Modern Moral Panics
It seems that wherever we turn, we find yet another “campaign” to promote some mental quirk or other to the level of an impending catastrophe. This month’s hot favourite is ADHD, the “epidemic” that didn’t exist as recently as early 1980. Now, it is such a threat that Federal Parliament will give up some of its valuable time for an enquiry. Submissions close on June 9th but I haven’t started mine so I’ll have to get a move on. My theme will be the same as always: psychiatrists don’t know what they’re talking about. The reason is that they don’t have a theory of mind or of mind-body interaction; they don’t have a model of mental disorder of any sort; no theory of personality and no model of personality disorder. When it comes to drawing a line to show where normality ends and abnormality starts, no psychiatrist can do better than guess. All talk of genes and neurotransmitters and “evidence-based psychiatry” takes place in an intellectual vacuum.
With the ADHD panic, we now have a range of authorities urging the population to examine themselves and make sure they and their families aren’t tainted, because taint is lifelong and devastating. This means we have all the background features for a moral panic. Wikipedia defines it thus: “A moral panic is a widespread feeling of fear, often an irrational one, that some evil person or thing threatens the values, interests, or well-being of a community or society.” This comes from the British sociologist, Stanley Cohen, who published a study entitled Folk Devils and Moral Panics in 1972. He listed five features that are normally seen in such episodes:
- An event, condition, episode, person, or group of persons is perceived and defined as a threat to societal values, safety, and interests.
- The nature of these apparent threats are amplified by the mass media, who present the supposed threat through simplistic, symbolic rhetoric. Such portrayals appeal to public prejudices, creating an evil in need of social control (folk devils) and victims (the moral majority).
- A sense of social anxiety and concern among the public is aroused through these symbolic representations of the threat.
- The gatekeepers of morality – editors, religious leaders, politicians, and other “moral”-thinking people – respond to the threat, with socially-accredited experts pronouncing their diagnoses and solutions to the “threat”. This includes new laws or policies.
- The condition then disappears, submerges or deteriorates and becomes more visible.
The biggest “moral panic” of the post-War era in the West was the “Reds under the bed” threat that led to McCarthyism in the US and to the surveillance state, both of which are still with us. Historically, the panic over witchcraft lasted nearly 300 years and consumed hundreds of thousands of lives all through Europe and in the colonies. More recently, we’ve had the Terrorist scare, leading to queues to board planes and more surveillance, but medical panics are a bit different.
When we talk about a medical moral panic, we are not talking about what is usually known as “mass hysteria,” for example, Royal Free Disease of the 1950s. This started among nurses at the Royal Free Hospital in London in 1955 and consisted of a variety of symptoms such as choking, fainting, irregular heart beat, spasms, numbness and tingling and so on. These are, as everybody knows, the cardinal symptoms of anxiety, and anxiety is the most communicable of all human emotions. Generally, it affected teenage or young adult women living together and, importantly, away from home for the first time. One of them got a bit sick from something, her friend started to worry and then said “I’m breathless too” followed by a chorus of “Me too’s” and then it was on, hundreds of nurses or students or young Army recruits (yes, even men) reporting sick with symptoms with no objective signs (fever, blood changes, bugs in the bowels, etc). It still happens from time to time, somebody will report a gas leakage near a school and in no time, the school has to be evacuated due to everybody twitching, gagging and fainting, even though the wind was blowing the other way.
So how does the ADHD craze meet the criteria for a moral panic? With children or adolescents, it’s the parents who panic because they feel that if they don’t do everything for their little darlings, they are failing morally. The “threat” is not new, it’s not invented, but it’s something unexplained that has been around for a long time. In Medieval Europe, there was a lot unexplained – famines, plagues, comets, eclipses and so on – but the main motivation was social/political. In a pamphlet published in 1486, entitled Malleus Maleficarum (Hammer of the Witches), a German priest whom his bishop regarded as “senile and crazy” listed all the dreadful things witches do and how they should be discovered and punished. Somehow, he got Papal justification; before long, the Inquisition was instituted and the rest is history.
More recent “moral panics,” in particular, the Yellow Peril and the Red Peril, were almost entirely beaten up by the wealthy elite and the politicians and media they controlled but that’s an enormous subject in its own right. Exactly as Cohen described, this century’s panic, the “Islamist terrorist peril,” has fallen below the event horizon and we’re back to fearing Dr Fu Manchu and Ivan the Terrible – or should that be Vlad the Impaler? Meanwhile, down here at the local level, today’s version of The Ever-Present Threat is the health and welfare of our offspring, and the moral component is that if anything goes wrong with little Johnny or Mary, it’s the parents’ fault and they should be ashamed of themselves if they didn’t detect it/ investigate it/ treat it. Aldous Huxley commented on this in his extended essay, Brave New World Revisited:
A society, most of whose members spend a great part of their time, not on the spot, not here and now and in the calculable future, but somewhere else, in the irrelevant other worlds of sport and soap opera, of mythology and metaphysical fantasy, will find it hard to resist the encroachments of those who would manipulate and control it.
He wrote this in 1958. Who is manipulating and controlling the panic over ADHD? Drug companies. Over the past fifty years, Big Pharma has made trillions of dollars from psychiatric drugs but they’re running out of steam – and time. The patents on their “blockbuster” drugs are expiring and their promise to find the biological cause of mental disorder has gone precisely nowhere. Drug companies don’t have any new classes of drugs in the pipeline and the human genome project has come and gone with no astounding insights into the nature of mental disorder, so most of them are giving up on mental disorder. Today’s Really Big Deal is immunology, as in immunisations against all sorts of bugs and immune treatment for cancers. The big target, of course, is immune treatment for Alzheimers, which would dwarf all previous drugs put together.
So all they can do is repackage and repurpose their existing portfolios of psychoactive chemicals to try to get new patents and wring a bit more money out of it before the taxpaying general public realise they’ve been taken for a ride. We’ve talked about brexpiprazole and Alzheimer’s agitation (May 9th), and tetrabenazine for iatrogenic tardive dyskinesia (May 23rd). In the case of ADHD, they have a far better business model: get your patients hooked on your drugs and you’ve got them for life. Regardless of who proves what about the brains of jittery or day-dreamy kids, once an addict, always an addict. From the capitalist point of view, it doesn’t get much better. The only better scam is charging rent on burial spaces in cemeteries. That way, you’ve got them for eternity.
The current push to make these drugs available to all arose because, until recently, they were only available for children. That was a problem for the children because they grow up and – how unexpected – they can’t get off the things. Except their supply has dried up, so they turn to the black market, buying drugs at school gates, or to much worse variants like methamphetamine (ice) or cocaine for the wealthy. So there’s pressure from them to list stimulants on the Pharmaceutical Benefits Scheme for adults but also, amphetamines are wonderful for anxiety. All the users will tell you: “I know I shouldn’t take them but I can’t resist, I feel ten feet tall and bullet proof.” So anybody who suffers from social or performance anxiety can drop a dexie and, mirabile dictu, cope. But nobody likes to admit they’re anxious, anxiety is still very widely seen as a moral failing. Far better to have a genetic disease (even though none of your relatives had it) and push the government to provide the drugs for adults. Finally, there are plenty of dealers who will memorise the symptoms from the many lists on Dr Google (this one from Cambridge University can’t possibly be wrong, can it?), front up at one of the many drug farms springing up to service this growth industry and you’re in clover.
The problem behind all this is that, as psychiatry doesn’t have a model of mental disorder, anything goes. All the symptoms listed on that checklist from Cambridge are equally or better accounted for by anxiety. At least 15% of the population are significantly affected by anxiety at any one time. If you can get 15% of the population on addictive drugs, you’ve got it made.
Aldous Huxley again from 1958:
Assembled in a crowd, people lose their powers of reasoning and their capacity for moral choice. Their suggestibility is increased to the point where they cease to have any judgment or will of their own. They become very excitable, they lose all sense of individual or collective responsibility, they are subject to sudden accesses of rage, enthusiasm and panic.
Or, in the words of Henry Mencken:
The whole aim of practical politics is to keep the populace alarmed (and hence clamorous to be led to safety) by menacing it with an endless series of hobgoblins, all of them imaginary.
This is also true for practical capitalism: Keep them alarmed so they hand over their money for something they don’t need. Unlike witches, anxiety is real. The idea that it is a biological disease of the brain is a hobgoblin.