ADHD. From Hypermedication to Biomedication

ADHD. From Hypermedication to Biomedication

The classic thesis of psychiatry, regarding ADHD, is that it is a neurodevelopmental disorder that, although it is unprovable due to the absence of clear markers, which has not prevented the proliferation of falsified studies, its ultimate cause does not admit of doubt. Symptoms, initially hyperactivity and impulsivity, were reduced via psychostimulants, which, curiously, were mainly focused on attention difficulties. The efficacy studies of the drug never managed to demonstrate much beyond the immediate effects in concentration, typical of any amphetamine in any subject, and instead they verified the side effects (blood pressure, cardiovascular, loss of appetite and growth arrest) and some especially serious (aggressiveness, suicide, toxic consumption in adolescence).

All this, plus the continued denunciation of hypermedication and overdiagnosis by both professionals and opinion-makers, forced a paradigm shift in the presentation of the disorder. The very Agency of Qualitat i Avaluació Sanitàries de Catalunya (AQuAS), dependent on the Department of Health of the Generalitat de Catalunya recently warned that "the persistent abuse of cognitive stimulants to increase performance or for recreational purposes should not be hidden". The first response was the emergence of alternative labels, such as the TCL (Slow Cognitive Time), which defined a group, in the United States not inconsiderable, of children and adolescents who presented serious difficulties in attention and concentration in academic tasks. A sort of "breaded" subjects who, without presenting hyperactivity or impulsivity, also required diagnosis and treatment. Their new “slow-minded” identity reduced the stigma associated with ADHD.

Then they began to talk about, and to create specific units, of Learning Disorders that included a diverse set of sub-labels (dyslexia, dyscalculia, slow cognition) and that put the emphasis on attention and learning difficulties whose cause was increasingly pointed clearly to developmental disturbances. This entire process has paralleled the transition from the DSM to the Research Domain Criteria (RDOC), from a diffuse and confusing taxonomy to a rigorous observation (?) That will include diagnostic tests and novel treatments aimed at activating brain areas involved in these functions. . Now, as Joshua Gordon, current director of the US NIMH, reminds us, it is no longer interested in classifying diseases through a set of symptoms, but through the identification of behaviors and neural circuits and biological mechanisms that support them. The criteria are no longer psychological but come from biology or ethology.

It is the return to behaviorism in its purest version but "in its modern version, with the support of biochemistry, brain imagery, genome sequence and response levels of the cell." Eliminating any allusion to subjectivity, including of course its particular modality of enjoyment. The NIMH All of Us research program is a key element in the prediction-based medicine pioneered by the Barack Obama administration in 2015 to reorient classical medicine toward the personalized medicine of the future. For this, it is necessary to collect the maximum data of each person through their permanent connection to a portal in which they will deposit their health data. This data-driven approach (data-driven-aproach) aims to decipher the behaviors of the subject. This current primacy of neuro has generated the emergence of a new market and today multiple star-ups are already being created with the aim of generating applications for the analysis of this data.

Other companies, including pharmaceutical companies, are also adapting to the new times. Two recent examples. Shire, a leading company in ADHD drugs (Vyvanse, Adderall), has created a spin off to segregate its business of psychostimulants, of doubtful future, and focus, absorbing other companies such as Baxalta specialized in the treatment of hemophilia, in the treatment of rare diseases, a market with a large and promising future in the new personalized medicine. The current education secretary of the Trump administration, billionaire Betsy DeVos, sister of the founder of the contractor Blackwater and activist against homosexual marriage, is the owner of Neurocore with her husband. Company that owns a dozen brain performance centers in Michigan and Florida where biofeedback technology is applied to help children and adolescents with ADHD and learning difficulties, including autism.

Neither ethical nor scientific reproaches have kept him in the least from his intention to generalize the application of this technology for "diagnoses and treatments based on brain data to help children and adults." The company says it uses "quantitative EEG data" to help diagnose problems and then treats them with "proven neurofeedback therapy." As Abel Novoa recently recalled: “Biomedicalization is a step beyond medicalization. Technology is creating new subjectivities by determining new categories of people at risk (for example pre-Alzheimer's), new forms of risk monitoring (genetic tests) and imposing new behaviors in the face of risk (mastectomy or prophylactic oophorectomy) ”. The ADHD universe is, then, a reality that makes us all hyperactive, although that does not make us homogeneous in terms of our inventions of enjoyment.

The return of the Name of the forcluded Father is present today in the submission to the figure that names each subject in relation to a supposed statistical normality. Hence, one of the most paradoxical data of the ADHD “class” is that children born in the last trimester of the year are much more likely to be diagnosed than those born at the beginning of the year.

This new social order that names each of us because of our deficit is, Lacan said, more "iron" than the previous one of the Name of the Father since it annuls the dialectic of desire and confronts us with the superego and its demands for unlimited enjoyment. Thus, where Big Pharma used to be, offering methylphenidate, now Big Neuro and its neurofeedback flourish. Change of identity for the current hyperactive deranged: now they will become slow and defective minds. We will have to be attentive to the off-label use they make and the new symptoms they produce.

The bibliographic references that can be consulted in the original have been suppressed

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Video: ADHD In Adults (August 2021).