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The Tyranny Of Desire

No, not another BDSM thread. This, from Psychology Today, is about a different kind of discipline [1]:

In the United States, at least 9% of school-aged children have been diagnosed with ADHD, and are taking pharmaceutical medications. In France, the percentage of kids diagnosed and medicated for ADHD is less than .5%. How come the epidemic of ADHD—which has become firmly established in the United States—has almost completely passed over children in France?

Is ADHD a biological-neurological disorder? Surprisingly, the answer to this question depends on whether you live in France or in the United States. In the United States, child psychiatrists consider ADHD to be a biological disorder with biological causes. The preferred treatment is also biological–psycho stimulant medications such as Ritalin and Adderall.

French child psychiatrists, on the other hand, view ADHD as a medical condition that has psycho-social and situational causes. Instead of treating children’s focusing and behavioral problems with drugs, French doctors prefer to look for the underlying issue that is causing the child distress—not in the child’s brain but in the child’s social context. They then choose to treat the underlying social context problem with psychotherapy or family counseling. This is a very different way of seeing things from the American tendency to attribute all symptoms to a biological dysfunction such as a chemical imbalance in the child’s brain.

The writer goes on to talk about how French parents take a more holistic approach to treating children who act up and act out, considering environmental and nutritional factors. And there’s this:

French parents have a different philosophy of disciplinine. Consistently enforced limits, in the French view, make children feel safe and secure. Clear limits, they believe, actually make a child feel happier and safer—something that is congruent with my own experience as both a therapist and a parent. Finally, French parents believe that hearing the word “no” rescues children from the “tyranny of their own desires.” And spanking, when used judiciously, is not considered child abuse in France.

This describes exactly how I was raised, and most Southerners in my town, of my generation, were raised — with the notable exception of food consumption, which for some cultural reason was not subject to discipline. My parents were fairly strict, but not unusually so for this culture, and I recall with deep appreciation how safe the limits set, and enforced, by my folks made me feel. Ruthie and I talked about that every now and then as adults, how free we felt as children within the behavioral boundaries set by our mom and dad. I mean, we wouldn’t have described it that way as kids, but that’s exactly what it was. I can remember the times we would go over to the house of someone whose kids ran wild. It felt unsafe, like there was no one in charge, and anything could happen.

I am aware of how our culture erred in ascribing moral failure to neurological distress, e.g., seeing biochemically-caused depression as a moral phenomenon. But in some cases, we overreact. Sometimes the problem does have a moral component, and we can train the brain to respond differently to outside stimuli.

change_me

Parenting is hard. So is civilization.

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24 Comments To "The Tyranny Of Desire"

#1 Comment By SusanKG On May 17, 2013 @ 2:20 pm

A close friend has two boys with ADHD, both of whom have had meds prescribed from an early age. The prescribing physician claimed that the reason ADHD rates were so high in the U.S. was due to our gene pool. His theory was that the people with the personalities to tame the frontier likely were impatient types who had short attention spans. Seems dubious, but it may have given the doc some cold comfort for handing out all those ‘scripts.

#2 Comment By Mary Russell On May 17, 2013 @ 2:23 pm

From the article:
“To the extent that French clinicians are successful at finding and repairing what has gone awry in the child’s social context, fewer children qualify for the ADHD diagnosis.”

Believe it or not, American clinicians (family doctors, pediatricians, psychologists, psychiatrists, etc.) also try to “find and repair” the bad stuff going on around the kids. But doctors and psychologists are no more able to fix a kid’s chaotic home environment than teachers can. What exactly do the French *do* that repairs what has “gone awry” at home? The article doesn’t say. Perhaps what is really going is that the French have superior social support for struggling families: better day care, better preschools, better schools, better health care, better nutrition. And all of that translates into a lower incidence of ADHD, or less severe ADHD.

[Note from Rod: That could be, but it’s also true in France that people are far more conformist — and I say that not in a critical way. Whether you are left-wing, right-wing, it doesn’t matter — you are expected to behave in certain ways. The French are not really all that interested in you being able to be the Very Special Snowflake you think you are. This has good effects and bad effects. I wonder, for example, how my child with Asperger’s and very serious sensory issues would do in a French classroom, or if they would just expect him to get on with it. On the other hand, I think there’s often a lot to be said for “get on with it.” — RD]

#3 Comment By elvisd On May 17, 2013 @ 2:31 pm

I often remark that my students with ADHD have been misdiagnosed. They probably suffer from BPS-Bad Parenting Syndrome. There’s also another once-commonly diagnosed disorder called BWBB- Boys Will Be Boys, but our enlightened psychologists now discount that there is such a thing.

#4 Comment By k On May 17, 2013 @ 2:38 pm

I was raised in a family of many children and among extended family where the children all “ran wild”. I remember how when going to the homes of children whose parents had typical behavioral boundaries, how suffocated I felt, so nervous or frightened that I would break one of the many rules I wouldn’t even know about, even how angry or offended at times I felt that adults would dare to be so controlling over children.
When I think of many other families I have known since then, it’s hard for me to see association between parental boundaries or structure and specifically ADHD type behavioral problems. Things I have noticed? Television/video viewing at young age, lack of any silence ever in the house (tv or music always on or people always talking/arguing), junk food and lack of certain nutrients, and simple lack of time spent by adults with the children (children who mostly only ever interact with other children develop personalities and behavior quite differently than children who have a greater proportion of time with an adult).
Anyway it’s such a sensitive topic to honestly discuss why certain cultures are so swept now with these problems in children, and why others simply are not. It serves and pays some people very well to view all these things as biological/medical diseases.

#5 Comment By Will in Mississippi On May 17, 2013 @ 2:39 pm

There’s a tremendous difference between strict and harsh which many people don’t get. My parents were quite indulgent–very far from either strict or harsh–but made very clear that certain behavior was unacceptable and that self-control had to be exercised.

I think of this because I have seen a lot of parents who don’t insist that children learn to control themselves. Things my indulgent parents would have called naughty and not permitted are treated as cute or precious…just part of being a kid. So children are out of control.

Out of control doesn’t mean the pathology described in recent threads, but it does mean that children (0r adults) acting that way make public spaces unpleasant. I see it in middle or even upper middle class families that are not (otherwise) disfunctional. Bet it make school feel like whiplash for the precious little kiddies involved.

#6 Comment By Myron Hudson On May 17, 2013 @ 3:06 pm

Great article. The tyranny of their own desires, indeed. My wife and I observed many peers who could not bring themselves to say “no” to their own children – even though the children routinely said “no” to their parents.

We called that the tyranny of the child. Close, but your article says it better.

#7 Comment By Michelle On May 17, 2013 @ 3:06 pm

I guess I must be French because I believe in providing children with age-appropriate limits and in enforcing consequences when those limits are transgressed. I also believe kids need to hear the word “no” when necessary. My husband, a Russian immigrant, and his ex-wife, hold almost the opposite beliefs and my stepson is much the worse off for it. I think my stepson got the message growing up that nobody really cared what he did because nobody bothered to place genuine limits on his behavior and back them up. It’s heart-breaking.

Too many parents these days don’t want to do the hard work of being parents. They want to be their kids’ friends, which reverts the natural order of things.

#8 Comment By C. L. H. Daniels On May 17, 2013 @ 3:24 pm

I heartily agree with Rod’s conclusions. My single mother was strict by the standards of most of my friends, and yes I occasionally earned myself a spanking, but it’s not like I lived in some reform school. Looking back, I account my mother to have been a very wise parent.

#9 Comment By Kevin in OH On May 17, 2013 @ 3:35 pm

I would love to find out that ADHD was merely social\behavioral or my own bad parenting, but having some experience with a child diagnosed that way (my oldest son), I strongly doubt it.

My son tests in the average range on IQ/ability, but is getting D’s in 2nd grade because he can’t focus long enough to get his work done (I am not a total fan of the school curriculum either, but that’s a different post). He was willful and difficult to manage from an early age, but we worked with a psychologist since he was 3 and tried all the “right” things: he watched no TV before 2 years old, and after that no more than 60-90 minutes a day. Never TV with commercials since we don’t have cable/broadcast TV. He had no video games until age 8, and then no more than 30 minutes a day. My wife stayed at home with him and played outside every day the weather was nice enough. I built him a sandbox and bought a swingset. We set firm boundaries. We took TV away or other favorite things away when he crossed them and I spanked him a few times (hard enough that now the threat of a spanking is always enough). We read books every night before bed. We eat dinner as a family every night.

None of that mattered. 2nd grade, and we struggle with him for 1-2 hours every night of the week trying to get through homework & make-up what he didn’t finish in school. We’ve met numerous times with his teachers, and the school has tried OT accomodations (kick-bands on the chair, letting him chew gum, placing him in front of the class), with no improvement. We tried as hard as humanly possible to stay off medication, but will now be starting him on it because we are completely out of other options.

Oh – and we adopted my son from Guatemala at 8 months, so you can’t put it donwn to “gene pool” or “in utero” environment or any of those early factors. But for all I know, it could easily be something in our drinking water…

#10 Comment By Charles Cosimano On May 17, 2013 @ 3:57 pm

A moral component to a medical condition? The French are nuts.

#11 Comment By Marchmaine On May 17, 2013 @ 3:58 pm

If you haven’t already, you should read: _French Kids Eat Everything_ by Karen Le Billon… it will gratify your outsider’s longing to understand French culture… food, children, tradition, and discipline.

[2]

Of course, Chesterton understood this as well… it was something of a cornerstone to his philosophy:

“Catholic doctrine and discipline may be walls; but they are the walls of a playground. Christianity is the only frame which has preserved the pleasure of Paganism. We might fancy some children playing on the flat grassy top of some tall island in the sea. So long as there was a wall round the cliff’s edge they could fling themselves into every frantic game and make the place the noisiest of nurseries. But the walls were knocked down, leaving the naked peril of the precipice. They did not fall over; but when their friends returned to them they were all huddled in terror in the centre of the island; and their song had ceased.” (Orthodoxy; Chapter 9).

#12 Comment By Karen On May 17, 2013 @ 4:00 pm

There is some interesting new research that is starting to suggest that ADHD is actually sleep deprivation in disguise. Most children under 12 need 9 or even 10 hours of sleep per night to function well. Very few actually get it with the absurdly early school start times that seem to prevail throughout the US. Anecdotally, my youngest son needs a lot of sleep -he sometimes sleeps 12 hours straight – and he is a nightmare to deal with behaviourally if he doesn’t get it.

[3]

#13 Comment By Leinad On May 17, 2013 @ 4:14 pm

I’m with you up until the point that you talk about this being a “moral” issue. I realize the topic of morality has been talked about a lot on this site the past few days, but I don’t see this as related to morality in any kind of religious or philosophical sense. I would agree though that there is a “social” component.

#14 Comment By W.E.B. Dupree On May 17, 2013 @ 4:38 pm

About a dozen or so years ago, I worked for several months on a reality show that aired on the Disney Channel about adolescent kids at a summer camp. It was pretty tame by reality TV standards; the kids did get up to some rather “adult” mischief, but of course none of that stuff was included on the show. The raw footage, which I saw, could be rather shocking, though.

One thing that never made the show was footage of the woman who would push a cart around during breakfast at the kids’ mess hall. On the cart were an assortment of little containers of pills — like something you’d see at supper time in an old folks’ home! Most of the pills were for the boys, most of whom had been diagnosed with ADHD or something similar. I was flabbergasted. Sure, when I was a kid, there were usually one or two kids in class who were known to be taking ritalin or something like that, but a majority of the boys?! And this was a pretty fancy camp, too; these were kids from relatively affluent families.

Another thing that spooks me about those drugs: When I was in college, I had a friend from Phoenix, and he was already on speed when he showed up as a freshman. He told me once that among his group of high school friends who were all using meth, almost all of them had been on ritalin or something similar as children. Sure, it could just be correlation, not causation, but still.

#15 Comment By Mary Russell On May 17, 2013 @ 5:11 pm

“I think there’s a lot to be said for “get on with it”.

I’m with you there. What I really object to in this article, though, is the coarsely stated dichotomy: “The French do this, Americans do that”. “The French way is good, the American way is bad.” It’s just simply not true that ADHD is not treated with family therapy in the U.S. Indeed, therapy for the child with ADHD is a mainstay of treatment and is considered “standard of care” for affected kids *along* with medication. And while I concede that some kids may be overtreated, it may be equally true that a lot of French kids who would benefit from the meds are undertreated. What would be a really useful article is one comparing *outcomes* in ADHDers treated with therapy alone, meds alone, or a combination.

#16 Comment By brians On May 17, 2013 @ 6:19 pm

Kevin in OH:

How about not making a 7 year old boy sit in a classroom for 6 hours & then try to do 2 hours of homework?

Why do we try to turn our little boys into little girls?

#17 Comment By brians in OH On May 17, 2013 @ 6:26 pm

Kevin in OH –

My previous comment is a little simplistic & probably unfair, but if the prevailing educational model is failing your son, for Pete’s sake, take him out!

#18 Comment By Fran Macadam On May 17, 2013 @ 7:08 pm

Naturally, to the man whose nation has a plethora of out-of-control corporations, everything looks like a corporate problem.

Consistent with that belief, with the utility of the forensic technique of “follow the money” and the principle of “Cui Bon” – who benefits – it sure looks like the sheer profits involved along with physician drug kick-back schemes have everything to do with this.

#19 Comment By MS On May 17, 2013 @ 7:55 pm

The article made no distinction between ADHD-Hyperactive and ADHD-Inattentive, which used to be called ADD. The Inattentive type does not seem to be helped by family therapies. In any case, this article on the same site seems to rebut the one that you posted: [4]

#20 Comment By EliteCommInc. On May 17, 2013 @ 8:01 pm

Well,

I understand that what they do is create a narrower model for what is diagnosed as ADD, which accounts for the 4% difference. But I am not sure that their actual diagnosis for ADD is different.

I may have misread the post. But ADD/ADHD are chemical imbalances.

Certainly environmental attributes and treaments can addressed. But if nutrion, which addresses possible chemical causes don’t shift behavior, I would be curious what they attend to next.

#21 Comment By Erin Manning On May 17, 2013 @ 8:43 pm

Kevin, your story reminds me of seeing a mom quiz her daughter on her spelling words at a Sunday afternoon parish dinner; they hadn’t had time to get to this part of the girl’s homework over the weekend. The girl had to memorize twenty unrelated words of six or seven letters or more, and be able to write both the word and the definition on her “test” on Monday; messy handwriting would get points off, too.

The girl was six. This was first-grade homework. And it was by far not the only thing she’d had to do over the weekend to turn in on Monday.

I’m sorry, but this push to make young children do more and more homework is part of the reason we have kids melting down, acting out, and giving up in middle school and junior high. The “fire-hose at a teacup” model of schooling has been shown not to work all that well; it takes time for a child’s brain to develop, and the development of motor skills can vary widely from child to child such that a child who reads quite well may struggle to print legibly, etc.

I’m not in any way second-guessing your decisions for your son re: medication etc., but I really do think that there are elements of modern schooling that are insane. As a homeschooling mom I’ve met families with boys (we have girls) who noticed huge changes when they started learning at home; sons who struggled to complete a worksheet of math or sentence-writing in the classroom found their own paces and went on to do quite well. I think–and I have nothing but anecdotal evidence of this, myself, but perhaps it exists out there–that boys actually do take longer to learn to do typical “seatwork” involving large amounts of written homework. But they catch up just fine if they’re allowed to give oral answers until their writing ability has caught up, in most cases I’ve known.

#22 Comment By Siarlys Jenkins On May 19, 2013 @ 8:53 pm

There are a lot of good points here, and a few bad ones. The first step toward wisdom is to recognize that any number of causes may underlie a set of symptoms that clinicians facilely label as this or that illness, including ADHD or ADD. The human mind is a complex and poorly understood thing, not to be authoritatively trifled with on whim or supposition.

I’m sure TV has a lot to do with it. I would keep a child away from TV at least until they are five, with the possible exception of the annual rebroadcast of The Wizard of Oz — oh, wait, they don’t do that any more now that there are DVD’s so it can be played over and over every day of the year.

From my experience volunteering in the library of a Boys and Girls Club, and tutoring high school students, I can testify to the truth of Erin’s observation about speeding kids up. There seems to be a belief among The Experts that the way to show our faith in children’s capacities, and to make them expert adults, is to shove more and more advanced stuff into their little lives sooner and sooner. One result is that teachers barely have time to cover a subject once, before rushing on to the next required item, and better than half the kids don’t get it. I recall a young lady with ambitions to study chemistry and then mortuary science who had detailed notes in impeccable handwriting, and didn’t understand what a word of it meant. My job as tutor became explaining what the teacher meant to teach by the material copied from the chalkboard in the notes.

I also recall a friend’s grandson whose teachers wanted to put him on Ritalin. The real problem was, he finished his work early, and correctly, and there was nothing for him to do, so he fidgeted and squirmed and found things to do. (Back in the day, my teacher used to send us to the library until time for the next assignment). I call this aspect Administrative Deficiency Disorder.

But I once read a letter to the editor from someone whose life was miserable until Ritalin was prescribed, and then felt calm, cool, focused, and competent. It was the best thing that ever happened to him. That taught me that just because its a bad diagnosis and worse therapy for a large number, doesn’t mean it isn’t just right for someone, somewhere, who really needs it.

And spanking, when used judiciously, is not considered child abuse in France.

It isn’t exactly in the United States either. It certainly isn’t illegal, not by parents anyway, and an awful lot of it still happens. One of the problems with lax parents who don’t really care is they do whip their kids — but capriciously, for their own convenience, not judiciously, to enforce limits and socially necessary restrictions. Many non-abusive parents still make use of it also.

There are social workers imbued with the misconception that it is illegal, and they do some damage, but look up the landmark case of Calabretta v. Floyd for a counter-point.

#23 Comment By Kevin in OH On May 19, 2013 @ 9:33 pm

Erin / Brians:

The homework is only supposed to take 20-30 minutes – it’s because of his poor focus that we have to struggle through 2 hours of it.

Yes, it would be great if homeschooling could work for our son – I don’t believe that every parent makes a good teacher though, and I think we’d be failing him worse if my wife tried to teach him.

I would love to see the research demonstrating the fire-hose model of education isn’t working, if anybody has it – be nice to share with the principal / school board.

#24 Comment By Erin Manning On May 20, 2013 @ 12:57 am

Kevin, first of all, though I’m an enthusiastic homeschooling mom (my girls are teens now) I would never tell everybody to homeschool, and if you think it wouldn’t work for you, I fully respect that.

As for the “fire-hose” thing, the best I can suggest is to do a search on the phrase “too much homework.” While it’s a controversial subject, there have been studies suggesting that the constant pressure to do increasing amounts of homework is robbing children of their time to just be kids (and increased standardized testing doesn’t help matters, especially in elementary school). They’ve already spent six or seven hours mostly sitting in classrooms, so it’s natural that they would balk at having to sit again when they get home. Interestingly, countries which give very little after-class homework include places like Japan, while countries that give a lot of homework include countries with failing school systems. America’s schools give average amounts of homework–and have average results overall. But the idea that lots of homework correlates to high grades and focused students is an idea without much of a foundation.

One suggestion I’ve seen frequently has been that students receive ten minutes of homework per night for each grade level (a maximum of 10 minutes a day in first grade, 20 in second, etc.). As a “rule of thumb” that’s probably not too bad, but if your son’s regular assignments are supposed to take 20 to 30 minutes to complete he’s already being pushed to and even beyond this particular maximum. And sometimes parents are told that assignments should take an average student 20 to 30 minutes, and in reality very few, if any, of the kids are going home and getting the work done that quickly, but parents won’t talk about it to each other (because everyone’s afraid their child is the one child who is working much more slowly than the rest of the class). I’m no expert, but from what I remember from lots of different children (my own, other family members’ children, my siblings growing up, etc.) 20 minutes of homework in 2nd grade should be one to two single-sided worksheets with, perhaps, five to ten math problems and five to ten short sentences to write, or possibly ten minutes worth of reading and another ten of memorization. And even though this is from three years ago, I found it interesting:

[5]

It looks like these parents were having similar problems: children being sent home with uncompleted classwork as well as homework, being made to write 21 spelling words five times each (!) along with other work…and the problem was that the children got out of their seats too frequently? Most of them are seven years old, for heaven’s sake! They’ve already been sitting all day, too. What does this teach them except that school is no fun and learning is a drudgery-filled chore?

Again, none of this is to criticize the diagnosis you’ve received for your son or your choices in how to help him–only you and your wife can know the right approach here. To me, one of the biggest problems in today’s education system is that we’re still following the Industrial Age model, when children needed to be trained to sit or stand for long periods of time doing boring tasks repetitively. The world has moved on to the Information Age, and a question I’d like to ask is: how long will it take for education to catch up? And what happens, in the meantime, to the kids who are bright and creative enough to know there’s something wrong with the endless drudgery, but who are too young to articulate their problems with it all?