SUSAN DENTZER: I want to go back to the point we were making at the outset, but I want to place you on the spectrum that you describe in your book between the people who believe that Ritalin is manna from heaven and the people who believe that Ritalin is poison. Where are you on that spectrum?
DR. LAWRENCE DILLER: I think that for the individual child, once you've explored issues of parenting and getting the school to work as best with that child as possible, and making sure the child doesn't have any learning problems, that if that child is still struggling, utilizing Ritalin to allow that child to cope more effectively I think is a legitimate avenue. That's my role as a doctor. But my role as a citizen is to ask the question why do we use 85 percent of the world's Ritalin.
Why have Ritalin use rates gone up 700 percent in our country in the last nine years? And again, I feel it's like a canary in a mine shaft, basically telling us the demands on children and families have increased, while the supports to them, their families and schools have decreased. And this Ritalin surge is the canary in the mine shaft, not just for the ADD kid, but for all our children. And again, the Tom Sawyers and the Pippi Longstockings are next in the Ritalin hit parade. But where will it stop is the question, since Ritalin works for everybody.
SUSAN DENTZER: So specifically for those kids, the Tom Sawyers, the Huck Finns, the Pippi Longstockings, what should we be doing?
DR. LAWRENCE DILLER: I think that we have to give parents - there are certain structural things that are a problem. We have two parent working families, we have children in day care from six in the morning to six in the evening, we have many more latchkey kids, we've got educational pressures on children, families, and teachers now that are unbelievable, we have an educational paranoia that says we all have to go to a four-year college and be computer geeks.
This has become glamorous. We have a managed care program that often makes the specialists have to make a decision on this kid, to medicate or not, within 20 minutes of a half an hour, and he gets two 15-minute follow up times with the kid. So we have a lot of pressures on families and the system to perform. This is not going to be easily remedied. We have a parenting philosophy that comes from the last 50 years that suggests if you know how to talk to ADD Johnny he will listen, and you can avoid a conflict with him. And my experience there is if you try talking to ADD Johnny, he's halfway down the street before you've finished your first sentence.
So I think we can help parents and teachers by telling them, be more immediate and direct in your rewards and consequences. Be more tangible with your rewards and consequences with your children, that lots of talk doesn't work with these children. They do know right from wrong, but they are relatively less able to utilize that knowledge to regulate their behavior. Don't appeal to their conscience so much, just tell them to do it and give them all a consequence if they don't. That would be very helpful.
SUSAN DENTZER: Culturally, what do you think - we have talked about some of the things that may be driving that, it's a performance oriented society. Why would we expect that in two major industrialized nations, the U.S. and Japan, why did the Japanese use Ritalin . . . .
DR. LAWRENCE DILLER: You know, I can only speculate. I think there are differences in early parenting. There is a much tighter expectation on Japanese parents. I think - on Japanese children, rather. I think that there is a much more rigid academic class system that exists in Japan. In the United States we have Horatio Algers and Bill Gates, you know, everybody can be a billionaire - would you want to be a billionaire I guess. And in Japan in the eighth grade everyone takes a test, and based on that test, you either go on to an academic track, or you go to a vocational track.
Now, I'm not saying that's the best system because in eighth grade a couple of Japanese kids kill themselves when they don't get into the academic track.
I think the other thing is as a society, we've bought a biological basis for behavior in our children more than any other society, and that's the, you know, the Prozac-Ritalin link, I call it, because Prozac paved the way for Ritalin, I believe.
And then lastly, as I mentioned, I think we epitomize our state religion is corporate consumer capitalism, or fundamental consumer capitalism. Again, we are a society that believes that if we get stuff, we'll be happy. And some of these other societies have other competing moral values that allow for a greater tolerance of temperamental diversity, you could say.
So we are operating with the notion of if you get stuff you'll be happy, and you've got to get a four year education, college education. Anyone can get it, and we believe that the brain is everything in terms of behavior, and I think that's what sets us up for using 85 percent of the world's Ritalin.
SUSAN DENTZER: You made a point in your book that the irony about America is that we prize individualism, but we obviously value . . . .
DR. LAWRENCE DILLER: Well, I think that actually if I had to be more succinct, and I think this will be the better sound bite actually, I think at the core there are consistent cultures and inconsistent cultures. As an aside, one of the theories of why the United States which I don't buy is this notion of we are a hyper-stimulated, beeper, video game, fax society, and that our children get addicted to stimuli. I don't buy that because if that was the case, children in Tokyo and Milan and London would also be using as much stimulants as we do.
I do think this idea of a consistent versus inconsistent culture makes more sense. A consistent culture demands group adherence and conformity throughout its child-raising time, and the best example of that is the industrialized Asian cultures of Hong Kong, or Japan, or something like that.
An inconsistent culture - excuse me - this consistent culture prizes individualism and spontaneity, of expression and self, but at the same time, demands conformity when you get to five or six in school.
The best example of an inconsistent culture is the United States, and Western Europe falls somewhere in between. And so what we do is we're giving a very mixed message to our children, our parents, and our teacher. On one level we want you to express yourself, but you better shut up at school.