James J. Hughes Deviance UConn – October 28, 2009.
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Transcript of James J. Hughes Deviance UConn – October 28, 2009.
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James J. Hughes
Deviance
UConn – October 28, 2009
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Medicalization of Deviance Defining deviant
behavior as a medical condition
Medical-industrial complex defining us as sick to sell us cures
Doctors claiming social “problems”
Thomas Szasz:Mental illness is just deviance
Peter Conrad: ADD is just deviance
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Medicalization Controversies Childbirth Shyness Aging Depression Addiction ADD/ADHD Aspergers Syndrome Unusual Bodies
Height, unusual genitals Sexual Behavior
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ICD: What is a Disease?
World Health Organization’s International Statistical Classification of Diseases and Related Health Problems
ICD-9 (WHO 1977) – 17,000 codes ICD-10 (WHO 1992) – 155,000 codes ICD-11 (WHO 2014)
569.42 = rectal pain
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Diagnostic and Statistical ManualManual of official diagnoses of the
American Psychiatric Association DSM-I (1952) DSM-II (1968) DSM-III (1980) DSM-III-R (1987) DSM-IV (1994) DSM-IV-TR (2000) DSM-V (2012)
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History of ADD 1930s stimulants prescribed to treat “minimal brain
dysfunction” 1960s “minimal brain dysfunction”
“learning/behavioral disabilities” and “hyperactivity” Ritalin synthesized in 1950s, prescribed in 1960s DSM-II (1968): “Hyperkinetic Reaction of Childhood” DSM-III (1980): “ADD (Attention-Deficit Disorder)
with or without hyperactivity” DSM-III-R (1987): “ADHD” ICD-10: “Hyperkinetic disorders”
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Diagnosing ADHD
DSM-IV criteria diagnose 4x more ADHD than the stricter ICD-10 criteria
DSM-based prevalence estimates between 3-10 percent of children and 3-6 percent of all adults1. Inattentive & Hyperactive-Impulsive
2. Primarily Inattentive
3. Primarily Hyperactive-Impulsive
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Inattentive CriteriaSix+ for at least 6 months to a point that is
disruptive and inappropriate for age: 1. Often does not give close attention to details or makes careless
mistakes in schoolwork, work, or other activities.
2. Often has trouble keeping attention on tasks or play activities.
3. Often does not seem to listen when spoken to directly.
4. Often does not follow instructions and fails to finish schoolwork, chores, or duties in the workplace (not due to oppositional behavior or failure to understand instructions).
5. Often has trouble organizing activities.
6. Often avoids, dislikes, or doesn't want to do things that take a lot of mental effort for a long period of time (such as schoolwork or homework).
7. Often loses things needed for tasks and activities (such as toys, school assignments, pencils, books, or tools).
8. Is often easily distracted.
9. Often forgetful in daily activities.
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Hyperactive-ImpulsiveSix+ for at least 6 months to a point that
is disruptive and inappropriate for age:
1. Often fidgets with hands or feet or squirms in seat.
2. Often gets up from seat when remaining in seat is expected.
3. Often runs about or climbs when and where it is not appropriate (adolescents or adults may feel very restless).
4. Often has trouble playing or enjoying leisure activities quietly.
5. Is often "on the go" or often acts as if "driven by a motor".
6. Often talks excessively.
7. Often blurts out answers before questions have been finished.
8. Often has trouble waiting one's turn.
9. Often interrupts or intrudes on others (example: butts into conversations or games).
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Treatment
Behavioral Stimulant
MedicationRitalin/ConcertaAdderallDexedrineStrattera
(atomoxetine - non-stimulant)
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Diagnostic Creep Where do we
draw the line?
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Conrad on ADD
Conrad’s 1975 “The Discovery of Hyperkinesis”
“The process of medicalization, often seen as humanitarian reform, has another side:
(1) expert control; (2) medical social control; (3) the individualization of social problems;
and (4) the depoliticization of deviant behavior.
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Is ADD a Disease?
There isn’t a sharp, clear indicator but… Heritable Comorbid with Tourettes, OCD, epilepsy
and oppositional defiant disorder Clear differences between ADD brains
and non-ADD brains ADD kids are helped by stimulants,
while not all kids are
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5 Squiffy Aspects of ADHD…that contribute to its
controversial nature:
1. No laboratory or radiological confirmatory tests or specific physical features.
2. Diagnostic criteria have changed frequently.
3. There is no curative treatment, so long-term therapies are required.
4. Stimulant drugs are thought to have abuse potential.
5. The rates of diagnosis and of treatment differ across countries.
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The ADD Lobby
Parent organizationsAssociation for Children
with Learning Disabilities (ACLD)
Children and Adults with Attention Deficit Disorder (CHADD)
Drug Companies Pediatricians and
Psychiatrists
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Anti-ADHD Theories Parental/societal permissiveness Decline of corporal punishment Over-achiever parents Medical capitalism Demonizing boyish behavior Neuroconfimism Dysfunctional education system Bad diet, toxins Television’s effect on the brain Hunter vs. farmer brains
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Regulation of Psychoactive Drugs
DEA has 5 categories of scheduled drugs, then over the counter
ADHD stimulants are regulated the same as narcotics
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Dopamine and Abuse
Antipsychotics and hallucinogens have little potential for abuse, but are still regulated
Caffeine and alcohol are not
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Proposed British Reform
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Decriminalization of Cannabis
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Bell Curve of Brains What if the
right half of brains benefit from stimulants?
What if the right 95% does?
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Dementia, Mild Cognitive Disorder The aging of society will allow increasing
medicalization of attention and memory disorders
ICD: Mild cognitive disorder - A disorder characterized by impairment of memory, learning difficulties, and reduced ability to concentrate on a task for more than brief periods. There is often a marked feeling of mental fatigue when mental tasks are attempted, and new learning is found to be subjectively difficult even when objectively successful.
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Cognitive Enhancement
Therapy vs. Enhancement 5% to 35% estimates of the
use of un-prescribed stimulants by college students as study aids
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Cognitive Liberty
The right to control your own brains, vs.
Society’s obligations to Protect public safety, control selling of harmful
substancesKeep people from selling themselves into
mental slavery
But what if a enhancing drug made you smarter without bad side effects?
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Modafinil (Provigil)
Developed and approved as treatment for narcolepsy and “excessive day-time sleepiness”
Schedule 4 controlled substance
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Review and Take Homes
3 types of ADHD according to ICD and DSM Difference between ICD and DSM Reasons for controversiality of ADHD Conrad’s complaints Alternative theories of ADHD Irrational regulation of psychoactive drugs Cognitive liberty Modafinil