The American Society for ADHD and Related Disorders (APSARD) will shortly release its guidelines on treatment of adult ADHD, thereby joining progressive countries like the UK, South Africa and Australia which have already taken the plunge. Some 6% of US adults, about 15million people, currently have the diagnosis, so standardising assessment and treatment is seen as important to ensure the matter doesn’t get out of hand. According to experts from the Australian ADHD Professionals’ Association (AADPA), early diagnosis and treatment of ADHD is critical as, untreated, it leads to major complications such as anxiety, depression, psychosis, drug and alcohol addiction, gambling, suicide, family breakdown, criminality, accidents, dementia and early death – pretty well everything, it seems, but paedophilia. Certainly, the pressure is on to diagnose more and more people, put them on drugs for life and excuse them from all sorts of burdensome responsibilities. Remarkably, until just a few years ago, nobody realised that ADHD, especially the adult form, actually existed, but that only shows how modern scientific psychiatry is powering ahead.
For the true believers, taking psychiatry to the unmedicated masses is a joyous and, at anything up to $3,000 for barely an hour’s humdrum questioning, a rewarding experience. In previous posts, I’ve reported on various conferences and meetings intended to spread the good word on ADHD, of which the most striking feature is the almost revivalist atmosphere. Indeed, one of them made me want to jump up and belt out a few choruses from an old Neil Diamond song (better at full blast). However, that’s not entirely a bad thing as psychiatry has been on a bit of a downer lately. Despite all the publicity, people are starting to question whether psychiatry is fulfilling the promises it made at the dawn of the Prozac era, some thirty years ago. Even with something like 20% of the adult population on psychiatric drugs, suicide rates are going up, not down, while early retirement and disability pensions for mental disorder are also rising steadily.
Clearly, something is missing, and the ADHD crowd are sure they know what it is: a new disease. All they have to do is scare enough people and they’re in business. The operative word there is “scare.” In order to stir the lethargic public into paying for treatment that they don’t know they need, psychiatrists have to instil fear where none exists. Now that’s not always easy, as the anti-smoking campaigners knows too well. The relationship between smoking and lung cancer, not to mention emphysema, gastric ulcers, gangrene of the toes and crows feet, is based on rock-solid facts yet still people refuse to be frightened.
Fortunately, the idea of mental disorder is inherently scary so psychiatry has a somewhat easier job. In fact, it has a lot of experience although generally, it’s not the sort of experience that psychiatrists like to talk about. In the first decades of the last century, psychiatrists were active in the broad push to improve society by eradicating mental disorders and deficiencies. At the time, this wasn’t by the modern means of putting everybody on drugs, it was by the rather slower but more certain process of eliminating “defective germ plasm” from the genetic pool. Eugenics, as it was called, now has a very bad reputation but in the 1920s and 30s, it had very wide support, particularly among the wealthy, the powerful, and the educated classes (they’re not the same thing). Eugenics means “even breeding,” and is essentially what farmers have been doing for millennia, selective breeding to improve the stock.
The idea stems from the work of Charles Darwin’s hyperactive half-cousin, Francis Galton (1822-1911), who started psychology’s enduring obsession with biology, statistics and questionnaires (“rats and stats”). Galton was convinced that practically everything bad about Homo sapiens had a hereditary basis and that by following standard ideas of selective breeding, mankind (sic) could, in the space of a few generations, be lifted to a plane of nobility, both physical and mental. As bad as this sounds now, it has to be remembered that, by the 1920s, practically everybody in a position of influence in Western society believed it. There was no question in their minds: all they had to do was look at how the poor lived in their squalid, teeming, alcohol-, disease- and crime-ridden slums, then compare them with their upright, God-fearing and responsible selves, and the evidence was, to them, unassailable. The poor were poor, and short, and sick and feckless, because they were inherently defective. Therefore, preventing them breeding like rabbits could only result in an improvement in the state of the nation. Even a simple task like lining up the workmen at a colliery and comparing them with the managers and owners was perfectly clear: the ruling class were a good head or more taller than their workers. Photos from 1915-16, when Britain was building its mass armies show this. The officers, who were all upper class and ate meat as children, towered over the masses of troops who were raised on oatmeal and potatoes. Who needed more evidence? And what they believed about their poor they held twice as strongly about foreigners, perhaps not tolerably nice ones like French or Germans, but all others, especially coloured races.
At the time, every western country had its eugenics society, composed of the great and good and patronised by the wealthy and powerful. The foundational belief is the concept of racial superiority, that some races are simply “better” than others, and this also applies within races. Their goals were two-fold: firstly, as an internal matter, to prevent anybody with “hereditary taint” from reproducing, and secondly, to prevent any inferior races from entering the country to spread their “defective blood.” They saw their role as spreading the gospel to sensible people (such as themselves) and influencing governments (composed of their friends). A full history of the eugenics movement would be enormous and today, our entire perception of it is dominated by the catastrophes of the 1940s but, at the time, it was held without question. The idea of selective breeding to prevent the lower classes and foreigners from over-running the country was seen as highly responsible, even virtuous, a cross between the temperance movement and spreading the gospel to the benighted.
Eugenics societies were very active in financing research to support their case and in lobbying governments to pass restrictive laws. They were most successful in three countries, Britain, Germany and the US and, in formulating these political programs, psychiatrists were right in the thick of it. For example, a book published in 1934 by the British Eugenics Society included a chapter on “The Inheritance of Mental Disorders” by Dr Aubrey Lewis [1], of London’s Maudsley Hospital, later director of the Institute of Psychiatry and doyen of British psychiatry. This was not a fringe movement of cranks, it was very much a product of mainstream, self-consciously scientific thought.
The US didn’t need any urging to pass race laws but jumped at the scientific gloss provided by the genetic researchers. In Britain, of course, the ruling classes never doubted their inherent superiority, not just to foreigners (including the Scots and Irish), but also to their own working classes. Both these countries, however, looked to Germany for the lead in scientific genetic research as the new Nazi government was throwing money at the field. In particular, German research in the genetics of mental disorder was preeminent and international psychiatrists eagerly applied to study with the German experts such as Ernst Rüdin. This was at the time Germany was devising and then instituting its program to “eliminate the defective germ plasm” by the very simple means of either sterilising anybody with a mental or intellectual deficit (including epilepsy), or killing them. The T4 program, as devised by psychiatrists, resulted in about 300,000 people being murdered and several hundred thousand more being sterilised (it later became the model for the Holocaust). The great bulk of all mental patients in Greater Germany died without children, but to no avail. It did not eliminate or even reduce mental disorder.
Post-war, everybody in the West quickly forgot how strongly they had supported the German research into the genetic basis of mental disorder, but they didn’t give up their fanatical belief that all mental disorder is biological, and thus (sotto voce) genetic. For example, under the patronage of Aubrey Lewis, British psychiatrist Eliot Slater studied under Rüdin and later became editor in chief of the British Journal of Psychiatry. In the 1990s, Kenneth Kendler, a singularly influential psychiatric geneticist of Virginia Commonwealth University and current editor in chief of Psychological Medicine, joined forces with Rüdin’s daughter to try to rehabilitate his reputation.
The fundamental problem with the idea of eugenics was that it was built on the concept of inequality. It took the very obvious fact of social, physical and psychological inequality and cemented it in place as a biological imperative. Naturally enough, the people who were winning in the sweepstakes of life accepted without question that they occupied a superior role just because they were superior types all round. The one thing they didn’t want was to lose their status, to be dragged down to the level of the common herd, the great unwashed. The very thought of being levelled down filled them with panic, which is the source of their visceral hatred of socialism. In truth, who cares what colour your grandchildren are as long as they’re healthy? Well, a lot of people care very much about the colour of other people’s grandchildren, somewhat less about their own. They don’t mind having brown or black or yellow people working their fields, their factories or their kitchens, or in their beds, but they don’t want them coming to their royal garden parties or their universities or the officers’ mess. They panic, and they will do all sorts of dreadful things to keep the coloured people in their places, including expelling them from their traditional lands and, as we have seen (and still see), slaughtering them en masse.
The basis of eugenics was the belief that God decided some humans would be better than others and, by virtue of their superiority, should dominate and control society. Naturally enough, the people who worked out the Almighty’s intent were the same people who felt that, by virtue of their innate superiority, they should be top of the pile. However, the eugenics program was implemented not by angels but by humans using the simple technique of a moral panic. People had to be scared into treating other humans as subhuman although, as I’ve argued [2], that doesn’t take much: xenophobia, the fear and hatred of The Other, is hard-wired into us. The essential features of a moral panic are (a) a passive but easily frightened populace (i.e. practically all humans), (b) a threat of some sort (foreigners, witches, paedophiles, communists, crime, disease, drugs, etc) and (c) somebody to whip up the fear and direct it. The latter are known as moral entrepreneurs, activists who seek to change the basic moral structure of the society, either by reinforcing some existing belief or practice or by imposing a new one on the obedient masses.
For eugenicists, the thought of endlessly breeding inferior people eventually replacing the worthy upper classes threatened their very existence. The only way to deal with it was through legislation, which they controlled anyway, to keep the lusty hordes at bay. The Nuremberg race laws passed by the Nazi controlled Reichstag in 1935 were modelled on Kentucky’s race laws which were already in force. They targeted Jews, Romany and Africans and were later extended to Slavs, whom the Nazi program intended to keep as serfs. The whole point of the idea of eugenics was built on the false belief that “inferiority” in any respect, physical, social, intellectual, etc, was necessarily biological. Poor people were poor because they didn’t save, not because the economic system paid them so little that they had to spend every penny they earned just to stay alive. In the US, blacks were regarded as intellectually stunted, which justified not spending any money on their education, which meant they couldn’t learn to read and write, which made them look intellectually stunted.
The whole belief system of eugenics was self-reinforcing. It started with the observation that some people don’t get ahead in life, and located the cause within, as we would say, the individual’s defective genes. The only cure for defective genes was their removal from the gene pool, initially by sterilisation but later by extermination. Opposing them, Karl Marx said inequality isn’t genetic, it’s the result of biases built into the economic system which could only be eliminated by revolutionary change. There was no other way humans the world over would be equal. However, for the wealthy classes, the thought of being on an equal footing with their workers, their servants, serfs and slaves, was simply unthinkable, which is why they hated Bolshevism with such unquenchable ferocity (to understand what moved Marx, see [3]).
The parallel with today’s ADHD moral panic is very real. Acting as moral entrepreneurs and backed by drug companies that stand to make fortunes, psychiatrists locate the causes of what are essentially social difficulties as a “genetic disease” within the individual. They then focus their “therapy” on just that person, ignoring the contributions of parents, schools, society, social media, prisons and so on.
A hundred years ago, eugenicists manipulated the science of the day to justify their prejudices. Today’s biological psychiatrists are doing the same thing. Plus ça change, plus c'est la même chose.
References :
1. Blacker CP (1934). The Chances of Morbid Inheritance. London: HK Lewis/UK Eugenics Society.
2. McLaren N (2023): Narcisso-Fascism: The psychopathology of right wing extremism. Ann Arbor, MI: Future Psychiatry Press. Amazon.
3. Brown J (1832/2019). A Memoir of Robert Blincoe, an Orphan Boyhttps://www.gutenberg.org/files/59127/59127-h/59127-h.htm