“But Steve freaked out,” David says. “He was yelling at Kevin, screaming, about what an asshole he was, what a shithead.” Kevin was laughing at Steve’s impotent rage and called him a “fag.” Enraged and crying, Steve picked up a stick from the ground and threw it at Kevin. It hit him in the chest and bounced off. Kevin took a single step towards Steve. Obviously crying, Steve ran off, leaving his backpack behind. Kevin shouted “you better run, fag!” and started laughing. Before long, the rest of the guys were laughing at Steve as well.
“What about Steve?” I ask.
“Oh, he got over it,” David tells me. “He was hanging around with Kevin again a week or so later.”
“And nothing happened to Kevin?”
“Nothing EVER happened to Kevin.”
While talking with a psychoanalyst who had a working knowledge of the case, I was getting nowhere getting him to explain what was wrong with Kevin Madden. The forensic scientist who had examined him at the Center for Addiction and Mental Health called him a “psychopath,” so I asked the psychoanalyst to explain exactly what that meant.
“Well, most of us don’t like to use terms like that anymore,” he told me. Then he began to explain what it did mean, back when it was still in vogue. But the thing he told me that made the most impact was that, to understand how mental illness works, you have to see it in action. On his suggestion, I went looking for it at my children’s school. Since he gave me a few tips on what this kind of mental illness looked like, it didn’t take long to find.
“Jason threw a brick at Emily today,” my seven-year-old son told me as I came up to greet him in the yard. (None of the kids’ names are real.) He didn’t seem scared or upset when he told me. It was more like he was reporting the mundane news of the day, like a surprise spelling test or some kid wetting his pants.
Although there are at least a dozen Jasons at the school, I immediately knew who he meant. I had first noticed him at a ball hockey game. While all the other kids who weren’t playing were watching the game, Jason was constantly moving around the gym and making noise. He wasn’t talking or singing or making funny noises to entertain the other boys; he was screaming, screaming as loudly and irritatingly as he could. It was all nonsense, seemingly designed to be annoying as possible. Instead of trying to make things better for those around him, he appeared bent on trying to ruin everyone else’s good time.
The coach, a friend of mine, repeatedly asked him to stop. “Quiet, Jason,” he said, over and over again. “Please be quiet, Jason.” It didn’t do any good. Eventually he gave up, but Jason didn’t. He just kept on screaming. Both he and the coach knew there wasn’t anything anyone could do about it.
When Jason finally got to play, he didn’t help his team much. He spent most of his time on the floor swinging his stick at shoulder level and yelling at the other kids as they ran by. The coach diligently noted and corrected every other incidence of high sticking, but had already given up on Jason, who was pretty much allowed to do whatever he wanted.
When Jason was subbed out again, he came to sit beside me. He didn’t like me, but he stared at me a lot. He kept his stick, even though another kid who was actually playing asked him if he could use it. He used it repeatedly to jab at the ball when it came near—showing far more alertness and coordination than he did while playing—and at players on both teams. While sitting out, he hit at least four kids with his stick. He denied two and claimed the other two were accidents. I was watching, he was lying on all four.
Then a kid I know, Miguel, a good kid, stepped over the bench to get off the floor. He tried to step over Jason, who was lying down in his way, but Miguel’s foot grazed Jason’s back. “You kicked me!’ Jason shouted. “You kicked me!” He then made a sound that was sort of like crying, though there weren’t any tears. Then he ran, still making that noise, all the way to the coach, and begged and pleaded with him to punish Miguel.
Jason was still complaining when his turn to play came up again. He started out trying hard, but quickly became distracted. The one time he managed to get his stick on the ball, my son managed to steal it from him. Immediately I was concerned. Jason and my son normally get along, but in his state of mind and with a potential weapon in his hand, I wasn’t sure it’d be okay. It wasn’t.
After the steal, Jason chased my son around the floor, swinging his stick at his head and missing. He never came close to connecting, mostly because he stopped to swing and my son (who had no idea this was going on behind him) never stopped moving.
Jason soon tired of this, or forgot why he was angry. Instead, he set up camp behind one of the nets and started moving it around. He wasn’t trying to give his team any advantage; rather, he just seemed to enjoy upsetting the goalie. Eventually, a couple of bigger boys came over and stood on the back of the net so Jason couldn’t move it anymore. He swore at them, then went to the center of the floor and swung his stick, oblivious to the game that was mercifully coming to an end around him.
After the game, I asked the coach about Jason. “Oh, he’s a handful, all right,” he said. “But he didn’t hurt anybody—and he’s just seven.” To me, he seemed to be more than a handful. He appeared to be fixated on hurting someone, anyone other than himself. And, as the weeks and months passed, I found out later that he did hurt people. My son would tell me that Jason had kicked this kid or thrown something at another kid. I asked my son if Jason had ever done anything to him. He looked at me, astonished, and said, “No, I’m bigger than him.” He then shook his head as though I had asked him something so stupid he was almost too embarrassed on my behalf to answer. I found out that a few run-ins with boys his size or larger didn’t always end well for Jason, so he learned to target smaller, weaker or less bold children, usually girls.
Jason’s parents won’t talk to me, but their close neighbor (who has kids at the same school) offered her observations. “He’s always been like that, even when he was a toddler,” she told me. “My kids won’t go near him, I don’t have to tell them.” She also told me that Jason’s mom had told her that they were seeking help for Jason’s Attention Deficit/Hyperactivity Disorder (better known as ADHD).
Said to affect about one in twenty people in the world, ADHD is a behavioral disorder indicated by a lack of attention, forgetfulness, distractibility and poor impulse control. That last symptom means that people with ADHD find it harder to control their desires when they come in conflict with social mores. For example, a child who shouts out answers in class, even though he or she knows the procedure is to raise his or her hand and wait to be acknowledged by the teacher, is showing poor impulse control.
Many people deny or minimize the existence of ADHD, suggesting that the symptoms that fit the profile really just amount to childish behavior and that we as a society are just too willing to rationalize, justify, classify and ultimately medicate any situation for the sake of convenience. ADHD was even parodied in The Onion as “youthful tendency disorder.” But the medical community and millions of concerned parents are convinced that it’s real.
Although the name ADHD is relatively new, the concept isn’t. Hippocrates of Cos II, almost universally considered the father of modern medicine and the author of the famed Hippocratic Oath, wrote about a condition in 493 B.C. that we would now recognize as ADHD. He attributed the disorder to an excess of fire in the patient’s bodily humors and prescribed lots of water and a bland diet that forbade red meat.
For a very long time after that, ADHD was observed, but rarely noted. William Shakespeare, a perhaps unmatched observer and cataloger of human behavior, once wrote about a “malady of attention.” It is interesting to note, though, that he was speaking of an adult, not a child. But for the most part, behavior we’d now describe as symptoms of ADHD would historically be attributed to youthful exuberance or a simple lack of discipline or intellect.
The disorder didn’t even have a widely accepted name until 1902. Pediatric orthopedist George Frederic Still had already made a considerable name for hi
mself by then in the study of juvenile arthritis—Still’s Disease, a degenerative bone disorder, is named in his honor. But while treating the bones and joints of thousands of children, he developed a consuming interest in their personalities and behavior. In a case study of 20 “problem” children at King’s College Hospital in London, Still noticed his subjects to be to be “overly emotional,” “lacking in inhibitory volition,” and “lacking in the power of attention.” He noticed they all engaged in exaggerated, “fidgety, almost choreiform [involuntary]” movement.
Still also found them to be “aggressive, defiant and [likely to be] cruel to others.” Delving deeper, he observed that the children’s behavior was not altered by punishment. Although he determined that the subjects had a “genuine fear of punishment,” it did not prevent them from engaging in activities that they knew would elicit it. In fact, often times a child would go back to the activity he was punished for immediately after the punishment was over and in full view of the staff. One child in the study consistently stole items from the hospital and other children, then presented them to his parents, despite knowing that they would punish him.
Still was genuinely surprised by the consistently “mischievous, destructive, dishonest and spiteful” behavior the kids showed. And, as was customary at the time, he put the phenomenon in moralistic terms, referring to the disorder as a “defect of moral control.”
Although he acknowledged that moral control—the ability to determine good from bad, and to act appropriately—was a taught skill and not something children were born with, he theorized that a defect of moral control was largely a physical problem. After he discounted any children from what he considered poor or ineffective parents from the study, all of the children in his study had some physical or inherited factor that he believed left them prone to behavioral problems. Many of them had a history of tumors, meningitis, epilepsy or significant head injury as infants or children. The remainder, he observed, came from families with a history of depression, alcoholism, suicide or, what was at the time a popular catchall diagnosis, “feeblemindedness.”
Convinced that the root of undisciplined behavior was damage to the brain, he called his discovery “Post-Encephalitic Behavior Disorder.” As a result, hyperactivity was associated with brain damage and, after the 1918 flu epidemic left millions of children with organic brain damage, the two became almost synonymous. As surely as a limp was the result of a leg injury or a congenital defect, so hyperactivity, a lack of discipline or even criminality—the thinking at the time went—must have come from head trauma or some inherited defect.
It was a fatalistic way of looking at things. Any child with behavior problems could blame it on a (perhaps forgotten) knock to the head or something inherited from a similarly luckless ancestor. The flipside of that concept was that any child unlucky enough to suffer a head injury or know of a questionable relative, could expect to lose at least some disciplinary control and would have to live with the accompanying stigma that came with the belief he or she would eventually lose control of their moral compass.
It wasn’t until 1960, when a woman of towering intellect, immense courage and almost superhuman doggedness challenged that concept. Stella Chess was born to Russian immigrant parents in Manhattan’s Lower East Side in 1914. She became a child psychologist in 1938, and later that same year, she married fellow child psychologist Alexander Thomas, who immediately became her collaborator.
After years of cutting-edge research, she became notorious, and then famous, after she challenged the all-powerful Freudian opinions of the time. She had a particular problem with the widely held beliefs that experiences such as weaning and toilet training were viewed as traumas that had profound effects on subsequent behavior. Injecting a little common sense to the argument, she wrote: “It seems incredible that a task accomplished routinely in most of the civilized and uncivilized world for a very long time could create so much worry in 20th-century Americans.”
Her drive and reputation allowed her to undertake perhaps the most ambitious psychological experiment ever. Started in 1956 and continuing to this day, the New York Longitudinal Study of Child Development closely followed the lives of hundreds of children of various ethnic backgrounds and financial strata. Instead of studying a small group of children (Still had drawn his conclusions from a test of just 21 subjects.) with one characteristic and trying to figure out what caused it, she took a large cross-section of kids and studied everything about them.
She found that her subjects fell into three very broad categories: easy children, difficult children and slow-to-warm-up children. The difficult ones demonstrated the same symptoms that Still’s “morally deficient” ones had. But while Chess acknowledged that such children could come from “adequate to excellent” parents as well as poor ones, she also found that many of them reported (or showed) no evidence of brain damage of any kind or any form of inherited fault.
Instead, she described these children as “hyperactive” because they carried out “activities at a higher rate of speed than the average child, or [were] constantly in motion, or both.” Chess theorized that hyperactivity could be the result of any number of factors and that brain injury is just one of them. Although her ideas were quickly accepted in the United States, European doctors held on to the older idea that hyperkinesis (as they called hyperactivity) was always the result of injury or defect until the late 1980s.
Chess spent the rest of her life trying to help what she called “difficult” children. She wrote books with titles like Know Your Child, Your Child Is a Person and How to Help Your Child Get the Most Out of School. She continued the Longitudinal Study, maintained a private practice and worked as a professor at New York University’s Child Study Center. When her husband and partner died in 2001, the university offered her emeritus status. She refused so that she could continue her daily work. Chess died March 14, 2007, aged 93. Her colleagues suspected as much because it was the first day in decades she didn’t show up for work on time.
But while Chess and her colleagues did much to illuminate the dark world of hyperactivity, they couldn’t figure out exactly what caused it. And, since nobody was sure what caused hyperactivity, there was little anybody could do about it.
At the time, the standard treatment was therapy. It wasn’t all that effective, but there was little else they could do. Help came, ironically enough, from a stimulant.
Chemical stimulants were in high demand in World War II—every one of the major armies fed their soldiers amphetamine, methamphetamine or even cocaine to keep them alert and confident in the face of combat. Nobody denied that the drugs worked and, in the heat of battle, side effects were not considered important.
In 1944, a Swiss company called Ciba—later Ciba-Geigy, now part of the enormous Novartis firm—developed a new, easy-to-produce stimulant called methylphenidate (MPH).
Working on the same process as cocaine—preventing the brain’s natural dopamine re-uptake hormones from doing their job, allowing the user to enjoy greater and longer amounts of dopamine, a hormone that increases energy and confidence—MPH was considered just one of the era’s many wonder drugs. It lacked cocaine’s immediate rush of euphoria, took longer to take effect, stayed in the body longer and was nowhere near as habit-forming.
After the war ended in 1945, many of these stockpiled stimulants were put to work in civilian markets, treating everything from narcolepsy and depression to impotence and the sniffles. MPH was put on the market under the name Ritalin in 1957.
Just like cocaine a few generations earlier, Ritalin was specifically prescribed to treat chronic fatigue, depression, psychosis associated with depression, and narcolepsy. Though effective for all of those purposes, Ritalin wasn’t an immediate commercial success, largely because of the existence of cheaper and better-established amphetamine-based drugs serving the same purposes. Ritalin did find a niche in hospitals and rehab centers because of its ability to offset the sedating effects of other medications. It was especia
lly effective and in demand for reviving the victims of barbiturate overdose—a significant concern as “downers” were a prominent recreational drug at the time.
But as Chess’s theories about hyperactivity gained increasing acceptance, researchers looking for a treatment experimented with all kinds of drugs. Ironically, the only one that seemed to calm and slow hyperactive children was Ritalin, which they knew was a potent stimulant. Nobody knows for sure why Ritalin helps ADHD patients, but the prevailing theory now is that people with ADHD have more dopamine transporters than other people and that the excess of transporters starves the brain of dopamine by spreading it too thin. While the increase of dopamine may stimulate those without ADHD, it basically brings those with the disorder up to a place we might consider “normal.”
Despite the side effects (which can include stunted growth and hallucinations) and the potential for addiction, Ritalin almost immediately became a popular prescription for children with ADHD. Doctors began prescribing Ritalin in the 1970s and usage steadily increased. As media attention portrayed Ritalin as the latest wonder drug, and as parents statistically spent less and less time with their children, usage exploded. From 1991 until 1999, sales of Ritalin rose by 500 percent, mostly in the United States.
While few deny that Ritalin works to control the symptoms of ADHD, a significant number of people (including many in the media and some medical professionals) have opposed what they feel is the rampant overprescription of the drug. And, since Ritalin acts as a powerful and admittedly enjoyable stimulant for those without ADHD, its prevalence has created an illicit market for the drug where none existed before.
Rage Page 10
