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Friday, September 12, 2008
Oppositional and Defiant--Or Critical Thinker?
cross-posted from howtheuniversityworks.com
An epidemic of compliance in higher ed helps turn parents and schoolteachers into corrections officers.
I’m working on a piece about undergraduate academic freedom that relates changes in campus culture to changes in the culture of schools. One area of particular interest is the medicalization of youth relations with authority. AlterNet’s Bruce Levine, a clinical psychologist, argues that “teenage rebellion has become a medical illness” with the 1980 introduction to the DSM IV of “Oppositional Defiant Disorder” (ODD):
Many talk show hosts think I’m kidding when I mention oppositional defiant disorder. After I assure them that ODD is in fact an official mental illness—an increasingly popular diagnosis for children and teenagers—they often guess that ODD is simply a new term for juvenile delinquency. But that is not the case. Young people diagnosed with ODD, by definition, are doing nothing illegal (illegal behaviors are a symptom of another mental illness called conduct disorder). In 1980, the American Psychiatric Association (APA) created oppositional defiant disorder, defining it as “a pattern of negativistic, hostile and defiant behavior.” The official symptoms of ODD include “often actively defies or refuses to comply with adult requests or rules” and “often argues with adults."
A diagnosis of ODD can result in medication with powerful tranquilizers like Risperdal and Zyprexa. Numerous experts have worried about overdiagnosis and overmedication of young people, and critical educators frequently worry that the problem is not lack of compliance by American youth but its precise opposite, an epidemic of compliance.
Norm Diamond, for instance, argues that many of the so-called defiant “symptoms” are in many cases “part of establishing independence and developing critical thinking. Equipping children to argue back is part of good parenting and good teaching.” Nonetheless a massive therapeutic industry of behavior modification, including pharmaceutical companies, now targets parents, promising cures for “defiant children.”
One of the most pervasive ad campaigns draws on the rhetoric of homeland security to label youth defiance “The War at Home,” urging a corrections mentality on the family: “The focus of treatment should be on compliance and coping skills, not on self-esteem or personality. ODD is not a self-esteem issue; it’s a problem solving issue.” .
Responding to Big Pharma ads for ODD medications targeting parents in his Portland media market, Diamond created a parody description of what he argues is the real social malaise, “Compliance Acquiescent Disorder,” which played locally in both radio and print versions. (An unexpected result of the parody was that outlets publishing them received calls from readers and listeners seeking treatment for their compliance disorder!)
Noting that “ODD-diagnosed young people are obnoxious with adults they don’t respect [but] can be a delight with adults they do respect,” Levine suggests that in many cases the symptoms of ODD are rational resistance to authoritarian abuses and “rebellion against an oppressive environment,” explanations rarely considered by educators or mental health professionals. Levine speculates that the willingness to medicate rebellion and nonconformity emerges in the social psychology of medical professionals, including a sense of shame for “their own excessive compliance”:
It is my experience that many mental health professionals are unaware of how extremely obedient they are to authorities. Acceptance into medical school and graduate school and achieving a Ph.D. or M.D. means jumping through many meaningless hoops, all of which require much behavioral, attentional and emotional compliance to authorities—even disrespected ones. When compliant M.D.s and Ph.D.s begin seeing noncompliant patients, many of these doctors become anxious, sometimes even ashamed of their own excessive compliance, and this anxiety and shame can be fuel for diseasing normal human reactions.
Of course, Levine’s observations would seem to hold for educators as well, many of whom welcome the diagnosis of ODD and other conduct-related disorders as “classroom management tools.” (On the other hand, the vast majority of teachers discussing “defiant” students on fora like ProTeacher.com are exchanging non-medical tips, often involving massive extra-curricular, non-instructional effort and expense on their part, voluntarily taking on the role of therapist and parent as well as instructor.)
“Finally, a cure for the class struggle,” wryly observed one of the Alternet discussion threads in response to Levine’s piece. “Is there a pill for megalomania and warmongering?” wondered another.
Thanks to Joel Westheimer (U Ottawa, formerly NYU) and Wayne Ross (U British Columbia, formerly U Louisville) for alerting me to the growing enthusiasm of educators and parents for ODD diagnoses of young people.
Comments
Does this really need to become a culture-war football? I can remember both the vaguely “leftist” idea that schizophrenia was simply a reaction to a confusing family environment and the decidedly rightist idea that Aspergers kids just need to be disciplined.
In my limited experience as a non-medical-professional (but as a parent talking to other parents) I’d guess that there are rare cases in which something like ODD does occur—when a very young child hits adults constantly, something is wrong—but that if it isn’t diagnosed by the time a child is seven or so, that child doesn’t have it. The idea of newly diagnosing college-age students with it is ludicrous. You can say that without playing the whole “ODD? Conspiracy by the pharma companies with the compliance of ashamed doctors” thing, which is sure to rightly piss off the parents of those rare young children who do have something like ODD, and who don’t appreciate being called either abusers or authoritarians by people who seem to want to attack either big pharma or professionality.
Does this really need to become a culture-war football?
I’m with Rich here. Speaking also just as a parent, things are probably difficult enough for families struggling with severe behavioral problems. I note that the DSM-IV diagnostic criteria specify that the behaviour must be causing “clinically significant impairment in social, academic, or occupational functioning.” If the diagnosis is being done responsibly, then, we’re not talking about kids who simply “argue back.” This is not to dismiss any role played by “Big Pharma” or expanding paradigms about what counts as a “medical” problem but to suggest that perhaps even in cases of seemingly “ludicrous” late diagnosis there may be some call for compassion to temper the skepticism.
This seems to have struck a nerve with some folks at the x-posted locations as well. (Had to delete one guy accusing me of collaborating with the fascists to deny youth medication so that we could control them with dogs and clubs instead.)
I don’t think Levine or Diamond are arguing that young people can’t be mentally ill and need treatment. Certainly I’m not.
Some of the things that a young person might do to merit an “ODD” diagnosis indicate serious mental problems, though whether that means ODD is the best angle on the problem is highly debatable.
In any event, they are arguing, in fairly good company, that medicalization and over-diagnosis are specific to the United States. They’re further arguing that these problems are enabled at the intersection of state power, public education, and private medicine, including but not limited to Big Pharma.
(This is especially clear with ADHD, which I’m posting on next.)
"I’d guess that there are rare cases in which something like ODD”
The key phrase here being “something like”. A child hitting adults constantly is, however, almost nothing like “a pattern of negativistic, hostile and defiant behavior.” To call the former behaviour “oppositional defiant disorder” both downplays, or at least misreads, the significance of that behaviour, whilst legitimating what is a highly specious definition of a “disorder”.
On this logic, what’s getting called ODD is a mild form of a somewhat violent and anti-social (or what have you) form of behaviour. But seriously, is it appropriate to define a disorder in terms of its mildest forms? A child who constantly hits adults may well have a disorder or mental illness of some type, but that in no way implies that ODD — as the diagnosis of otherwise mundane behaviour as a “disorder” or “mental illness” — is anything other than an extremely worrying invention.
If anyone’s concerned about the feelings of parents of those rare young children who have some kind of mental illness, I would think they would be wanting to stress the significance of that illness by insisting that it is not ODD, and precisely because ODD is an abuse of medical science (among other things).
Given the fact, moreover, that any kind of (socially) critical statement is routinely described as “negativistic, hostile and defiant”, I think Diamond’s position is entirely justified.