Treatment for ADHD
Posted: Tue Mar 01, 2005 10:30 pm
A Cutting Edge Approach to the Treatment of ADHD in Male Children: Surgical Castration
Frederick J. McGavran
The role of Ritalin therapy in the treatment of Attention Deficit Hyperactivity Disorder (ADHD) is so well established that the author hesitates to propose an alternative, regardless of its merits. However, given the pervasiveness of the problem, there is clearly room for improvement. Numerous double blind studies have shown that ADHD has an incidence of between 17 and 35 percent in American males between the ages of 2 and 13; idiosyncratic experience suggests that the morbidity rate is actually much higher. Among the private and suburban school population, one frequently finds some 70 percent of white males in this age group undergoing Ritalin therapy, as an adjunct to their mothers careers
The desire to consider an alternative arises not out of any argument against controlling disruptive male behavior, but out of a need to employ a pharmaceutical model. Ever since the President and Mrs. Reagan held hands before an awe-stuck nation and encouraged children to Just Say No to drugs, Ritalin therapy has been criticized as incompatible with the goal of a drug-free America. Some claim Ritalin teaches young boys to take drugs; others suggest that parents and caregivers prefer it to television as a substitute for quality time with their little charges. If, then, chemical castration is found to conflict with important social policy, perhaps it is time to consider surgical castration.
The modern procedure is quick, painless under proper anesthesia, and can be performed on an outpatient basis, at least through the age of ten. Many assert that the earlier the procedure is undertaken, the less likely it is for offensive traits to develop. Indeed, it has even been proposed that infants be sterilized at the same time they are circumcised in order to spare parents the added expense of psychological testing and of having to experience the antisocial behavior of their own offspring. However, this author is reluctant to recommend such an aggressive treatment strategy. Given present economic constraints on medical resources, allowing the child a few trial years appears preferable to early preemptive surgical intervention.
Once done, the result of the surgery is immediate and permanent. No more worries about forgetting to give him his medicine; no more unpleasant side effects; no more calls to the doctor to renew the prescription; no more inconvenient trips to the pharmacy; no more classrooms filled with listless little boys. And, most important, we send our children the right message: drugs are not the answer.
There are a host of other benefits to surgical castration as well, benefits far beyond the reach of Ritalin. Boys choirs will no longer suffer ruinously high turnovers as the choristers reach adolescence; after auditions, successful candidates will be able to serve until retirement age. A glorious new age in choral music is on the horizon: not since the eighteenth century, when the Vatican ceased employing choirs of castrati, or the late fifties, when the falsetto briefly reemerged in popular music, have the prospects for countertenors been so bright.
We can also anticipate a sharp decrease in certain debilitating injuries known to plague contact sports. No longer will the action be broken, while some unlucky contender writhes in pain; no more timeouts as the injured athlete is carried off the field.
Of course, several investigators have voiced objections to the procedure, but all may be overcome with reason and good will. The strongest objection arises, surprisingly, from mental health professions and a particular pharmaceutical company, fearful of losing market share. If Ritalin therapy is replaced, they claim, an entire industry will be destroyed, displacing tens of thousands of test administrators, evaluators, therapists, physicians and plant workers. In addition to the obvious economic impact, there is the subtler but no less serious human cost to consider as networks of mothers, teachers, psychologists, and pharmacists unravel. Fortunately, psychology itself has already addressed this concern.
Although the consequences of long-term Ritalin therapy remain unknown, the results of surgical castration are well documented. Even the most conservative studies find sequelae ranging from anxiety to major depression to the entire panoply of symptoms and mental disorders. In other words, therapists, who now routinely lose contact with their patients at adolescence or early adulthood, can look forward to following them throughout their adult lives. Our patients will no longer outgrow us.
For industry, the prospect is equally exciting. Instead of one manufacturer monopolizing the market, the entire pharmacopoeia would be prescribed in the endless search for an unattainable antidote. A simple change in treatment could usher in a golden age of analysis, therapy, and marketing.
Another objection is social: would not African Americans, Asian Americans, Americans with Spanish surnames, and every other ethnic group regard the procedure as little more than a cynical attempt to rid the nation of minorities? Although history provides considerable support for this concern, it is misplaced here. Statistically, very few minorities use Ritalin with their young; indeed, this therapy is employed almost exclusively by members of the white upper class. It seems safe to say that surgical castration will also be the remedy of choice for these folks, at least until HMO contracts and diagnostic criteria can be rewritten.
Moreover, where the dominant race and class happily subjects itself to such a treatment, it is difficult to argue a sinister Darwinian motivation, at least on their part. The real battle probably will emerge over government funding, as it did with abortion. Impoverished and disfavored minorities always assert a right to participate in any procedure that race and economic status appear to deny them. As with other seemingly difficult contemporary issues, the answer is not to restrain the privileged and wealthy few, but to empower the marginalized and impoverished many.
Other objections to the procedure may be dealt with summarily. Disfigurement need not concern us; veterinarians have long since mastered the art of suggesting what was once there; surely general surgeons can follow suit. Expense need not be a factor either. When we compare the cost of years of Ritalin therapy and concomitant psychological evaluation with the cost of ten minutes of a surgeon and an anesthesiologists time, it just about evens out.
Finally the objection that the procedure can only be performed on males begs the question of whether or not it should be performed at all. In parts of Africa and Asia, a form of female castration has been successfully practiced for centuries. Illusions of cultural superiority must not blind us to what we may learn from others.
Surgical castration, therefore, will not only free the younger male generation from the tyranny of drugs and sex, but also from the pretended superiority of American civilization. Not only will ADHD disappear, male violence, especially male abuse of female spouses, will be a thing of the past. In fact, without fighter pilots, war itself may cease. Certainly, we will have seen the last Tail Hook Convention.
Let us hope then that science and reason will overcome inertia, prejudice and self-interest. Our children deserve better; in the name of public health and morality we must pursue this course. Finally, the passionless future that Ritalin heralded and Rep. Patricia Schroeder (DCol.) predicted will become a reality. The author, for one, embraces it and invites his colleagues to join him.
Journal of Polymorphous Perversity, vol. 20, no. 2 (Fall/Winter 2003), pp. 68.
**********
Frederick McGavran is an attorney in a large, multi-state law firm. He mostly represents pharmaceutical companies in defense against class-action lawsuits and represents doctors defending themselves in malpractice cases. He is also on the advisory committee of a large urban school board.
Volume 20, number 2 was the final issue of the Journal of Polymorphous Perversity. It was a wonderful journal and I treasure my full run of all 20 years.
Frederick J. McGavran
The role of Ritalin therapy in the treatment of Attention Deficit Hyperactivity Disorder (ADHD) is so well established that the author hesitates to propose an alternative, regardless of its merits. However, given the pervasiveness of the problem, there is clearly room for improvement. Numerous double blind studies have shown that ADHD has an incidence of between 17 and 35 percent in American males between the ages of 2 and 13; idiosyncratic experience suggests that the morbidity rate is actually much higher. Among the private and suburban school population, one frequently finds some 70 percent of white males in this age group undergoing Ritalin therapy, as an adjunct to their mothers careers
The desire to consider an alternative arises not out of any argument against controlling disruptive male behavior, but out of a need to employ a pharmaceutical model. Ever since the President and Mrs. Reagan held hands before an awe-stuck nation and encouraged children to Just Say No to drugs, Ritalin therapy has been criticized as incompatible with the goal of a drug-free America. Some claim Ritalin teaches young boys to take drugs; others suggest that parents and caregivers prefer it to television as a substitute for quality time with their little charges. If, then, chemical castration is found to conflict with important social policy, perhaps it is time to consider surgical castration.
The modern procedure is quick, painless under proper anesthesia, and can be performed on an outpatient basis, at least through the age of ten. Many assert that the earlier the procedure is undertaken, the less likely it is for offensive traits to develop. Indeed, it has even been proposed that infants be sterilized at the same time they are circumcised in order to spare parents the added expense of psychological testing and of having to experience the antisocial behavior of their own offspring. However, this author is reluctant to recommend such an aggressive treatment strategy. Given present economic constraints on medical resources, allowing the child a few trial years appears preferable to early preemptive surgical intervention.
Once done, the result of the surgery is immediate and permanent. No more worries about forgetting to give him his medicine; no more unpleasant side effects; no more calls to the doctor to renew the prescription; no more inconvenient trips to the pharmacy; no more classrooms filled with listless little boys. And, most important, we send our children the right message: drugs are not the answer.
There are a host of other benefits to surgical castration as well, benefits far beyond the reach of Ritalin. Boys choirs will no longer suffer ruinously high turnovers as the choristers reach adolescence; after auditions, successful candidates will be able to serve until retirement age. A glorious new age in choral music is on the horizon: not since the eighteenth century, when the Vatican ceased employing choirs of castrati, or the late fifties, when the falsetto briefly reemerged in popular music, have the prospects for countertenors been so bright.
We can also anticipate a sharp decrease in certain debilitating injuries known to plague contact sports. No longer will the action be broken, while some unlucky contender writhes in pain; no more timeouts as the injured athlete is carried off the field.
Of course, several investigators have voiced objections to the procedure, but all may be overcome with reason and good will. The strongest objection arises, surprisingly, from mental health professions and a particular pharmaceutical company, fearful of losing market share. If Ritalin therapy is replaced, they claim, an entire industry will be destroyed, displacing tens of thousands of test administrators, evaluators, therapists, physicians and plant workers. In addition to the obvious economic impact, there is the subtler but no less serious human cost to consider as networks of mothers, teachers, psychologists, and pharmacists unravel. Fortunately, psychology itself has already addressed this concern.
Although the consequences of long-term Ritalin therapy remain unknown, the results of surgical castration are well documented. Even the most conservative studies find sequelae ranging from anxiety to major depression to the entire panoply of symptoms and mental disorders. In other words, therapists, who now routinely lose contact with their patients at adolescence or early adulthood, can look forward to following them throughout their adult lives. Our patients will no longer outgrow us.
For industry, the prospect is equally exciting. Instead of one manufacturer monopolizing the market, the entire pharmacopoeia would be prescribed in the endless search for an unattainable antidote. A simple change in treatment could usher in a golden age of analysis, therapy, and marketing.
Another objection is social: would not African Americans, Asian Americans, Americans with Spanish surnames, and every other ethnic group regard the procedure as little more than a cynical attempt to rid the nation of minorities? Although history provides considerable support for this concern, it is misplaced here. Statistically, very few minorities use Ritalin with their young; indeed, this therapy is employed almost exclusively by members of the white upper class. It seems safe to say that surgical castration will also be the remedy of choice for these folks, at least until HMO contracts and diagnostic criteria can be rewritten.
Moreover, where the dominant race and class happily subjects itself to such a treatment, it is difficult to argue a sinister Darwinian motivation, at least on their part. The real battle probably will emerge over government funding, as it did with abortion. Impoverished and disfavored minorities always assert a right to participate in any procedure that race and economic status appear to deny them. As with other seemingly difficult contemporary issues, the answer is not to restrain the privileged and wealthy few, but to empower the marginalized and impoverished many.
Other objections to the procedure may be dealt with summarily. Disfigurement need not concern us; veterinarians have long since mastered the art of suggesting what was once there; surely general surgeons can follow suit. Expense need not be a factor either. When we compare the cost of years of Ritalin therapy and concomitant psychological evaluation with the cost of ten minutes of a surgeon and an anesthesiologists time, it just about evens out.
Finally the objection that the procedure can only be performed on males begs the question of whether or not it should be performed at all. In parts of Africa and Asia, a form of female castration has been successfully practiced for centuries. Illusions of cultural superiority must not blind us to what we may learn from others.
Surgical castration, therefore, will not only free the younger male generation from the tyranny of drugs and sex, but also from the pretended superiority of American civilization. Not only will ADHD disappear, male violence, especially male abuse of female spouses, will be a thing of the past. In fact, without fighter pilots, war itself may cease. Certainly, we will have seen the last Tail Hook Convention.
Let us hope then that science and reason will overcome inertia, prejudice and self-interest. Our children deserve better; in the name of public health and morality we must pursue this course. Finally, the passionless future that Ritalin heralded and Rep. Patricia Schroeder (DCol.) predicted will become a reality. The author, for one, embraces it and invites his colleagues to join him.
Journal of Polymorphous Perversity, vol. 20, no. 2 (Fall/Winter 2003), pp. 68.
**********
Frederick McGavran is an attorney in a large, multi-state law firm. He mostly represents pharmaceutical companies in defense against class-action lawsuits and represents doctors defending themselves in malpractice cases. He is also on the advisory committee of a large urban school board.
Volume 20, number 2 was the final issue of the Journal of Polymorphous Perversity. It was a wonderful journal and I treasure my full run of all 20 years.
A-1 