Manuel Vallee, University of California at Berkele Non-Profit Organizations and Hegemonic Systems of Knowledge: CHADD's Role in the Growth of Ritalin Consumption

Over the last three decades, in America, there has been a dramatic increase in the prescription and consumption of Ritalin¹ and the other psychostimulant medications aimed at eliminating off-target behavior. In itself the increased consumption of any prescription drug should be a disconcerting fact for as one interviewed M.D. has stated:²

"Every drug we consume is a toxic poison, poisons that have deleterious effects at one or more levels of the body ... The only reason we consume some of them is that some have beneficial side effects." (the emphasis is mine)

Now, while the increased consumption of Ritalin is alarming, it becomes more alarming when we realize that the main consumers of this drug are children. Moreover, whereas 6 to 12 year olds were once the target market, now the drug is being prescribed to infants as young as 2 years of age.³ In the case of the younger children the consumption of Ritalin is even more alarming, for their organs and immune system are having to process these toxic chemicals, even though those bodily systems are still in the developmental stage. Subsequently, one is led to ask why is it that this social phenomenon has come to pass? Why is that an increasing, some would say alarming, number of American parents have led their children to consume these toxic poisons?

The Outline of an Answer

In this paper I will argue that the social phenomenon is the result of three seperate, but inextricably intertwined, struggles⁴, struggles that are never-ending, and whose outcomes are largely shaped by economic and cultural factors. The first of these struggles is being waged over what is and is not acceptable child/teenager behavior.⁵ The rise in Ritalin prescriptions can be seen as an indicator that something has happened with children's behavior: i.e. either it has indeed "worsened", as some might claim, or it could be that the behavior hasn't changed, but that society has become less tolerant of children's behavior, or it could be a combination of both. However, regardless of whether it is the behavior or the social norms that has changed, the end result is that an increasing number of kids are manifesting behavior that is now considered unacceptable.

The second of the three struggles has been waged over how to account for the increased levels of misbehavior; i.e whether to attribute the rise of misbehavior to genetic defects with the individual person or to defects with the individual's environment (including the nutritional, emotional, structural, and/or cultural environment).⁶ Some participants in this struggle have attributed the "problem" to the nutritional practices that have become normalized in America; practices that lead kids to consume a diet high in sugar, chemical additives and pesticides. Others have pointed to the children's increasingly impoverished emotional environments, a social world in which parents have become progressively less accessible (both physically, and emotionally) than they were thirty years ago.⁷ A third group argues that the changing culture has played a part in the "problem", arguing that the rapid-fire nature of present-day American culture has acculturated children to have shorter attention-spans, thus leading to the problematic behavior.⁸ Still others have argued that the problem is structural in nature, that teachers have been inadequately trained to handle the large number of children in their classroom. Moreover, these teachers are seen as being poorly trained to relate to the new generation of kids, kids who are now so educated (via the internet, television, cd roms, etc..) that traditional classroom education no longer holds their attention. However, while each of these positions seem to have salience, it is the "genetic defect" explanation that has gained widespread support. What has happened is that instead of seeing the "misbehavior" within its structural, cultural and environmental context⁹, the problem has been attributed to the individual's biological makeup.

As for the third struggle, it has been fought over how to resolve the "problem" of childrens' unacceptable behavior. In line with the positions taken in the second struggle, some have sought to treat the problem by addressing the dietary, social, cultural and/or structural factors. However, currently the dominant solution is to "fix" the non-conforming individual by administering prescription drugs to him/her. Now, the struggle over how to solve the problem is inextricably linked to the struggle over how to explain the problem, for getting parents to believe that the problem is genetic in nature predisposes them to eschew solutions that seek to redress the problems with the child's dietary, emotional, cultural, and structural environments. Instead of those solutions they are predisposed to seek out bio-medical solutions, which in this case is prescription drugs. Moreover, it is important to note that the outcomes of struggles two and three haven't emerged in an economic vacuum, for those who produce solutions to the problem (such as the pharmaceutical manufacturers) have an enormous economic stake in the matter. Subsequently, we should expect that these producers and their agents will be active participants in the struggles outlined above, and that each will deploy powerful tactics to protect their interests.

The Focus on the CHADD Patient Advocacy Group

In an effort to better understand why the consumption of Ritalin has increased so dramatically in recent decades, I have sought to identify the various agents who have and continue to participate in the struggles outlined above; elucidating the ideological positions they hold vis-a-vis the issue of the children's misbehavior, and how they seek to influence the way that the "problem" gets dealt with. In this paper, my "gaze" shall be focused on one particular agent, that being CHADD (i.e. CHildren & Adults with ADD), the "non-profit" patient advocacy group dedicated to disseminating information about ADD to parents. In particular, I will elucidate the rhetorical and discursive processes by which CHADD has sought to shape 1) the way that parents, and the rest of society, understand and explain the childrens' "abnormal" behavior, and 2) the means by which this socially defined problem gets addressed. However, before I begin this examination I will quickly outline why I have chosen to focus on CHADD.

Why the Focus on CHADD?

One of the initial factors that compelled me to study CHADD is that they are a major player in the struggles over how to understand and address the children's "misbehavior." One of the reasons for their importance in the struggle is that they are the largest patient advocacy group dedicated to the issue of ADD, boasting a membership figure of over 32,000. A second reason is their institutional infrastructure, as they have established over 500 chapters nationwide. Such an infrastructure can be an important in an organization's ability to recruit new members, and to mobilize a constituency.
Subsequently, whenever an organization has that sort of institutional infrastructure and popular support, it behooves us to understand the role they play in shaping the public's understanding of an issue, as well as the cultural practices that emerge from that understanding.

What made CHADD more compelling as a subject of study was the close parallels existing between the ideological framework they advocate, and the interests of the pharmaceutical industry. More specifically, CHADD espouses a bio-medical¹⁰ framework for understanding and addressing the problem of children's "misbehavior", an ideological framework that directly caters to the economic interests of the pharmaceutical industry. Subsequently, discovering this link led me to question CHADD's claim that they were an unbiased disseminator of ADD related information. Moreover, discovering this link compelled me to examine CHADD's role far more closely, for as a patient advocacy group, CHADD occupies a very strategic position vis-a-vis patients and their advocates; i.e. they are in a position to exert a considerable amount of influence over how the patient community understands the problem, and how they seek to solve it. Subsequently, this led me to examine more closely CHADD's actions, while seeking to understand the role of those actions in the struggles over how to understand and address the children's "misbehavior."

The third factor that compelled me to study CHADD is that they play a very active part in the struggle to influence the minds of parents, doctors, and the rest of the public. In particular, CHADD dessiminates information through the annual conferences they stage, conferences that are now attended by over XXXXXX people. In addition, CHADD disseminates information through newsletters, press releases, and their web site. The latter means of disseminating information is particularly important in this era, for the patient community is educated, assertive and predisposed to seek out and use medical information. With this new weapon, a patient advocacy group (such as CHADD) can now disseminate information, and organize constituencies at a far more rapid pace than ever before. Subsequently, the internet has become an important new weapon in the struggle over the minds and consumption practices of patients and their advocates. Theoretically, this weapon of persuasion is available to all. However, the reality is that the advantage tends to fall in the hands of those who have the money, time and energy to fully exploit its potential. Moreover, such inequalities of resources are even harder to perceive when the corporations act under the cover of a non-profit front group, such as CHADD. Consequently, for those who share a concern about corporate power and how it gets used, it behooves us to understand the connections that exist between corporations and non-profit groups. Moreover, it behooves us to understand the processes by which the co-option of these non-profits helps corporations strengthen a hegemony that benefits their industry. Subsequently, in the remainder of this paper I will try to show that CHADD is not the unbiased disseminator of information it claims to be, but rather a non-profit organization whose actions support the ideological and economic interests of the pharmaceutical industry.

In sum, I have chosen to study CHADD because they espouse an ideological position that reinforces the status quo, and because they have a large following in the patient community, they have established a grass-roots network, and they are very active in the process of disseminating information on the issue. In other words, I am studying them because they are a central player in the struggle over how the problematized behavior gets interpreted, and how it gets dealt with.

Notes

¹ Ritalin is the prescription drug that is marketed as the solution to Attention Deficit Disorder (ADD), and Attention Deficit Hyperactivity Disorder (ADHD)

² And which has been reiterated by numerous other interviewed doctors.

³ New York Times...

⁴ Here I am relying heavily on Bourdieu's "fields of power" concept. Such a field emerges around a an issue that is contested by agents who possess different types of capital, which gives them varying degrees of power within that circumscribed social space.

⁵ The principal participants in this struggle have included parents, teachers, doctors, the media, the manufacturers of "cures", and patient advocate groups, among others. For a long time an important group of individuals who were missing from this struggle were the consumers of the drugs, the children themselves. However, lately there have been an increasing number of grown up children who have become outspoken of the treatment they underwent.

⁶ It is important to note that in this struggle the participants take for granted that there is an increase in misbehavior, an increase that has yet to be empirically proven.

⁷ Such a position would be supported by data showing that Americans' now work XX% more hours per week than they did in 1980. Moreover, Americans now work more than any other industrialized nation, including Japan.

⁸ Richard DeGrandpre, Ritalin Nation: Rapid-Fire Culture and the Transformation of Human Consciousness, W.W. Norton & Company, New York, 1999

⁹ Which includes, among other factors, could include changing norms regarding what is acceptable behavior, or, if children are really more active than before, the rapid-fire culture within which the kids are being raised, the increased consumption of chemicals (in the guise of artificial sweeteners and pesticides), the reduced student-teacher ratio's in school, and the possibility that teachers are unable to relate and cope with the new generation of students.

¹⁰ i.e. a position that seeks to problematize the individual, rather than the structure, and to "treat" the problem through prescription drugs.