Redd Våre Barn
12 August 2012
More discipline: Medicating schoolchildren in Norway
By Joar Tranoy
This article was first published on 22 July 2012 by Pravasi Today in Delhi:
Joar Tranoy is a Norwegian research scholar, psychologist and criminologist who has written a number of books and articles on social history, on abuse of power in the field of psychiatry and psychology, on child protection at present, and on the history of child protection in Norway. He has held a research position at the University of Oslo, and is now working in the Agency for Children, Adolescents and Families of a Norwegian municipality. Mr Tranoy has functioned as an appointed expert before county committees and courts in child protection cases and as an expert witness for the families in further cases.
The nanny state
Norway is an authoritarian society. The authorities exercise unreasonable and unnecessary power over the behaviour of adults by taking children into care if their parents deviate from what the state prescribes. But this is not all. The children are also under scrutiny, and 'troublesome' children are liable to be taken away from their home, an action which should ostensibly help them but which is certainly perceived by the child as punishment.
A method of regimentation
The environment with a maximum of focus on children´s behaviour is undoubtedly the school. The medicating of behavioural problems in Norwegian schools is approaching epidemic conditions with regard to diagnosing and treating children with behavioural difficulties. This is particularly true of the diagnosis Attention Deficit Hyper-activity Disorder (ADHD). At least 12,000 schoolchildren are medicated by means of the central-stimulating agent Ritalin and similar medications. The number is twice as large as in our neighbouring country Sweden, with twice our population.
Figures from the Norwegian Pharmaceuticals Depot show that the use of Ritalin in the period 2004-2011 had increased from 4,000 to 12,000 in Norway. School-related behavioural problems have become a major individual clinical area of attention connected to regional and nationwide centres with psychiatrists, neurologists, psychologists and special pedagogues in a professional medical environment. "Norway is the country in Europe to follow U.S. development and has the highest consumption of the drug treatment of ADHD. And this worries us" says the head of U.N. Office Drug Control, Giesela Wieser.
Justification by way of diagnosis
Behavioural problems are regarded as a functional disorder in the brain of a biochemical nature. Children are heavily medicated in order to achieve calm in the school. In this way the adults concerned are exempted from responsibility. Such a medical disciplining of disruptive and inattentive schoolchildren often leads to fundamental, problem-creating system conditions. Alternative provision (such as alternative schooling) is precluded because the authorities wish to preserve the semblance of 'integration of all' within a uniform school system.
The diagnostic basis for ADHD is extremely unclear. It is said that children are inattentive because they have ADHD and that they have ADHD because they are inattentive. On the form for diagnosing ADHD the question is asked, for example, whether the child has the following bad habits: Is it not attentive enough to details or does it make careless mistakes in its schoolwork? Does it fumble with its hands and feet, or sit restlessly on its chair? Does it have problems in sustaining attention in tasks or games? Does it often leave its place in the classroom or get up elsewhere when it should be sitting still? Does it not appear to hear when being directly addressed? If the answer is 'yes' to these questions, the criteria for the diagnosis are, so to speak, met. The border between 'sick' and normal is a fluid one.
The registration is undertaken at home by the parents and at school by teachers. When the reports from the teacher and the parents are contradictory, consideration is normally given to the teacher’s report since the latter possesses greater awareness of age-related norms. The symptoms are more easily registered in situations that require self-development, as in the classroom. The deviation may actually not be present in other situations.
The teacher’s assessment often appears to be the decisive one, and the School-councelling service as the expert instance normally follows up the school assessment of who is a 'normal' child. It is not necessarily the pupils who create the problems, but rather the school’s teaching and frameworks that create difficulties for the pupils.
Normally, if parents object to the school´s treatment of their child and do not want the child to be under central-stimulating medication, want to try and give the child better food habits and make it take more physical exercise, or they simply hold that the child is bored at school, then the school will immediately threaten them with reports to the Child Protection Agency. If the parents continue their opposition, their 'lack of cooperation' with the school is considered proof of a 'care failure' and the Agency steps in, puts the child into foster care and authorizes medication. I have seen several cases of this type personally. The family has been denuded of its functions, parents are marginalised. Child experts no longer talk of a child´s family but of its 'care base', i.e. the place where it happens to be staying at the moment.
ADHD and Ritalin in practice
The diagnosis of ADHD is highly subjective and is decided on the basis of culture-relative norms. In addition there are framework conditions and contexts such as, for example, the child’s daily pattern etc., that are not taken into consideration. Moreover the treatment level may vary considerably between children, even within the same family.
The incidence of ADHD shows itself to be proportional to the presence of, and influence by, behaviour diagnosticians, testers and therapists in the schools, not only in the USA but also in Norway.
Social conditions also exert an influence. For example, there is the worsening of the physical and social environment in the schools with reduced opportunities for play and physical development. At the same time the pressure of theory has increased. Children can easily be run over in the school system with its behavioural experts, towards whom even the teachers and advisors feel powerless.
One example is the teenager Tore. There was disagreement as to whether Ritalin could help Tore. After a few months of medication the opinions were divided. The school´s adviser stated, for example: "I am now doubtful as to whether we have proceeded in the right way. Tore has been calmer during the lessons. But several of us are somewhat uneasy. We do not really recognise Tore now. His charm has almost disappeared. There is hardly ever a smile to be seen. His school performance is about the same as before. Purely egoistically one may say that he has become easier to deal with. But he is not entirely Tore any more."
Neither Tore´s parent nor the treating psychologist were willing to comment. But Tore´s friend expressed the following: "It has become calmer, yes. Most of those in class are, perhaps, happy about that, but not me. Tore is not quite the same. I miss his funny and crazy things. Now there is nothing there. The worst time is in the breaks. He doesn´t join anything any more." Tore himself did not wish to say very much. His face showed that he was not particularly satisfied: "I feel that I am no longer in control. My body takes over. I have to have the tablets in order to feel my body. I am no longer able to be aware of anything. I don´t really know what the others think of me. Not that it really makes any difference. I´m the one there is something wrong with." Tore´s class tutor did not really wish to say anything. But he expressed himself in a very serious manner: "This is a very difficult and sad case. The classroom disturbancees have been greatly reduced. It is clear that certain pupils have profited from it."
The results of having defined a problem
The employment of Ritalin appears to serve as a solution or an alternative to changing the school environment and the school system. Ritalin becomes a short-term aid. The child becomes easier to deal with without there being a documented effect on school performance and psychosocial functioning in the longer term. A particular difficulty is the danger of addiction. It is difficult to stop taking the medication after long-term use. The problem is referred to as a 'withdrawal syndrome', and involves serious and sustained depression and suicide danger.
Follow-up examinations are subject to serious limitations. The observation time is seldom longer than a year. The assessments of the results are completely restricted to the actual symptoms, and do not include subjective reports regarding well-being etc.
It is not necessarily the case that the absence of symptoms is synonymous with subjective well-being and quality of life. Even in those cases where freedom from symptoms also involves subjective well-being, Ritalin treatment is not ethically defensible if, in the longer term, it contributes towards social invalidity. Ritalin and the label ADHD individualise social and moral problems: Social and ethical problems will, by means of the diagnosis, be construed as a question of deficient individual adjustment. How are trouble-makers, disruptive elements, to be dealt with? The child is rendered ill and stigmatised.
We adults save our own honour, but not that of the child. With the power and disciplining perspectives of Michel Foucault, we are able to regard the medicinal practice in respect of children as a kind of separation and exclusion practice, in which the treatment represents an extension of society’s excluding procedure through subjecting children to chemical control.
Those who determine normality possess power. Groups of experts are the ones who possess this power through their social technology. The determination of the deviation concept becomes increasingly fine-meshed: classification of deviation is subjected to ever new categorising and new dividing lines. The new diagnoses are directed particularly at children. Among these are ODD (Oppositional Defiant Disorder), CD (Conduct Disorder) and OCD (Obsessive Compulsive Disorder). The diagnosis ODD applies to what is referred to as the defiance illness for children aged 5-6 years who are 'egocentric and narcissistic'. Since the 1950s the diagnoses in the two international psychiatric diagnosis systems have increased more than twofold.
In conclusion: Do we wish to have a society comprising only well-controlled and pliant people? Are we about to realise Aldous Huxley’s frightening vision of the future in 'Brave New World'?
Parts of this article were published in 2001, under the title of "Medicating of schoolchildren", in Something rotten in the state of Norway, UKS - Forum for Contemporary Art no 1/2-2001