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Content uploaded by Ilina Singh
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All content in this area was uploaded by Ilina Singh on Oct 27, 2015
Content may be subject to copyright.
Bad Boys, Good Mothers, and the “Miracle” of Ritalin
Ilina Singh
Centre for Family Research, Faculty of Social and Political Sciences, University of Cambridge
Argument
Contemporary debates around Attention Deficit/Hyperactivity Disorder (ADHD) and the
most common form of drug treatment, Ritalin, are rarely placed in the context of the social-
scientific history of diagnosis and drug treatment. This is possibly due to the fact that brain talk
and brain imagery have replaced earlier theories about children’s psychopathology that had
mainly focused on the toxic effects of the mother. These theories and their psychoanalytic
roots are considered somewhat embarrassing and certainly unscientific in a contemporary
light, and modern biological psychiatry has worked hard to demonstrate that physiological
and genetic factors underpin this contested disorder. Such theories have tended to make the
history of ADHD and Ritalin seem irrelevant to scientific progress and understanding of
disorder, as well as to public understanding and acceptance of disorder and drug treatment.
Examining this history, however, clarifies the relation between social, cultural, and scientific
values in constructing a need for medical intervention within the domestic realm. When
Ritalin came on the United States market in 1955, neither psychiatric diagnosis of children’s
behaviors, nor drug treatments for children’s behavior were commonplace. Mothers especially
were located in the center of active political, moral, and scientific debates over boys’
normative behaviors. These debates helped codify an intimate association between a problem
boy and his problematic mother in relation to ADHD diagnosis and Ritalin treatment. The
story I tell here suggests that this association may have supported mothers’ acceptance of
medical intervention and drug treatment for their boys’ troublesome, but arguably not
pathological, behaviors. In the concluding sections I argue that the lack of attention to these
social-scientific roots means that we miss seeing their potential relevance to the contemporary
predicament of rising ADHD diagnoses and Ritalin use.
Introduction
In 1996 Newsweek magazine called Attention Deficit/Hyperactivity Disorder
(ADHD) America’s “No. 1. childhood psychiatric disorder” (Hancock 1996, 51). In
1998 a National Institutes of Health Consensus Conference statement admitted in its
final remarks, “After years of clinical research and experience with ADHD, our
knowledge about the cause or causes of ADHD remains speculative” (National
Institutes of Health 1998). Despite the mysterious etiology and consequent
Science in Context 15(4), 577–603 (2002). Copyright © Cambridge University Press
DOI: 10.1017/S0269889702000650 Printed in the United Kingdom
controversy over ADHD, however, diagnoses continue to rise.
1
Based on 1994 U.S.
Census figures, 6 per cent of boys and 1.5 per cent of girls in the United States
population have been diagnosed with ADHD (Swanson et al. 1993). As alarming as
these numbers may seem, at least one prominent researcher of ADHD believes the
true proportion of ADHD in the U.S. children’s population to be nearer 10 per
cent.
2
Hand in glove with the ADHD controversy is controversy over Ritalin, the most
common form of treatment for the disorder. Ritalin is the market name for the
stimulant drug methylphenidate, originally manufactured by Ciba (now Novartis).
ADHD and Ritalin cannot truly be disaggregated in contemporary debates. U.S.
consumption of Ritalin has risen sharply, from 70 defined daily doses (DDD) in 1990
to approximately 425 DDD in 1999. To put these numbers in some perspective: In
1999 the U.S. accounted for 85 per cent of worldwide medical use of Ritalin (United
Nations Report 1999).
3
In contemporary debates ADHD and Ritalin enjoy almost iconic status; they are
a focal point of modern anxieties about children, parents, families, schools, cities,
civilization, and genetic futures. Popular media articles capitalize on the novelty of
the “Ritalin riddle, a brain teaser for the 90’s,” questioning whether “our culture has
gone so high-baud haywire” that it is willing to tranquilize children into submission
(Hancock 1996, 51). Psychologists writing for a popular audience have called ADHD
a symptom of a “rapid-fire culture” rather than brain-based disorder (DeGrandpre
1999), and have connected ADHD diagnosis with a cultural intolerance of boys,
whose high energy levels and aggressiveness can make them difficult for teachers and
parents to handle. By this argument Ritalin is used to “medicate boyhood” (Pollack
1998; Kindlon and Thompson 1999).
4
Environmental explanations for ADHD diagnosis and Ritalin use are positioned on
one side of a sharply polarized debate about the true causes of symptomatic behaviors
and the legitimacy of diagnosis and treatment. On the other pole, the biological
1
According to DSM-IV, ADHD is a childhood psychiatric disorder characterized by three core behavioral
problems: impulsiveness, inattention, and hyperactivity. The intensity and pervasiveness of these common
childhood behaviors are key components in the translation of behaviors into symptoms; symptoms must be
present in two or more locations and they must have been present to a disruptive degree for six months or
longer. There is no diagnostic test for ADHD, and evaluations for the disorder vary widely, from 15-minute
sessions with a pediatrician to multi-disciplinary neuropsychological evaluations.
2
Joseph Biederman is one of America’s foremost experts on ADHD, and he is the Chief of Harvard Medical
School Child Psychopharmacology Clinic (see Biederman 1996, 26).
3
I am using Ritalin representatively here, as there are other stimulants on the market for ADHD. While in the
past Dexedrine was another popular stimulant, the relatively new drug Adderall appears to be making gains
in the market. In 1998 Adderall was the second most commonly prescribed treatment for ADHD by U.S.
pediatricians. However the difference in number of prescriptions is still large: In the year ending August 1998
pediatricians wrote 4.6 million prescriptions, valued at $165 million, for generic methylphenidate (Ritalin);
and 742,000 prescriptions, worth $24 million, for Shire Richwood’s Adderall (http://www.quintiles.com).
4
It is difficult to discern whether these writers believe that such “boy behaviors” are innate or culturally
derived, or a combination of both. There is increasing discussion of biological and genetic bases to young
children’s gendered behaviors within American developmental psychology (see for example Maccoby 1998).
578 Ilina Singh
perspective on ADHD posits dopamine processing dysfunction as the key to
understanding the disorder and views stimulant drugs as the most effective treatment.
While the media continues to stoke the nature-nurture debate, the reality is that the
medical-scientific perspective on ADHD is now widely accepted in the U.S.
5
Theories of a genetic basis to ADHD are rapidly gaining currency: Recently Russell
Barkley, a psychiatrist and a prominent proponent of the genetic account, has
suggested that we view ADHD as a template for understanding that human inhibition
and self control are “traits [which are] largely, though not solely, genetically
determined” (Barkley 1997, 318).
Public and scientific agitation over ADHD and Ritalin has a distinctly
contemporary flavor, caught up in the familiar language of neurotransmitters, genes,
stress, and competition. And so it may come as a surprise that as far back as 1971 the
U.S. Department of Health, Education and Welfare estimated that 3 per cent of
school age children suffered from an antecedent of ADHD called “hyperkinesis”
(HEW 1971). Indeed, diagnosis and treatment of ADHD have been inspiring medical
and public debate for almost a century. Ritalin too has a history, now almost half a
century old and riddled with controversy. Over 30 years ago the Washington Post
created a media sensation with a report that 5–10 per cent of children in Omaha
school districts were being prescribed Ritalin or other behavior modifying
medication (Maynard 1970). National outrage over the “Omaha Incident” prompted
a federal inquiry entitled, “Federal Involvement in the Use of Behavior Modification
Drugs on Grammar School Children in the Right to Privacy Inquiry” (U.S.
Congressional Report 1970).
Despite the rich scientific and social history of ADHD and Ritalin there are few
historically based accounts in the literature. Peter Conrad’s influential accounts of
medicalization have queried the relationship between the creation of a “hyperkinesis”
diagnosis and the availability of a “social control mechanism” in the form of
psychotropic drug treatment (Conrad 1975; idem 1992). Shrag and Divoky (1975)
include chapters on the “invention” of the hyperactivity diagnosis and Ritalin, which
present important details about governmental and pharmaceutical company practices
during the 1960s and 70s. However this history is rather biased due to the authors’
strong anti-psychiatry position. Other literature on ADHD in the anti-psychiatry
tradition has tended to pursue a contemporary critique without delving further into
the historical context of diagnosis and drug treatment (i.e., Grinspoon and Singer
1973). Recent popular books on ADHD sketch a history of ADHD in their
introductory chapters (i.e., Barkley 1997; Hallowell and Ratey 1994; Diller 1998). To
a great extent these authors tend to repeat a version of the history of ADHD without
sufficient critical inquiry or analysis, collapsing a complicated century of changing
5
In comments to me on a research proposal, a prominent pediatrician and author wrote that “the ideology
of ADHD behavior as a brain disorder is so strongly entrenched in the U.S., that any study that might deny
or delay the use of medication in the above age 6 years age group might be seen as medically unethical.”
Bad Boys, Good Mothers, and the “Miracle” of Ritalin 579
diagnostic labels, symptoms, and etiology into a coherent story of disorder.
6
One
problem with such accounts is that they veil the productive processes by which this
disorder and its drug treatment achieved meaning, status, and power. The story of
how ADHD and Ritalin came into being and how they became meaningful as
solutions to the problematics of children’s behavior is still unfolding.
In this paper I hope to further the process of re-contextualizing ADHD and Ritalin
by excavating some of the historical and cultural surroundings that have nurtured
both this diagnosis and its drug treatment in America. On a general level I want to
understand something of how the diagnosis and drug came into being, and into
parents’ consciousness. More specifically I seek to understand and describe the social-
scientific context that supported parents’ turn to medication to improve their
children’s behavior. I hope to make the point that as long as we understand ADHD
to be a de-contextualized problem of an individual brain we miss seeing the social-
scientific commitments that have been borne along in the ADHD diagnosis and in
Ritalin treatment. One such commitment I focus on in this paper involves the
intimate association between a problem boy and his problematic mother. I suggest
that this association has encouraged scientific interventions in childrearing generally,
and more specifically, it has supported, and may continue to support, mothers’ turn
to ADHD diagnosis and Ritalin treatment for their children’s behavior and
performance.
Science on the Domestic Front
Ritalin came on the U.S. market in 1955, a time when pediatric psychotropic
treatments were not commonplace. How did it come to pass that a little more than
a decade later rates of Ritalin use would inspire a congressional inquiry? However
many pieces there are to that puzzle, at its center sits a family, and a boy (usually)
whose behavior is seen as problematic. Parents’ perceptions of these behaviors as a
medical problem that requires a medical solution is not a given. Therefore, in order to
understand the appearance and success of a medical diagnosis and intervention into
children’s problem behaviors, we need to understand something of how the science
of abnormal child behavior entered into and persuaded the domestic realm of its
authority and efficacy.
6
One widely cited claim in this history of ADHD is that the British physician George Still (1902) was the
first to describe ADHD-like behaviors in children. In a series of lectures published in the Lancet, Still described
children who lacked “inhibitory volition” and had deficits in attention and concentration. A closer look at
Still’s descriptions of this group of 23 children reveals that attentional issues are secondary to his concern with
“moral control.” Still lists these children’s major qualities as “(1) passionateness; (2) spitefulness-cruelty; (3)
jealousy; (4) lawlessness; (5) dishonesty; (6) wanton mischievousness-destructiveness; (7) shamelessness-
immodesty; (8) sexual immorality; and (9) viciousness” (1902a). Most of these qualities are not considered
primary symptoms of ADHD (for further argument along these lines, see Palmer and Finger 2001).
580 Ilina Singh
Important domestic sources for scientific information on childrearing and child
behavior from the 1940s through the 1960s included popular books and magazine
articles. It is difficult to discover how parents acted in response to received advice and
information about child development; however the substance and nature of the
material itself can illustrate the particular kinds of scientific knowledge and beliefs
that penetrated the domestic realm (Mechling 1975). In popular women’s and
parenting magazines during this period hundreds of articles provided advice and
information to women on the broad topic of child behavior. Regular contributions
by prominent figures such as the pediatrician Dr. Spock
7
indicate that magazines were
seen as an important and valid forum for the dissemination of expert advice and
information.
This paper is based in part on a systematic qualitative review of more than 200
articles on child rearing and child behavior found in two women’s magazines and one
weekly newspaper advice column between 1945 and 1965.
8
These articles provide a
glimpse of macro-level social movements and ideological shifts that affected the
family, schools, and mental-health professions, as well as providing insight into advice
and concerns regarding micro-level details of children’s behavior. Articles on younger
children’s behavior are specifically relevant to this paper, and cover topics including
obedience, discipline, parental authority, disturbances or deficits, and treatments.
9
Magazines can be seen as part of the social machinery that drives the dissemination
of scientific products and ideas into families and homes. In the 1940s and 1950s, a
burgeoning industry of experts in mental health began descending on families,
penetrating the domestic sphere via popular publications, and communities via the
schools and community health clinics.
10
In all media resources I consulted, writers
clearly targeted mothers as the primary, or even sole, interested party in the area of
the child’s upbringing. More surprisingly, almost all early childhood articles focused
on boys, and almost all articles were about boys’ behavioral development, and
particularly aggressive behaviors such as “fighting,” “talking-back,” “toughness,” and
“sports.” In contrast, most articles about girls were aimed at teenage girls and often
assumed that the girl herself was the audience, having picked up her mother’s
magazine. Articles emphasized etiquette, grooming, and dating. Boys in early
7
Dr. Benjamin Spock wrote the enormously popular book, Baby and Childcare, first published in 1946, now
in its 7
th
edition and still a bestseller.
8
Much of this research was performed at Harvard’s Schlesinger Library, which houses complete sets of
numerous women’s magazines in its archives. I reviewed two popular monthly magazines, Woman’s Day and
Parents, and the weekly parenting advice column in the New York Times Magazine, between 1945 and 1965.
I limited my review to three sources because articles in women’s and parenting magazines tended to replicate
each other. These selections represent my attempt to achieve a balanced view on issues from three publications
with differing styles and, to some extent, differing readership. While I could not hope for a diverse readership
based on race or class, I do feel that my selections represent a balance of views and opinions.
9
I have occasionally included relevant articles from one or two other women’s magazines and weekly journals
such as Time and Newsweek, but these magazines were not reviewed systematically.
10
There are a number of books that detail aspects of this deluge of experts and its impact on women, including
Ehrenreich and English 1978; Grant 1998; and Margolis 1984.
Bad Boys, Good Mothers, and the “Miracle” of Ritalin 581
childhood were viewed as still heavily dependent on their mothers, and articles on
boys’ development were addressed to mothers. In this sense, experts writing in these
magazines were clearly defining boys’ behaviors as the significant topic of research
and discussion in the area of early childhood development. They were also reinforcing
a focus on an interrelated group of subjects: mothers, sons, and problem behaviors.
11
In the 1940s this relationship between mothers and sons was framed by a
philosophy known as “permissive childrearing.” The permissive era was itself a
reaction to the strict behaviorist approach propounded by developmentalists such as
John Watson (1928) whose book Psychological Care of Infant and Child urged the
“scientific upbringing of the young” and discouraged mothers as a “potential threat”
to this scientific endeavor. In 1946 Dr. Spock’s seminal work Baby and Childcare
invited mothers back into their children’s lives, with the encouragement to “trust”
themselves. As the historian Michael Zuckerman (1975) points out, however, the
Watsonian image of mother was not replaced so much as subtly amended in the
permissive era. In both periods, mothers were seen as impediments, first to men of
science (who interpret the laws of nature), and then to natural law itself. As the vision
of the child changed from a creature needing strict management to one needing very
little outside control at all, the child with the “inborn wisdom” to know his needs was
hampered by mother’s comparatively poor childrearing instincts (Weiss 1985).
Mothers needed to rely on experts to avoid becoming impediments to their boys’
development. A notion that boys operated according to certain “natural laws of
being” (Bevans 1946a) encouraged mothers to keep an appropriate distance from
their sons. From this distance, mothers, drawing upon expert knowledge, could
observe the boy and monitor his needs. Magazine columnists warned mothers that
discipline or control could tarnish a boy’s natural “joy of living” and his desire to do
good (Bevans 1946b). Zuckerman has suggested that Spock’s manual is punctuated by
a “concerted effort to detach the youngster from the moral authority of the
immediate family” (Zuckerman 1975, 226). My reading of magazines in the same
period narrows the relevance of Zuckerman’s point: sons need to be detached from
mothers.
Magazine columnists rarely acknowledged that advice given to mothers about
childrearing was written from the perspective of a particular paradigm. This gentle
gloss over complicated and contested territory was, and is, relatively usual fare for a
magazine column. In the late 1940s, however, it veiled the growing influence of
psychoanalysis on ideas of mothering and the mother-son relationship. Psychoana-
lytic ideas shaped Spock’s perspective on mothers and childrearing, and almost
certainly influenced the focus on the mother-son relationship during early childhood
in magazine articles written during this period (Weiss 1985). It was probably near
impossible to soften psychoanalytic theories of mother into the agreeable tones of the
11
From here on I will refer specifically to “boys” and “mothers” instead of “children” and “parents” to
underline the implicitly gendered nature of the discussion in the pages of these magazines.
582 Ilina Singh
standard magazine column without emasculating the message entirely. But the
complex interplay between mother’s presence/absence and her son’s well being,
hinted at in magazine columns, is fully elaborated in many psychoanalytic writings,
most famously, perhaps, in Frieda Fromm-Reichmann’s articulation of the
“schizophrenogenic mother.” In 1948 Fromm-Reichman wrote: “The schizophrenic
is painfully distrustful and resentful of other people due to the severe early warp and
rejection he encountered in important people in his infancy and childhood, as a rule
mainly the schizophrenogenic mother” (Fromm-Reichman 1948). Two important
qualities characterized the schizophrenogenic mother: overprotection and rejection.
The result of these mothering qualities was boys who grew up to be dictatorial, weak,
or psychotic.
In the postwar period, these kinds of men were not viewed merely as an annoyance
or disappointment to their communities. They were a threat to democracy. Fromm-
Reichman claimed that Hitler and other fascist leaders were born of a fatherless
homeland following World War I (Neill 1990). In a widely read book called Their
Mothers’ Sons, psychiatrist and U.S. surgeon general Edward Strecker argued that
mental breakdown during war reflected a soldier’s immaturity. Mature men were
essential to ensuring the future of democratic nations: “There is nothing of which
Psychiatry can speak with more confidence and assurance than the danger to our
democratic civilizations and cultures from keeping children enwombed psycho-
logically and not permitting them to grow up emotionally and socially” (Strecker
1946, 219). Unfortunately for democracy, psychiatrists and psychologists working in
World War II diagnosed 12 per cent of all recruits as predisposed to mental breakdown
during pre-screening tests. Over one million more soldiers suffered from some form
of neurosis during combat (Herman 1995).
Against this backdrop of World War II, the breezy voice of the 1940s magazine
columnist appears disingenuous, veiling a deep connection between concerns about
the normalcy of male behavior and the supremacy of the democratic world, as well
as a trenchant political and moral critique of mothers and their relationships with
their sons. Such connections among mother, son, nation, and neurosis were further
encouraged by a new generation of childrearing experts propelled into schools and
communities under the aegis of the National Committee on Mental Hygiene
(NCMH). The central mission of the influential NCMH was prevention of mental
illness, which was regarded as a problem involving the personality rather than the
brain. Hygienists believed that a child’s “adjustment” or “pre-delinquent” states
would be most effectively identified through the school, which they saw as “an
institution to develop children’s personality.” Combining psychoanalytic premises
with biomedical understanding of disease prevention, hygienists’ ideas for American
education effectively resulted in what Sol Cohen has called the “medicalization of
American education” (Cohen 1983a). Newly trained teachers, counselors, social
workers, and psychologists flooded the schools. The presence of these experts helped
to reinforce the idea that parents were the root cause of early psychological and
Bad Boys, Good Mothers, and the “Miracle” of Ritalin 583
behavioral damage to children; parents sowed the seeds of mental disorder in children
through “harsh restraints, prohibitions, and punishments” (Cohen 1983b).
The hygienists’ emphasis on preventive mental health care likely helped encourage
the scientific establishment of normative standards of children’s cognitive and
emotional behaviors. In magazine articles, the pervasiveness of the scientific attitude
is clear: mothers are invited to avail themselves of evaluation and assessment of the
child in the home (social worker); the school (school psychologist, school nurse and
guidance counselor); and the clinic (psychologist, psychiatrist). The “scientific
attitude” according to one columnist, “pervades everything we see, think and know
– including our functioning as parents and as people” (Puner 1958, 40). As a result
parents are “self-critical and self-examining” while children are being “watched,
studied, measured and tested as never before” (Barclay 1957, 76).
The “Normal” Boy
By the end of the 1950s, magazine columnists had moved away from talk about
maternal instincts and permissive childrearing and had embraced a different agenda,
focusing on two interrelated topics: discipline and normalcy.
12
In 1959, Dorothy
Barclay, the New York Times Magazine childrearing advice columnist from 1949 to
1963, celebrated a “decade of progress” outlining not only the changes in childrearing
philosophy but also the extent to which experts had taken over from parents:
Research revealing that children as well as adults suffered in an atmosphere of total
license led to a renewed setting of reasonable standards of behavior and a return to favor
of “discipline” achieved through education, guidance, planning and, wonders of
wonders, a firm “No!” when necessary. . . . Counseling services have increased and
parents in growing numbers turn to them for help. (Barclay 1959, 24)
Barclay’s emphasis on discipline through education and guidance echoes the ideals of
national education put forth in the 1958 National Defense Education Act (NDEA).
Enacted partially in response to the Sputnik launch of 1957, one of the Act’s
stipulations was to identify gifted young people through testing, and with the help of
the guidance counselor ensure their early and successful planning for a college
education. The Act helped officially establish the guidance counselor in schools, and
institutionalized testing and college counseling. The NDEA once again reminded the
public that the probing of boys’ mental and emotional depths was a matter of national
interest. As one columnist suggested, the NDEA was meant to strengthen community
12
Ehrenreich and English link this change in childrearing ideology to the failure of the Americans to beat the
Russians in the satellite launch race. After 1957, they argue, education became an issue of national defense.
While it seems unlikely that a widespread change in ideology would be linked so intimately to one event, it
is certainly true that the cold-war climate encouraged a variety of defense-based education initiatives, such as
the National Defense Education Act.
584 Ilina Singh
and citizenship by uncovering not only intellectual gifts, but also deviance and
trouble (Bemer 1964).
The new “toughness in schools” and the “new discipline” were also part of an
institutional attempt to undo the damage of parents who had “been said to be too
permissive” and who had seen a “loss of authority” with their children (Hechinger
and Puner 1959; Mead 1958). Therefore mothers were told to encourage their
children to use the school’s resources: “Children with worries know they can go to
the school social worker. He has been trained to listen” (Bemer 1964, 78). Mothers
themselves could draw upon these external resources to discover their sons’ problems:
“Go to the school psychologist, who will consult with your child’s teacher” (Carson
1959, 44).
Mothers trained in the wisdom of the permissive era were likely in need of some
education in face of these new ideals of childrearing. Good mothering was now
dependent on discipline, and discipline had an important relationship to “normalcy.”
Articles on discipline-related areas, such as obedience and aggression were heavy with
talk about normative levels of (boys’) aggressiveness, impulsiveness, and conformity.
Such articles emphasized that mothers should be able to make a distinction between
normal and abnormal behaviors, but confirmation of this distinction and intervention
of most any kind was the job of the expert. However well mothers observed their
sons, boys’ behavior was not straightforward and therefore normalcy was difficult to
ascertain. Mothers might view behavior as a manifest sign of normalcy, but experts
knew that behavior was not necessarily a reliable sign of mental health. As one
columnist wrote, “It is a common misconception that ‘being good’ is a sign of mental
health in a child” (Honor 1957, 57). Articles on “sound adjustment,” “emotional
balance” and “temperament” revealed the murky depths of psychopathology; and
mothers needed expert help to determine “pre-school growing pains from real
trouble” (Carson 1959, 44).
13
The specter of “real trouble” must have been
particularly frightening for mothers, especially when psychological problems were
compared with severe physiological illnesses. In a move that clearly medicalized
behavior, treatment for a psychiatric disorder was likened to treatment for a physical
illness, thereby underlining the need for preventive care and emphasizing need for
expert attention. Two well-known psychologists compared untreated emotional
problems in a child to “an untreated cold [that] could be a symptom of pneumonia”
(Ames and Ilg 1957).
There is some critical reaction to experts’ jurisdiction over children in the pages of
these magazines, aimed mostly at the homogenizing goals of expert evaluation. One
columnist told mothers not to worry about normalcy, for they, and their children,
were “different, peculiar human beings” with “all the vagaries and foibles that go with
individual differences” (Jenkins 1958, 71). Similarly, another columnist argued that
13
Talk about “adjustment” and “balance” was likely derived from the work of Adolf Meyer on mental illness
as maladaptation. Meyer’s version of psychoanalysis was enormously influential in shaping American
psychoanalysis generally.
Bad Boys, Good Mothers, and the “Miracle” of Ritalin 585
normal was average, and “great men aren’t normal” (Whitman 1960, 46). Expert
advice was viewed as undermining parents, who had a “gnawing sense of insecurity
about how their youngsters measure up” (Tolchin 1961, 32). To avoid the experts,
mothers should rely more on their own knowledge and celebrate the “simple
wonderfulness” of their boys (Hunt 1957, 35).
Yet only a handful of articles indicate such resistance to the experts; the majority
of writers appeared to find experts’ scrutiny and research both helpful and necessary
for proper childrearing. One reason for the lack of resistance may be that by 1960 an
increasing number of articles were written by experts themselves. Articles by non-
experts often just summarized expert research on a particular topic. A few articles
propounded the importance of a lay perspective; one such author urged mothers to
speak up about the boys “[we] know as our own” (Hunt 1957, 35).
14
Much more
often, however, mothers’ authority was undermined and expert advice pushed
forward. This loss of authority culminated in advice that sent mothers themselves to
the experts, not only to understand their children but also to seek advice and help for
their own behavior. Columnists recognized that mothers might feel “overwhelmed”
with all their tasks; they might feel “guilty” for promoting emotional difficulties in
their children; they might “inflate disturbances.” Most often the advice was to “seek
professional help.” The cycle renewed itself: expert opinion caused mothers confusion
and anxiety that was properly managed by consulting more experts. As Julia Grant has
pointed out in her study of mothers’ letters to advice columnists in this period:
Whatever negative behavior their children exhibited, mothers questioned what they
might have done, or failed to do, to cause the problem. The mothers who wrote to child-
care experts during the 1950s judged themselves harshly, often seeking in vain to find the
source of their children’s troublesome behavior in their own conduct as mothers. To
some extent, they had incorporated enough of the philosophy of scientific utopianism
to believe that proper child management could alleviate their intrinsic difficulties. (Grant
1998, 227)
The new emphasis on a boy’s mental health served to further remove mothers from
jurisdiction over their sons’ development and codified deep anxieties about
mothering behaviors and the mental stability and strength of young boys through
scientific discourse. Childhood psychiatric diagnoses had become a ground on which
local and national anxieties surrounding mothers and sons could be elaborated. In the
early 1950s, magazine columnists began to pay more and more attention to one such
diagnosis, an ancestral form of ADHD called “emotional disturbance.”
14
It seems important to note that mothers did speak up in their letters responding to expert columnists. These
letters document a more robust critique and resistance of experts than I found within the magazine articles
themselves (see Grant 1998, chap. 7).
586 Ilina Singh
Emotional Disturbance
Emotional disturbance was the most commonly noted mental health problem
affecting young boys in magazine articles spanning the 1950s to 1965. The symptoms
of emotional disturbance, culled from the pages of women’s magazines and clinical
psychology textbooks of this period, suggest a close relationship to the contemporary
ADHD diagnosis. Symptoms affected boys almost exclusively, and included
hyperactivity, inattention, moodiness, delinquency, and impulsiveness.
15
In magazine
articles emotional disturbance has a number of variants including “emotional trouble”
and “emotional illness.” A clinical psychology textbook published in 1965 indicates
that contemporary researchers saw emotional disturbance as the “eminently normal
result of abnormal (in the case of socially and morally deviant) behavior” (Mowrer
1965, 243). Proposed causes for these deviant behaviors were split predictably along
the nature-nurture divide; but emotional disturbance itself was viewed for the most
part as a set of secondary symptoms of underlying disorder. When the underlying
disorder was left untreated abnormal behaviors would multiply, thereby exacerbating
the emotional sequelae of the disorder.
Emotional disturbance is increasingly referenced in articles at a moment when
mothers’ attention is excruciatingly fixed on the mental and emotional normalcy of
their sons. Discipline, conduct, and aggressive behavior had been the mainstay of
mothers’ concerns about their sons, as represented in these magazines, and these
qualities are at the center of the symptom cluster that characterizes emotional
disturbance. However as a descriptive diagnosis emotional disturbance must be
viewed as an immature scientific category, extending an extremely wide net over a
range of behaviors that were, as yet, not categorized as distinctive disorders. Magazine
articles and clinical textbooks of the period suggest that the disorder was not well
differentiated from dyslexia and learning disabilities, disabilities resulting from head
injury, behavioral disorders of childhood such as oppositional defiant disorder and
conduct disorder, and depression. Emotional disturbance was explicitly linked, and
occasionally interchangeable with Minimal Brain Dysfunction (MBD), which most
researchers consider an early diagnostic form of contemporary ADHD (Barkley 1997;
Diller 1998). MBD was the term most often used in a scientific context; its name
points to the hypothesized organic cause of disorder. Emotional disturbance had a
more ambiguous etiology and was a term more often found in popular venues.
This close association between emotional disturbance and MBD is somewhat
curious, given that emotional disturbance was often identified as a psychological
problem borne of anxiety and conflicts, and MBD was almost always seen as an
organic problem. The frequent linking of the two actually reveals an interesting
15
Emotional disturbance is still referenced in social science and medical journals today, and it is still a
somewhat ambiguous category. In addition to symptoms such as depression, emotional disturbance can also
include ADHD or other disorders now categorized as neurobiological disorders. My overall impression,
however, is that today’s emotional disturbance connotes something deeper and more severe than ADHD.
Bad Boys, Good Mothers, and the “Miracle” of Ritalin 587
interaction between traditionally psychoanalytic ideas and ideas more usually found
in biological psychiatry, as related to the production of a scientific diagnosis for boys’
problem behaviors. Historians of psychiatry have tended to present great antipathy
between biological psychiatry and psychoanalysis during this period (Shorter 1997);
however, in the case of children’s behavior disorders pediatricians and child
psychologists brought these disorders and associated treatments into the limelight in
work that overtly pulled from competing positions within psychiatry. Their work
created an inter-disciplinary setting in which experimentation with drug treatments
for children’s behavior problems could occur alongside other psychoanalytically
oriented treatment approaches with relatively little fanfare.
Benzedrine Experimentation in a Cooperative Atmosphere
In 1937, Charles Bradley, a pediatrician, published the first article documenting
experiments with the stimulant Benzedrine on children with a wide variety of
“behavior problems” in the American Journal of Psychiatry (Bradley 1937a). Bradley
performed his experiment on 30 children, ages 5 to 14, who manifested a variety of
behavior disorders ranging from specific educational disabilities to epilepsy. All the
children had normal intelligence. He pronounced the results most “striking” in the
effect of Benezedrine on school performance. Almost half the children responded in
“spectacular fashion” presenting with unusual motivation to work, and an enhanced
ability to read, comprehend, and do arithmetic. In their “emotional response” too,
Bradley reports that half the children became “more placid and easy-going,” a clinical
improvement in the opinion of the staff.
16
In a series of subsequent articles, Bradley
and his colleagues build on this body of work, publishing their results in the major
psychiatric and medical journals of the day.
Charles Bradley was the director of the Emma Pendleton Bradley Home in East
Providence, Rhode Island, which opened in 1931 as the nation’s first psychiatric
hospital devoted to children. The Home was “planned and equipped especially for the
care of children with neurologic and behavior disorders” (Bradley 1936, 651). In
1936, there were 269 patients at the Home, 80 with behavior problems, 64 with
convulsive disorders, 40 with CNS (central nervous system) birth disorders, 37 with
mental deficiency, and the remainder with a variety of disorders including reading
disability and post-encephalitic syndrome. Bradley does not specify the gender of
these patients; however patients included girls as well as boys. In his first published
experiment with Benzedrine Bradley included approximately twice as many boys as
girls (21 boys, 9 girls); in subsequent research the proportion of boys is larger. Bradley
asserts that these numbers reflect the incidence of behavior problems by gender in the
clinical population. By 1940 one of Bradley’s samples includes 77 boys and only 23
girls. Much of the other research with Benzedrine on children during this period did
16
Bradley does not specify the gender of children in his analysis of results.
588 Ilina Singh
not include girls at all in part because behavior problems were so closely associated
with delinquency, and experiments were frequently performed in homes for
delinquent boys.
17
The design of the Home in Bradley’s descriptions appears to have been grounded
in a combination of behaviorist, psychoanalytic, and mental hygienist principles,
emphasizing a natural, healthy, and encouraging environment as essential to a child’s
mental well being. Bradley contrasted this environment with the environment of the
family home, which he felt was chaotic and troubling to his patients, often sending
them into relapse upon their release from the hospital. Bradley felt the Home’s
environment was particularly therapeutic for children with behavior problems, who
benefited from multiple activities based in natural and cultural surroundings,
reinforced by nurses and teachers “who have combined the rare endowment of an
attractive, unruffled and ingenious personality” (ibid.). But while Bradley grounded
the plans for his patients’ daily life in these environmental principles, he also
emphasized more active biomedical interventions with patients. The Home was
envisioned specifically as a hospital for treatment of children’s psychiatric disorders,
with the facilities and opportunity for therapeutic experimentation. A surgery
handled the more extreme therapeutic interventions, while experiments with drug
therapies were performed in a more naturalistic setting, but under closely controlled
conditions. To add to the therapeutic mix, Bradley also had children undergo
individual psychotherapy, believing that “even the best environmental adjustment
does not preclude the advisability of personal psychotherapy, particularly in cases in
which a rather exhaustive analysis and reconstruction of the patient’s personality are
indicated” (ibid., 652).
In his published work Bradley mixes psychoanalytic, behaviorist, biomedical, and
mental hygiene perspectives quite masterfully, finding ways to appease potential
critics from all sides. A central factor in this process is his repeated emphasis that drug
therapy is not a reason to ignore modification of the environment in the promotion
of children’s mental health. Indeed, the success of Bradley’s Home, which housed
patients anywhere from 6 to 18 months, was predicated on the therapeutic efficacy
of separating children from the environment of their family homes. Writing in the
American Journal of Orthopsychiatry in 1940, Bradley and his colleague Margaret Bowen
state:
17
As Conrad and Schneider have noted in their book, Deviance and Medicalization (1980), stimulants are part
of the medicalization of delinquent behavior. The authors do not make much of the gender dynamics at play
here, but clearly delinquency is a gendered phenomenon. Since the history of Ritalin is part of the history
of delinquency, and both are part of the history of ADHD, it is not so surprising that ADHD too is largely
a problem of boys. When ADHD is presented purely as a neurochemical problem, neurochemistry must
explain the gender skew.
Bad Boys, Good Mothers, and the “Miracle” of Ritalin 589
The use of pharmacological agents such as amphetamine sulfate, offers a supplementary
. . . approach to the treatment of children’s psychiatric problems. This approach in no
sense replaces that of modifying a child’s surroundings and so removing the sources of
conflict. Neither can it offer the same assurance of mental health as do forms of
psychotherapy which enable a child to work out his emotional problems. . . . However,
distressing surroundings cannot always be altered, and lack of facilities frequently make
effective psychotherapy impossible. In such situations the simple administration of a drug
that produces an improved social adjustment or accelerated school progress may offer
considerable assistance. (Bradley and Bowen 1940, 102)
Throughout the 1940s, children with disturbances thought to be of psychological and
biological origin were subjected to experiments with Benzedrine, usually by child
psychologists and pediatricians. This research continues the kind of cooperative, all-
inclusive tone initiated by Bradley. In 1948, a well-known psychologist explained
that, “an illness [minimal brain damage] which interferes with normal maturation will
give rise to anxiety” (Bender 1948, 412); and Benzedrine was a “useful adjunct to the
treatment of the neurotic child” (Bender and Cottingham 1942, 116). Such
explanations helped create the ground for a productive interconnection between
biomedical orientations and psychoanalytic perspectives around MBD and emotional
disturbance in the 1950s.
Throughout this period of experimentation with Benzedrine the possibility of
mother’s toxicity and the necessity for separating mother and child went
unchallenged in published articles. Indeed, one important factor that these diverse
scientific positions agreed upon was the potentially harmful nature of a child’s family
environment, with special focus on mothers. From the hygienist perspective, mother
was not expert enough to be given the responsibility of her child’s upbringing; her
understanding of the child was “pre-scientific” (Cohen 1983b, 129). Behaviorists like
Watson (1928) felt that mother-love was a “dangerous instrument” while psycho-
analysts stressed the pathology-inducing nature of mother-love. Even Dr. Spock
(1946), under the influence of psychoanalytic ideas, subtly expressed that “the life of
a child can be harmed by improper mother love” (quoted in Weiss 1985, 291).
Thus we see at the center of this early experimentation with Benzedrine therapy
for problem children certain ingredients for a scientific model for ADHD and Ritalin
treatment. First, and simply, there is the pairing of mother and son. This pairing will
be the normative object of investigation in most family based studies of ADHD in the
past several decades.
18
Second, there is the centrality of mother in the development
of problem behaviors in boys. Third, there is the centrality of separation from mother
in the construction of healthy male development.
18
In a review of ADHD literature using the psychology database PSYCHINFO I found only a handful of
articles involving fathers in hundreds of studies in the past 15 years. Of 25 studies I reviewed concerning
effects of medication on parent-child interactions, two involved fathers and two involved girls. In my
experience in public and clinical ADHD-related settings, fathers are largely absent from the clinic, support
groups, and public talks and conferences on ADHD.
590 Ilina Singh
A New Name and A New Drug Treatment
By the late 1950s, the spirit of cooperation between biologically oriented
pediatricians, psychiatrists, and psychoanalysts was in decline. Frustrated with the lack
of therapeutic results in psychoanalysis, some child psychiatrists decided to challenge
the psychoanalytic identity inherent in the term “emotional disturbance” by
emphasizing the organic etiology in the term MBD.
19
Their efforts were assisted by
two developments. First, a new term appeared to describe emotional disturbance/
MBD. The term was “hyperkinetic disorder of childhood,” coined in 1957 by
Maurice Lauffer, the new director of the Bradley Home. Reflecting the cooperative
atmosphere at Bradley, Lauffer was trained as a pediatrician and a child psychiatrist.
But Lauffer and his co-author, Eric Denhoff, writing in the Journal of Pediatrics rather
than in a psychiatric journal, emphasized the “organic components” of the disorder
and recommended the use of “amphetamine” for its treatment. With this move,
Lauffer and Denhoff effectively narrowed MBD and emotional disturbance to one
symptom through nomenclature and drug specificity, and grounded the new disorder
in biological foundations.
Following Lauffer and Denhoff, psychiatrists urged the community to make up for
its neglect of biology and organicity. In psychiatric journals, writers encouraged “the
consideration of organic factors when diagnosing children’s behavior because the
psychogenic factors have so often been exclusively emphasized” (Knobel 1959, 319).
Others suggested that child psychiatrists look “as carefully among the myriad of
possibilities of organic causation as we have in the past among the interpersonal,
deprivation and stress factors” (Clements and Peters 1962, 17).
Among childhood psychiatric disorders, “hyperkinetic syndrome” held unique
promise for a revived biological psychiatry because it was already connected to a
specific drug treatment. Indeed, Lauffer and Denhoff claimed that “a favorable
response to amphetamine is supportive evidence for a diagnosis of the hyperkinetic
syndrome” (Lauffer and Denhoff 1957, 473). These revivalist psychiatrists had to tread
carefully, and well into the 1960s their articles still offered some integration of
psychoanalytic and biological perspectives.
20
The important conceptual shift,
however, was that biological psychiatrists now emphasized medication not as an
adjunct to psychoanalytic therapy, but as a therapy with its own specific role.
The second important development during this time was the appearance of a new
stimulant called Ritalin, marketed by Ciba Pharmaceuticals (now Novartis) in 1955.
Ritalin was not initially indicated for hyperkinetic syndrome; instead it was a
19
Leon Eisenberg, a child psychiatrist now at the Department of Social Medicine at Harvard, was one of the
first psychiatrists to urge this change in nomenclature. He told me his reasons in a conversation we had in the
fall of 1996.
20
Even DSM-II, which appeared in 1968, hedged on the etiology of “hyperkinetic reaction of childhood,”
specifying that “if this disorder is caused by organic brain damage it should be diagnosed under the appropriate
non-psychotic organic brain syndrome.”
Bad Boys, Good Mothers, and the “Miracle” of Ritalin 591
treatment for mild depression and narcolepsy. Treatment for “various behavior
problems in children” was first indicated in 1961.
Marketing Ritalin
Stimulants were one of three major types of drugs used for behavior modification in
children during this period; tranquilizers, such as Raudixin, were also used, as were
anti-depressants such as Tofranil and Aventyl (Ladd 1970, 68). Ritalin came to market
at a time of extraordinary growth and competition within the pharmaceutical
industry: According to one estimate, there were 150,000 pharmacological prepara-
tions available in 1961 (when Ritalin was first licensed for use in children for behavior
problems), of which 90 per cent did not exist in 1951. In 1961, approximately 15,000
new drugs were being put on the market each year, while about 12,000 were dying
off each year (Time 1961).
It is likely that Ciba Pharmaceuticals were aware early on of Ritalin’s benefits as a
patented drug with a strong research record, few side effects, and known benefits for
children’s behavior. Pharmaceutical companies invested heavily in sponsoring
experimental research in clinical settings. Smith-Kline-French supported Charles
Bradley’s Benzedrine experiments (Bradley acknowledges the donation of tablets in
his published work); and Diller claims that “Ritalin research fueled many grants and
careers in the 1960s,” although he provides no direct support for this statement (Diller
1998, 25). Ciba played an important role in the promotion of Ritalin within the
medical industry through paid clinical research, advertising in physicians’ journals,
and direct sales strategies.
21
This kind of promotion was standard practice for drug
companies in this period, and unethical advertising practices would prompt a series
of congressional hearings, notably the Kefauver (1957), Nelson (1967–1979) and
Kennedy (1979) hearings.
22
In the Kefauver hearings particular concern was voiced
over the industry’s role in popularizing anti-depressant drugs for relatively common
“unpleasant tension states” (Kefauver Hearings 1960). Later critiques would focus on
the medicalizing of “human problems of living” through drug advertisements (Katz
1972; Hill 1977). It is more difficult to establish Ciba’s role in promoting acceptance
of Ritalin within the domestic realm. It can be argued, speculatively, that Ritalin
benefited from a shift in public understanding of mental illness, promoted in part by
the creation and marketing of drugs for a nation of “worried well.” In particular, the
success of anti-depressant drugs may have contributed to mothers’ acceptance of
Ritalin for relatively common behavior problems in boys. The pharmaceutical
industry and the medical profession probably targeted women for anti-depressant
21
Shrag and Divoky (1975) provide some useful information about Ciba’s marketing strategies for Ritalin in
the 1970s and they cite interviews with (anonymous) Ciba sales representatives and FDA officials during this
period.
22
See Smith 1991 for a very useful, but generally uncritical compilation of material from these hearings
relevant to the regulation of drug advertising.
592 Ilina Singh
diagnoses and treatments (Cooperstock 1978), and women accustomed to drugs for
their own relatively common problems may have been more likely to accept Ritalin
for their sons’ problems. The history of Ciba’s marketing agenda for Ritalin is difficult
to access; therefore much of the above remains speculative.
23
In recent years, however,
Novartis has clearly demonstrated its interests in the domestic realm. For the past
decade it has funded the major American ADHD parents’ organization, CHADD
(Children and Adults with ADD). This organization provides such a powerful lobby
for Ritalin that in 1995 the United Nations International Narcotics Board issued a
warning about its role in rising rates of Ritalin consumption (United Nations INCB
Report 1995).
Novartis and other stimulant drug-makers have also actively employed the
relationship between mothers and sons in contemporary public advertisements for
Ritalin. Direct-to-consumer advertising of Ritalin, a controlled substance, was
prohibited in 1971 as a result of the Convention on Psychotropic Substances of 1971
(ibid.). Until approximately two years ago, the pharmaceutical industry respected this
prohibition and did not advertise Ritalin and other stimulants to the public. Today
advertisements for ADHD drug treatments can be found in many popular magazines
including women’s and parenting magazines. The great majority of advertisements for
Ritalin and other stimulants for ADHD depict only two characters – a boy and his
mother.
24
Popular Reactions
For mothers with problem boys, the news about drug treatment and the emphasis on
the organic nature of children’s behavior problems appears to have been very
welcome. Schooled to give their children up to expert treatment, weary of mother-
blame, and anxious to look good in the eyes of society, mothers represented in these
magazines appeared to herald drug treatment for their sons’ problem behavior as a
true miracle. Magazine articles on this topic were filled with positive testimonials
23
In the spring of 1998 I had several telephone conversations with a representative from Novartis Medical
Information Services. I was given Medical Information Services each time I called Novartis to ask about
archival and historical information about clinical testing and marketing. Unfortunately I was not given much
information in these conversations. I was sent a half-page time-line of Ritalin-related developments. I asked
whether Novartis could provide access to their records of the procedures that led to the approval of Ritalin
for child behavior problems. I was told that the approval was based on a “large number of physician
testimonials made by private investigators during the 1950s,” and given a list of five references (Letter, March
2, 1998). Novartis must protect its own interests, of course, but the lack of access and information will do little
to encourage accurate reports on Ritalin’s history.
24
My own collection includes ads for Ritalin, Metadate, Adderall, and Concerta, since 2001. In September
2001, Time published an article entitled, “New Ritalin ad blitz makes parents jumpy” (Novak 2001). The
author claims that the U.S. never passed a law in line with the 1971 UN prohibition on public advertising of
controlled substances (although the U.S. did sign the UN document). According to the article, the FDA and
DEA do not have the authority to control public advertising for Ritalin and other stimulant treatments for
ADHD.
Bad Boys, Good Mothers, and the “Miracle” of Ritalin 593
from mothers; the titles of many articles themselves reinforce the sense that there is
a new future for troubled boys and mothers, highlighting “new frontiers” and the
“opening [of] doors” in child psychiatry. Popular women’s magazine articles
uniformly assert both the overwhelming presence of mental illness in children and the
need for expert medical intervention, including drugs. One writer called “childhood
mental health” America’s “Number One Neglected Health Problem” and urged the
medical profession to further differentiate and categorize illnesses (Krieg 1960).
None of the magazines I surveyed contained an overtly negative article on the
issues surrounding children and psychostimulant medication. Although the child
psychiatrist Leon Eisenberg writes in 1964 of the “heat” generated in discussions of
“the proper role of drugs in treating disturbed children,” I found little evidence of
such debate in the pages of popular women’s magazines (Eisenberg 1964, 167).
Ritalin and the various diagnostic terms for “problem boys” likely benefited from the
positive atmosphere surrounding drug treatments following the “pharmaceutical
revolution,” which also helped bring about a renewed emphasis on the organic
etiology of mental and emotional disorders (Lasagna 1969). The emphasis on
organicity found its way into media treatment of psychiatric disorders. Following a
U.S Public Health Service report on MBD in 1966, the editor of Time took on the
task of public education in face of a possible epidemic:
There are hundreds of thousands, possibly millions of such boys and girls in the United
States [with MBD] and little is being done about them. There are not enough pediatric
psychiatrists to treat them all, and most of them get no farther than the family doctor’s
office. (Time 1968, 92)
Such editorials should not be taken to mean that parents were not skeptical about
psychiatric labels and drug treatments for their children’s behaviors. It does appear
that these magazines did not give voice to dissent during this period largely because
they promoted expert advice and research so actively, and because of a tendency to
soothe parents’ anxieties by reducing problems and presenting absolute solutions. The
cocoon-like atmosphere of these magazines is further illustrated by the lack of
discussion about the active debate around pharmacology generally in the late 1950s
and ‘60s, which is documented in many articles in weeklies such as Time, Newsweek,
and U.S. News and World Report. Although most of the concern focused on regulation
of the pharmaceutical industry, a few editorials take on the larger philosophical
questions surrounding the use of pharmaceuticals to manage not only disease but also
behavior (e.g., Newsweek 1959).
Another reason for the lack of criticism of drug use may have been that a biological
tool suggested a biological problem. An increased emphasis on the organic
underpinnings of childhood behavior problems meant that mothers were more often
assured that mental illness was not their fault. Still, the dynamic of mother’s presence/
absence in relation to a boy’s problems remained complicated. While an organic
account of mental illness potentially absolved a mother of blame it simultaneously
594 Ilina Singh
removed her from the sphere of authority over her son’s behavior and well-being.
Thus even while articles in magazines do more to relieve the burden of guilt and
blame on the mother, there remains a pervasive undercurrent of judgment. This
judgment appears in a number of guises but continues to be organized around the
dynamic of mother’s presence/absence. Articles that dealt with the stigma of mental
illness in children, for example, sometimes judged mothers harshly for neglecting
their children’s mental health in order to preserve the public appearance of family
harmony. One writer claimed that “the well-to-do children are often the last to get
help. They suffer the most because their parents feel that emotional trouble will affect
the family’s social position” (Honor 1957, 57). While the aestheticized ideal of the
1950s American family held little room for mental illness or family upset, mothers
were likely conscious that not only their social position but also their quality of
mothering would be harmed by an admission of emotional problems in a boy. A
mother whose son was put on medication for emotional disturbance assured readers
of both her social position and her love for her son: “We are the average one TV, two-
car family; we go places on weekends . . . and to church in the morning . . . friends
who drop by in the afternoon. . . . Our boy has a decent home; he loves his family
and is loved” (Dunn 1962, 45).
25
However the close association between problem boys and problematic mothers
lingers even more insidiously in the suggestion that mothers of out-of-control boys
had themselves become out-of-control. A (male) writer recalls a mother whose
realization of her son’s needs (medication) “changed her life”; she is “calmer, more
poised, more attractive” (Moak 1959, 35). Mother’s self-control is linked directly
with her aesthetic qualities: “Her newly learned self-control has made her a more
attractive person.” Given that this aestheticism is, in the 1950s, so closely linked to
ideals of domesticity, I would suggest that to some extent this writer hints at a project
of domestic sanitization, through medication. Part of what is sanitized within the
family is mother’s authority. As scientific practices displace mother’s authority, mother
is able to more nearly achieve the ideals of 1950s domestic life.
Medication use also tended to raise the specter of mother-love albeit now in
sanitized fashion. Mother’s inability to love her troubled son was amended through
expert treatment: “Now I can love this child again,” claimed one mother (Time 1968).
This admission of lack of mother-love for a problem boy echoes the association
between maternal neglect or rejection and child psychopathology. In another article
a (female) columnist quotes a “pretty young mother” as saying, “[With expert
intervention] Mark has become the potentially loveable child he always was” (Welton
1964). A mother who loves her son achieves an aesthetic ideal – as long as her
mother-love is mediated, sifted and sanitized, through expert intervention.
25
Of course the lifestyle outlined by this mother is not so “average” at all; in fact it is privileged. This points
again to the nature of readership in these magazines and reminds us not to generalize from this commentary
to the experiences of women of other social classes and ethnicities.
Bad Boys, Good Mothers, and the “Miracle” of Ritalin 595
It is important to say that articles which heralded the discovery of drug treatment
and organic theories for emotionally disturbed children were also punctuated by the
real anxiety and distress mothers felt over their boys’ behaviors. While much of the
discussion above tends to incorporate a critique of scientific attitudes toward mothers
during this period, it is by no means meant to minimize the emotions of families
dealing with problems associated with emotional disturbance and other associated
disorders. Many women at a loss over their sons’ behaviors did probably see
remarkable improvements not only in their sons’ behaviors but also in their own
mental and emotional well-being through the “magic of child psychiatry” (Moak
1959, 35). The decision to treat children for emotional disturbance was clearly not
made lightly by mothers: “The hardest part . . . was recognizing that our boy did have
a problem and needed more help than we, his parents, were able to give, and then
going out and getting it for him” (Dunn 1962, 46). In face of writers urging that
emotional disturbance “needs to be treated quickly” (Tolchin 1959, 70) mothers who
made such decisions no doubt felt their sons’ behaviors were intolerable and that they
were doing the right thing in medicating them.
Given the historical stream of events that links mothers, sons, and childhood
psychopathology in the period preceding the development of Ritalin, magazine
writers’ apparent reluctance to protest drug treatment for boys’ behaviors is not so
surprising. A problem boy struck his mother at the heart of her insecurity about the
quality and the repercussions of her mother-love. No matter what the ultimate cause
of a boy’s behavior, mothers who questioned their ability to love their boys properly
were programmed to worry that their inadequacies could do further harm to their
sons. Consulting the experts and accepting medical intervention had the paradoxical
effect of absolving mothers of some blame and guilt, and displacing their authority
with social-scientific ideals.
Lingering Residue: Mothers, ADHD, and Ritalin Today
The philosopher of science Elizabeth Lloyd uses the phrase “pre-theoretical
assumptions” to describe “the social assumptions and prior commitments of scientists
[that] play a major role in the practice of science itself ” (Lloyd 1993, 150). Multiple
social assumptions and prior commitments played leading roles in the creation of
ADHD categories and Ritalin: the construction of certain kinds of “problem
behavior” in boys as a medical problem; the belief that science had superior methods
for raising psychologically healthy boys; and an association between problems in boys
and problems in mothers. These social assumptions do not just shape the way science
is done. They also shape the way scientific knowledge is received and incorporated
back into society, thereby creating a complex interrelationship between social
assumptions and scientific knowledge. This dynamic can lay the groundwork for the
legitimizing of social and cultural prejudices through scientific theory and practices.
596 Ilina Singh
The social-scientific assumption that a boy’s ADHD-type behaviors are associated
with the neurotic behavior of his mother is disturbing enough that we may wish to
dismiss it as an idiosyncrasy of mid-century thinking. I believe we would be wrong
to do so. Mothering ideals continue to powerfully shape American women’s
experiences of mothering.
26
In addition, rising rates of ADHD, depression, and
violence among young American boys have prompted psychologists to declare a
national crisis: “Boys today are in serious trouble, including many who seem ‘normal’
and to be doing just fine” (Pollack 1998, xix). A recent explosion of popular books,
television shows and conferences related to the psychological problems of young boys
helps fuel this crisis.
27
Many of these popular books on boys’ problem behaviors
contain direct prescriptives for better mothering of sons. In particular, ADHD
symptoms are now seen as evidence of boys’ psychological and emotional distress,
possibly over a rejecting mother. One prominent psychologist has argued that
ADHD-type behaviors in boys are a sign of boys’ distress at being forced by mother
and a cultural “boy-code” to separate emotionally and physically from mother at an
early age (ibid.). Other psychologists suggest that mothers’ emotional separation
from, or rejection of, sons is a result of mothers’ confusion over how to raise “happy,
successful men” (Kindlon and Thompson 1999). These publications and the
enormous public interest in them (several of these books spent many weeks on the
New York Times bestseller list) indicate the extent to which the linkages between
problem boys and problematic mothers linger today. Even as authors attempt to
persuade mothers that their sons’ problems are not medical, they enforce the idea that
mothers are part of boys’ problems and that professional intervention into the
mother-son relationship is required for boys’ future wellbeing. I would suggest that
under these conditions contemporary American mothers are likely to view medical
intervention into their sons’ problem behaviors as one of an array of available
professional services of which they will avail themselves in the process of trying to be
good mothers to their sons.
Modern American mothers are historically programmed to worry about their sons’
behaviors and to blame themselves when those behaviors do not meet normative
standards of achievement and success.
28
Mothers’ perceptions of their sons’ behaviors
are likely to be filtered through their desire to be good mothers, the pressure to
produce good sons, the need to consult expert opinion, pervasive media coverage of
26
The “good mother” ideology is often mentioned in feminist treatments of mothering, and there is
substantial agreement as to the substance of the good mother aesthetic. See, for example, Thurer 1994;
O’Reilly 2001; and Glenn et al. 1994.
27
For a sampling of books, see Pollack 1998; Kindon Thompson 1999; Garbarino 2000; Newberger 1999;
and Gurian 1998.
28
Susan Bordo (1998) has argued that women are especially vulnerable to technologies that promise to
enhance women’s appearance, behavior, and performance in line with cultural and social norms. Bordo has
written about the use of cosmetic surgery to bring women’s bodies into line with cultural ideals; others (i.e.,
Kramer 1993) have suggested that Prozac can be used to improve women’s behaviors in line with social ideals.
Part of Ritalin’s appeal is that it can “improve” mothers and sons.
Bad Boys, Good Mothers, and the “Miracle” of Ritalin 597
ADHD and Ritalin, and blatant advertising appeals to improve their relationships
with their sons through the use of stimulant medication. Mothers are not to blame
for rising diagnoses of ADHD; however it is possible that mothers’ tolerance for their
sons’ problem behaviors is reduced because of the factors outlined above, leaving
them vulnerable to medical intervention. It is important to incorporate an awareness
of mothers’ vulnerability to ADHD diagnosis and Ritalin treatment into public and
clinical spaces. While this vulnerability is still veiled, or unspoken for fear of blaming
mothers, mothers are less able to resist medical intervention for their sons’
behaviors.
Conclusions
I hope this elucidation of the historical concerns with the behaviors of mothers and
sons in the particular context of ADHD and Ritalin brings an embodied perspective
to the predicament of mothers of boys with ADHD. When we embody the overly
generous spaces of this diagnostic category with historical actors we begin to glimpse
the scaffolding of a gendered social order that the diagnosis serves and upholds.
Mothers’ talk about the effects of their boys’ medication surfaces a deep identification
with the cultural script that connects behavior problems in boys to problematic
mothers. As a diagnostic category, ADHD serves and maintains this anxiety about
boys and their mothers.
A question remains related to historical memory: Why is the history of ADHD and
Ritalin largely unrecognized, indeed, forgotten, in the heat of contemporary debates?
My own thinking about this puzzle begins with Foucault (1965) and his ideas about
the processes by which social behavioral norms become codified in psychiatric
categories. Foucault argued that these categories appear to be divested of social
“subjective” meaning even while psychiatric practices continually reproduce
normative social standards and (re)inscribe them on the social body. Psychiatric
categories thereby reify social norms as objective truths by removing them from the
social body and from the historical space the body inhabits. Scientific understanding
of ADHD in this decade has actively promoted a disembodied reality to ADHD
through a brain-based discourse of neurotransmitters, receptor sites, and chemical
processes. The brain, divorced from the body, is divested of time and history in which
the body moves, and so ADHD, which resides in the brain, would also appear to have
no history.
Unfortunately this Foucauldian answer to the puzzle of memory ignores the fact
that a substantial portion of the social body strongly contests scientific explanations of
ADHD. These contestations would appear to re-embody ADHD, casting it as a social
phenomenon invested with a litany of social anxieties and elevated to cultural icon
status. However as cultural icon the ADHD phenomenon is sufficiently inflated to
have become a site crowded with noisy ideological debates that often lose sight of
grounded realities. As it becomes more and more difficult to look at on-the-ground
598 Ilina Singh
experiences with ADHD and Ritalin, it also, paradoxically, becomes more difficult to
understand ADHD and Ritalin as embodied phenomena.
And so I would venture the hypothesis that our historical memories fail us because
from both a sociological and a scientific perspective, we do not tend to treat ADHD
and Ritalin as phenomena grounded in time, space and people’s lives. We in a sense
reify the icon through research and analyses that produce a-historical medical
narratives and disembodied social critiques. Both types of narratives veil the medical
profession’s long (and potentially embarrassing) romance with ADHD diagnosis and
Ritalin as tools to manage a professional concern: the relationship between mothers
and sons.
A final note: Throughout this discussion I have attempted to treat ADHD as
simultaneously a real and a constructed diagnosis. While the legitimacy of the
diagnosis is obviously at stake in an analysis of its social functions and historical roots,
I am not here attempting to say that ADHD as a neurological disorder does not exist.
Indeed, it is impossible to say definitively whether ADHD does or does not exist. It
is perhaps more useful to note that the diagnostic category has expanded significantly
over the past century, incorporating ever milder and more ambiguous behaviors. The
state of the diagnosis today is such that many young American boys fit diagnostic
criteria, and that if a diagnosis of ADHD is desired, it can very likely be obtained. The
important question, it seems to me, is not about the reality of ADHD; rather it has
to do with the desire for ADHD diagnosis.
Ritalin is an effective, quick and safe drug for improving focus and attention.
29
A
major NIMH study has recently found that Ritalin is the most effective treatment for
ADHD (MTA Group 1999). However successful Ritalin treatment provides no proof
that a diagnosis of ADHD is “real.” In fact, Ritalin has been found to improve
attention and focus in “normal” as well as ADHD boys (Rapoport et al. 1978).
30
Therefore Ritalin is a key factor in the desire for ADHD diagnosis, as long as ADHD
diagnosis is required for a Ritalin prescription.
As with many psychiatric disorders, the evaluation of children’s behavior as
symptomatic of pathology is subjective, and the strident and narrow attitude of some
biological accounts of ADHD reflect the effort to lessen the subjective nature of this
ambiguous diagnosis. No matter what future evidence for the biology or genetics of
ADHD emerges, it seems important to remember that children do not ask for
Ritalin; adults do. Therefore adults and the adult-world are necessarily and
legitimately included in the scope of diagnosis and treatment. The child’s developing
29
As an amphetamine, Ritalin’s effects are felt within 30 minutes, and last only about 3–4 hours. Children
must take several doses a day to experience lasting improvements in behaviors. Side effects to Ritalin are
usually mild and include loss of appetite, sleeplessness, and tics. These side effects can often be ameliorated by
adjusting the daily dosage schedule. At present, there is very little research support for media reports about
long-term side effects to Ritalin use.
30
Ritalin’s widespread effectiveness in improving attention and concentration is (anecdotally) confirmed by
reports of its use among American university students as a “study-aid.”
Bad Boys, Good Mothers, and the “Miracle” of Ritalin 599
brain is embedded in the collective mind in any case, in addition to having its own
inherent strengths and weaknesses. The real complexities surrounding the ADHD-
Ritalin phenomenon are surely most productively elaborated from this embedded
starting point.
Acknowledgments
I would like to thank Anne Harrington, Hans Pols, and two anonymous reviewers for
their comments on earlier versions of this paper.
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