatrists (RANZCP) called “ADHD across the lifespan” has to be seen in this context. First point: It was prepared by a group within the college called the ADHD Network Committee. Who are they? Don’t know, but we do know they are psychiatrists who selected themselves and wheedled the college into approving their committee to work on the position statement. One more thing we know: there were no critics on the committee. There was nobody to ask “Hang on, can we be sure of these results? Is this actually a diagnosis or is it an artefact? Yes, the drugs seem to work in the short term but what about the long term risks?”

Around the world, these types of committees are composed of people who stand to profit in one way or another from the diagnosis. When they sit on a committee which could advance their interests, it’s called “conflict of interest.” This blog gives a list of the world’s top “ADHD experts” and their endless ties to drug companies. The RANZCP position statement did not give any indication of conflicts of interest of the unnamed people who wrote it, but we can be sure they are there. The main conflict, of course, is the fact that the psychiatrists involved make the bulk of their money from diagnosing people with this disorder. If they stop diagnosing it, their referrals will dry up. This is Economics 101: they are paid when they diagnose the disorder so that’s what they do.

For an initial assessment (Medicare Item 296), for which the Medicare rebate is about $240.00, private psychiatrists specialising in making ADHD diagnoses charge from $550 – $2000. This is ipso facto a conflict of interest, so all statements of any committee member who is in that position are flagged as potentially unreliable. Is that statement itself reliable? It is. There has been extensive research over the years to show that practitioners who take money from drug companies are likely to favour them in their diagnoses and their prescribing habits. So before we’ve even read the first sentence in the RANZCP statement, there is clear reason to doubt its conclusions.

Moving on, it says “ADHD is a major mental disorder.” What does that mean? It is “major,” like schizophrenia is a major mental disorder, or major as in common? We don’t know, it’s left to reader to apply to apply their own interpretations. This little debating ploy, where a sentence can be interpreted in different ways, is called an “intuition pump.” The formal definition is that a first or superficial reading of the material leads to a conclusion that is not supported by a closer analysis. It’s a good expression, propagandists use intuition pumps all the time.

Next, we learn that people need “treatment and management throughout their lives.” Except a few lines down, it says the incidence of ADHD is 8.2% in children but only 2.5% in adults, so most don’t need life-long care, they just get over it – without help. So you see how this document is subtly shaping the reader’s perception, shifting the focus from “Is this a real thing?” to “OMG, we urgently need to spend more money to save all these poor people.” And that is exactly the sort of impression that people who make pots of money from this diagnosis want everybody to gain.

But worse: if you take the plunge and stand up in public to say something like Thomas Szasz would have said, such as “I think this whole thing is a racket that’s got completely out of control. These people are not sick in any sense of the word, this is all normal behavioural responses to abnormal life events. Fifty years of expensive research has not shown a biological basis to it, and these dangerous drugs are worse than doing nothing,” then the very demons of hell will land screeching on your shoulders and start clawing and biting. This is because drug companies don’t just pay psychiatrists to tout their products (“lecture fees, honoraria, travel expenses”), they also feed material to the media (“press releases,” “background briefings,” “specialist contacts”) as well as pay for the general public to get involved (“grassroot support groups,” aka astroturf groups).

But drug companies do not do this out of the generosity of their hearts: like the Wicked Witch, they don’t have hearts. Companies do not donate money to anybody (including politicians) unless they think there’s going to be a return on the investment. So the company-appointed role of the conflicted psychiatrists is to poo-pooh any questions about the legitimacy of their science; the role of the media is to make people scared, especially to scare parents about the mental welfare of their offspring; and the role of the “community groups” is to bombard critics with abuse or to ring their local members and scream at them. It’s a pretty good arrangement and it works.

You may have heard of the “Tobacco Playbook.” This was the program followed by the tobacco companies to attack the science that showed their product was dangerous. They even paid the foremost British psychologist, Hans Eysenck, of London University and Institute of Psychiatry at the Maudsley Hospital, £500,000 to “prove” that tobacco wasn’t addictive, it was all due to smokers’ being genetically-programmed to get addicted to anything. That’s the equivalent of about AU$5million today. That playbook was also used by the asbestos industry and, as we’re now learning, by the fossil fuel companies who have been paying vast sums to a few crackpot “scientists” to attack the science of global warming.

So now we have a new playbook. Call it the “ADHD Playbook”: suborn the profession, pay off the media and frighten the general public. You read it here first.

We’ll flick through the rest of the RANZCP position statement as it’s not interesting. I mentioned the meaningless expression “neurodevelopmental” last week; that allows them to use the term “neurotypical,” again without defining it, but it does what it’s supposed to do, which is wow the uninitiated and subdue the critics. No doubt it will soon graduate into a form of abuse: “Oh but you’re just so neurotypical, no empathy at all.” We could safely ignore the whole statement as self-serving propaganda except for this little item: “Equitable access to services for people with ADHD requires system level change.” That means money. It means people being granted pensions on the basis of a diagnosis alone, and then given access to NDIS funds (additional government disability funds to pay for “essential services” from private companies). The problem is that little item under Background:

ADHD is the most common neurodevelopmental disorder, affecting 8.2% of children and 2.5% of adults in Australia … it remains under-diagnosed and under-treated.

The pressure will be on for everybody to diagnose this “condition,” and then for the afflicted to start their drugs, and lodge their claims for pensions and grants. And when the figures double, or treble, it will bankrupt the health and welfare system, not to mention wrecking people’s lives after they are told they’re mentally ill when they’re not. All over a matter with no established scientific basis. This is why science counts, to separate genuine conditions from the fads. “Aha,” you say, “but the Senate enquiry will sort all this out.” No, it won’t. If you check the terms of reference of the enquiry, it is quite clear that the decisions have already been made.

Start with item (a) “Adequacy of access to ADHD diagnosis.” Note that it doesn’t start with “Can we first be sure we know what we’re dealing with?” It says “If you want a diagnosis, can you get it easily?” Answer: Of course, just go to Dr Google and you will find lists of symptoms to memorise that will get you the drugs. Item (c) is more ominous: “The availability, training and attitudes of treating practitioners…” This can be taken as meaning “If you don’t pass our training course and have the right attitude, you’re out, we’ll make sure you’re never allowed to see any of these people. And if you’re too troublesome, we’ll lodge anonymous complaints with the College and with the Medical Board, maybe even tell them you’re mentally-impaired.”

Don’t think this doesn’t happen, especially when they give warning, as the RANZCP does with its last Recommendation, coyly hidden right at the end of the document: “Regulatory bodies (should) utilise professional opinions from experts in ADHD when a review of a psychiatric practice related to ADHD is considered.” That says: “If anybody wants to criticise all of this fanfare about ADHD, the final judges of any matter will be the very people who beat it up in the first place.” That’s like letting spy services decide the fate of a person who has leaked their secrets. Oh, they already do that? Well, psychiatry is following a well-trodden path of capturing the regulators in order to suppress criticism.

When it comes to treatment, that’s open and shut: according to item (e) of the Senate Terms of Reference, treatment means drugs. It doesn’t say “Some of these children are reacting to bad life experiences, so can we look at alternative forms of management?” With adults, it doesn’t say: “How many of these people have a primary diagnosis of personality disorder, because personality disorder doesn’t respond to drugs, and giving them amphetamines is likely to make them worse.” No alternatives are considered, which tells us who wrote these terms of reference: the drug companies, through their proxies.

Item (f) is the killer: “The role of the National Disability Insurance Scheme in supporting people with ADHD, with particular emphasis on the scheme’s responsibility to recognise ADHD as a primary disability.” If the honourable senators have any sense, and some of them actually do, they will recognise this as the Trojan horse that will open the door to millions of people lodging claims for benefits. Meanwhile, people with genuine problems will be elbowed aside in the stampede. More likely, we will see pressure on governments to set up parallel mental health services that only deal with this “condition,” thereby draining funds and staff from existing (underfunded, understaffed) services.

Next item: (j) “The viability of recommendations from the Australian ADHD Professionals Association’s Australian evidence-based clinical practice guideline for ADHD…” In the absence of a formal, publically-available model of mental disorder, “evidence” is what the supporters say it is, i.e. the expression “evidence-based” is code for prejudice. Same goes for Item (k) “International best practice for ADHD diagnosis, support services, practitioner education and cost.” If you ask a zealot, be prepared for a zealous answer.

Item (l) was written for me: “Any other related matters.” Yes, Your Honours, I have quite a few related matters. Like, What about the conflicts of interest? or, Can we drill down on the biological science? What about life events research? Placebo research? And, above all, what about the role of critics in applying the brakes to this shining example of the “madness of crowds”?

That will do for today. Despite what you may hear, I get tired of always being a critic. So why do it? Well, you see, God said that somebody had to do it so I decided it may as well be me.

(PS. That’s not original, it was the composer, Arnold Schönberg).

Welcome to new subscribers, especially the Kiwis, and to fellow-critics in the UK, US, Germany and, not least, St Petersburg. Welcome, Dr Valentina.

And a surprising final note: Last week, I received a letter from the Queensland Attorney-General, personally signed. That was a bit strange, as I hadn’t contacted his office. He assured me that a Bill is in preparation that will authorise visits of the UN Subcommittee for the Prevention of Torture to inspect psychiatric wards in this state. No mention of why they couldn’t do it last October but I’ll see if I can get more information.