Very recently a very informative and responsible article on Dr. Eisenburg, a man accepted by some as the 'Father of ADHD' was published by realfarmacy.com and yet was removed even before I finished this commentary. It read "The Man Credited with “Discovering” ADHD Makes a Startling Deathbed Confession “ADHD is a prime example of a fictitious disease.” realfarmacy.com|By The Farmacy.
The only trace I could find of the Eisenburg piece was a commentary from Snopes that ranked this smothered article as "mostly true" and then went on to ratify the content. I suppose such an outcome works better than a 404 error page. Perhaps the piece raised too many uncomfortable questions for psychiatrists, pharmacists and others to address in public forums and regular practice or the authors did not think it good for business.
Rather than just bury my own commentary in exasperation amidst the suspicious withdrawal, I reinforce the points made herein with reference to another very similar interview of Harvard psychiatrist Dr. Jerome Kagan by Speigel online in August 2012, "Speigel Interview with Jerome Kagan 'What About Tutoring Instead of Pills?'" Here is He refers to ADD as an "invention" that encouraged “fuzzy diagnostic practices” and the over-prescription of drugs such as Ritalin for behavioral problems in children.
Though sometimes helpful, Amphetamines can also cause much harm, especially with long term use. The reality is until fairly recently, Americans have largely been denied optimal management of ADD/ADHD because of the inflexibility built into the allopathic orientation of many MDs serving this industry. One of the most troublesome practices in ADD/ADHD treatment was to insist that patients take amphetamines on a definitive regular schedule without teaching them to read signs of adrenal stress, exhaustion and burnout, making careful adjustments along the way. Though this protocol has fortunately waned in recent years, there remains a residual crater of profound blindness, in part caused by a greedy pharmaceutical industry and researchers with overly simplistic self serving models, at times contributing to other mental disorders and even non psychiatric physical problems in vulnerable young patients.
After several decades of very slowly recognized evidence pointing to the negatives associated with 'standard' inflexible standard treatment regimes of ADD/ADHD and the rising status of Osteopathic and Naturopathic physicians, we are learning in retrospect how much better life would have been for millions had their insights and methods had more influence and been incorporated into standard models of practice much earlier.
Think about this question. Had the holistic physicians dominated the treatment of ADD/ADHD in the early years, what might of been different? I think we would see less mental illness and dual diagnosis.
For starters, we can assume that if the pedagogy of such practitioners had been in vogue in the early days, the approach would have likely been to treat the problem with as many holistic alternatives as possible and in some cases cautiously move a low dose amphetamine into the equation. In many other cases alternative treatments may have been decided upon. Clearly, somewhat fewer people would have been issued amphetamines, but more pointedly, the prescription strengths would have been less and given with much more flexible instructions supporting multiple supplements and more. They would have recognized that while almost all antidepressants should be given on a regular schedule, amphetamines were not of the same nature and required a completely different approach.
Those who really understand their neurology and physiology REALIZE intuitively, You don't push these on an inflexible schedule - but what is the value of "intuition" to a typical allopathic physician - especially in the "old days" where few had the nerve to publicly question prevailing paradigms and approaches? "Evidently", not enough!!!
In the alternative schema, Holistic treatments would have much more quickly emerged. The first line of treatment would have BEGUN with holistic, flexible and adaptive approaches to include supplements and lifestyle changes along with more moderate use of amphetamines and the routine inclusion of a variety of positive catalysts and buffers such as Vitamin B's and fish oil (just to start a long list which might include agents like magnesium, lecithin, zinc and many others). Who knows what new and better holistic interventions may have been developed had the pedagogical space for ADD/ADHD been dominated by other schools of thought.
It is not so much a question that these ADD/ADHD diagnosis' and in many cases drug treatments have some validity, it is the sufferer's have been to some extent abused, deprived of good guidance and multifaceted treatment. ADD and ADHD are real conditions. Categorizing them as mental disorders per se is a complicated matter and something they have been pretty careless about framing and establishing. On the other hand, we have 'traditional' physicians like Hallowell and Ratey who themselves suffered from ADD / ADHD and were way ahead of the curve in advising many people within the ADD spectrum on how cope and adjust to in order to live out more optimal lives.
Contemporary neuroimaging is fairly clear in detecting the existence of 'cognitive deficit disorders' ranging from ADD to Asperger's to Autism... these categories define what is diverting from "normal function" in a continuum of degree and severity. Again, we have come to a point in time where it is now reasonable to claim that ADD and ADHD can be detected in neuroimaging with a significant degree of diagnostic objectivity and certainty.
Eisenburg may have had noble motives for identifying the top end of these syndromes and yet it seems at the end of his life, doubts about the merits of his observations and analysis emerged because of the large numbers whose conditions could be construed as ADD/ADHD and because of so much grey running into normal was also a factor. He never-the-less addressed a distinct set of variables of a somewhat distinct portion of the population adroitly - with diagnostic criteria. Unlike the nature of almost any other medical condition, there are some, but not a lot of ADD / ADHD individuals who will end up being more successful than most of their peers and contemporaries. This confounds the category of prognosis and opens it up very wide.
Most in this special category would have had the benefit of understanding their conditions in early childhood and learned to successfully master helpful adaptions with an eye to fully utilize available support and education. Predictably some of the education will be both very informative as well as aspirational -- more fully including perspectives on how these 'disorders' may be gifts and how great people in history evidenced similar struggles and prevailed with a lifetime of impressive achievements!
Such thinking has not played well with the epistemology of medicine. After all, medical notions such as "prognosis" are meant to predict the success of treatment within more manageable and reliable constructs.
Being ADD/ADHD is a little like being an alcoholic because the suffer is urged to accept his or her condition and overcompensate by mastering study techniques, eat the right things, take the right supplements, get out of denial and learn how to relate better to others and anticipate dealing with struggles ahead equipped with the best social support and medicine has to offer. In addition, "the others" in patient's life might be candidates who are informed about the condition and learn ways to be supportive. To their credit, some ADD snuffer's have successfully capitalized on this caring culture, receiving compassionate assistance from schools, workplaces, summer camps and Church communities. The have "found" themselves and often a large measure of success, albeit somewhat fragile.
So, here we go, achieving at the top end of the treated ADHD spectrum is arguably better than reaching a "social normal" and yet the top end sometimes, demands" medical attention and related support to get there. This is a similar to the host of concerns invoked by nootropics in general. Such issues are augmented because ADD / ADHD people at times demand special accommodations in school and yet when they enter the workplace may seem more presumptuous and less manageable than peers who were more disciplined, better students with more socially acceptable outlook and personality. Conversely, a portion of ADD people may also be a bit more "noticed" and demanding as they blossom into highly creative, intuitive and inspirational roles.
Eisenburg arrived in the world under a given set of conditions. He chose to embrace medicine as a career. He, like the vast majority of his peers may have been in partial denial about the the magnitude of predatory and unethical practices rolled out by Big Pharma - which almost surely had a significant influence on his medical practice. His remarks dismissing ADD as factitious seem to translate into a sentiment that he would like to destroy the entire paradigm and its contingencies and start over.
Those who produce texts in the history of medicine and other related scholars would do well to probe the depths of such notions - including the possibility of questionable agendas, not on the surface that indicate the desire to frame interventions with new underlying of 'preferred scripts' and socially acceptable developmental paradigms for such individuals. Clearly most people believe in self direction for patients, but fewer evidence the magnanimity to create societies that make is possible for such people to succeed on a high level
Until recently, America's record for a high quality supportive culture for people with disabilities, even subtle ones has been one of the best the modern world has known. We are still doing pretty well but seem to be slipping in education generally and our workplace is very complex. It is a tremendous undertaking to attempt to draw those with 'minor handicaps' to a high level of functioning when our current norm is at such a low level.
The "evidence" is not so much that Eisenburg's diagnosis of or at least perception of ADD / ADHD was 'incorrect', but his evidently flawed capacity to diagnose, discern and "rule on" the nefarious nature of Big Pharma's agendas and their plans to orchestrate them through such leaders as Eisenburg.
For the sake of a less disputable and reliable history of medicine for posterity, I would like to know a fuller account of Eisenburg's day to day orientation -- where he and other practitioners he knew decided that pressing for rather exacting regimes for amphetamines was not working so well and especially over the long run quite possibly doing damage. Maybe now in the wake of Eisenburg, others with similar life experience will step up to the plate with more more transparency and accuracy.
Who is going to do justice to the American public as well as the future of medicine.? Tell the truth without too much white wash - PLEASE!
Transitioning to the arena of education served Eisenburg and others very well. It is utterly obvious that schools have had trouble managing many kids diagnosed with attention deficit disorders, AND they almost always behaved better on medication. The issue is in earlier times, such problems existed, but was somehow managed by individuals overcompensating without medication. There problems were much more under the radar.
Discipline is about controlling impulses and not causing trouble even if you feel somewhat "out of it". For those who believe in a modicum of free will, encouraging self discipline and offering proper guidance can go much further than drugs to accommodate those suffering from attention deficit distractibility and impulse control issues. However, most today would argue that the use of drugs to increase performance of the ADD/ADHD population is essential. Integrating these perspectives for a proper balance seems essential if we are to advance our educational systems to a higher, more competitive level.
Yes, the drugs help, but if we are depending on drugs as the primary variable to control behavior problems at the starting gate, we will probably keep handing out higher MGs in greater volume in the near future. At the root, we as a society and as families and individuals are dealing with basic pastoral and philosophical issues! Let's not let the school district consultants minimize these variables - they should be up for discussion and part of the counseling process!
Many in the medical community have made 'functional and often self serving assumptions' about best practices, human nature, the value of human life in the context of spiritual growth and freedom as well as physician's perceived "need" to comply with the ethos of unreasonable health care organizations in league with Big Pharma. For the most part they have not pushed back so much. However, hopefully there is change on the horizon. We can no longer afford to sweep so many issues under the rug and claim we are adequately communicating. We are not. We may know the answers, but we are terribly short on public testimonials and earnest disclosures in the interest of the common good from those who have moved on from the status quo.
Perhaps Eisenburg would have preferred ADD/ADHD be described as "minor' abnormalities that in times prior have generally been thought of as personality traits or minor handicaps, but not mental disorders. There is wisdom in such an orientation but it does not play well with No Child Left Behind Laws, Big Pharma and other industries that benefit from platforms that serve their best interest. Perhaps if another brand of medicine had dominated treatment in the earlier stages of recognizing these 'syndromes' within an more holistic integrative medicine venue, the magnitude of problems would have been less. In the final analysis we want a culture that cares and we also want all individuals to assume as much responsibility as they can.
Eisenburg' is quoted in this article:
Let’s go back 50 years. We have a 7-year-old child who is bored in school and disrupts classes. Back then, he was called lazy. Today, he is said to suffer from ADHD (Attention Deficit Hyperactivity Disorder). . . . Every child who’s not doing well in school is sent to see a pediatrician, and the pediatrician says: “It’s ADHD; here’s Ritalin.” In fact, 90 percent of these 5.4 million kids don’t have an abnormal dopamine metabolism. The problem is, if a drug is available to doctors, they’ll make the corresponding diagnosis.).
While agreeing with Eisenburg's sentiments about the problems with contemporary medical practice and ADD treatment, it does seem he feels compelled to frame his position within a set of variables that comply with a mechanistic and very misleading paradigm. Herein lies a very major misgiving that has risen to the surface in my mind -- and stayed there. A person suffering from ADD/ADHD may have a basically "intact dopamine metabolism" (in relation to existing brain and nervous system) but still have minor brain damage or congenital defects in the distribution of neurons or certain kinds of glial cells (the hallmark of many ADD cases) which requires overcompensation AND regulation, NOT normalization by the 'intact dopaminergic' system that medication ramps to a much fuller throttle.
Brain and related nervous system physiology will probably produce normal or near normal levels of dopamine for the ADD/ADHD suffers, but the neurotransmitters are serving defective or abnormal "hardware". In order to sustain optimal learning and development in ADD / ADHD, allopathic physicians have gotten into the habit of pushing the dopmergenic system to be more productive -- YET, not to overproduce in order to compensate for inadequate levels of dopamine. They simply want to 'ramp up' the functioning of the brain and nervous system and entire physiology to a more optimal level - for a limited amount of time.
The big error of many allopathic orientations is to function with an ethos that does not demand they be much better equipped to define and address complexities in a way where the consumers (patient and family) know what the benefits, risks and drawbacks are and be given some ideas of various thresholds of homeostasis waxing and waning over a long period of time that they need to consider. Discussions about a wide range of alternative and multifaceted treatment and ongoing complementary / integrative supplements that may allow for lower dosing of amphetamines is absolutely essential. In this way the patient and family can plan better, making much better choices at almost every interval.
The challenge at hand is similar to a long distance runner asking a doctor for a cortisol shot in order to compete in the next big event. Sure, this major anti-inflammatory agent is going to remove pain and its symptoms but not the source of the pain. A day or two after the event when the endorphins and related agents recede, a much greater pain from an injury re-injured and made worse will likely result. Maybe the doctor should have engaged in a holistic discussion with the patient even if he made less money AND also referred the patient and loved ones to a counselor with knowledge about the condition and proven ability to help.
In the case of ADD / ADHD the damage caused by overuse of amphetamines may not show up for years. When it does, such etiology may very well be 'overlooked' for obvious reasons - thus the "evidence" for damage is often cumulative, not obvious for a LONG TIME. Parkinson's is but one example. How about depression from a distressed and burned out adrenal system combined with social and economic problems due to decreased levels of functioning?
If the public had relied primarily on Osteopathic and Naturopathic practitioners to help manage ADD / ADHD from the time it became standardized as a disorder (see a fairly modern description as provided in the DSM II in 1980), Americans suffering from or supporting someone with this condition would surely be in a different boat than the current state of affairs. But even here, since the allopathic mindset reigned supreme, there were built in disincentives for physicians to look very deeply or to frame in ways which did not empower the medical community and keep patients guessing and off balance - and dependent.
The deep questions and decision making on a philosophical / moral / spiritual level still remain somewhat obscured as a result. As pointed out in this article, even the public neurological explanations, apologies and caveats from top minds are filled with distortions because they have been cultivated for a very long time with faulty, industry serving models and a gross lack of attention to a host of variables that matter a lot.
The elephant in the room is twofold -- and paradoxical. On one hand there are technically extra demands on neurochemistry to get from point A to B in ADD treatment. Confusingly, on the other, there is abundant evidence that when those who really need amphetamines take them, wear and tear on the nervous system and physiology as a whole is considerably less than it would be for someone who really does not meet the criteria for ADD/ADHD but still wants to have the medicine in order to perform better. I think many would agree with the informal, practice wisdom difficult to prove experimentally that homeostatic adjustments though compounded for anyone who takes amphetamines are not the same for everyone and favor those who clearly have organic deficits to overcome.
We must also consider the generally beneficial complexity of having extra ingredients such as omega3 fatty acids in modern holistic treatment of ADD. To understand all the variables surrounding the neurology surrounding ADD, not just a reductionistic and often false representation of "dopamine deficinecy" is critical. What is the function of Choline, acetylchoine, Epinephrine, Norepinephrine, GABA, Glutamate etc.? According to a fairly comprehensive encyclopedia article Amphetamine (retrieved 5.10.17),
The full profile of amphetamine's short-term drug effects in humans is mostly derived through increased cellular communication or neurotransmission of dopamine, serotonin, norepinephrine, epinephrine, histamine, CART peptides, endogenous opioids, adrenocorticotropic hormone, corticosteroids, and glutamate, which it effects through interactions with CART, 5-HT1A, EAAT3, TAAR1, VMAT1, VMAT2, and possibly other biological targets.[sources 14]
In sum, Amphetamines 'hit' the dopamine receptors, as agonists, but there is a broader cascade going on, both in terms of scope of functions and types of neurotransmitters involved. Put bluntly, frank discussions about the dangers of long term use of amphetamines, including over-taxing adrenals and to pressuring various neurons to burn out and not adequately produce, re-uptake and refurbish.
People make the decision to ramp up the dopamine metabolism (better put - amphetamine metabolism) as well as adjacent physiology believing it to be the lesser of two evils. Taking amphetamines in not inherently good though it may help a person function at his or her best IF NOT ABUSED or depended on too much. This assumes a person has a strong feel for dangerous thresholds and has a reasonably good handle on life management. It presumes that treating physicians are able to advise on encourage a holistic treatment regimes.
See Also: Addicted To Adderall (Video - Dr. Oz and Guests)
Notice: I am a clinical social worker with an academic Ph.D. in Cultural Clinical Psychology and High School teaching credentials / teaching experience in science, health science technology and other areas. College teaching experience has been limited to social work, psychology and sociology. Most of my practice in recent years has been in geriatrics though I am open to limited work with other populations (i.e. Coaching). I do a lot of independent research in order to develop interdisciplinary systems related to medicine but this is a broader, generalist orientation that to some degree extends beyond medicine per se.
This article is for informational purposes only and should NOT be construed as medical advice. Please seek personal medical guidance from a fully credentialed Physician, Pharmacist or Independent nurse practitioner about your individual medical needs. AGAIN, please consult with such sources before making any medical decisions.