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interview: peter breggin

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Psychiatrist and author of Talking Back to Ritalin, Breggin founded the nonprofit Center for the Study of Psychiatry and Psychology. He has been a vocal opponent of the ADHD diagnosis and he strongly opposes prescribing psychiatric medications to children.

FRONTLINE interviewed Breggin on May 3, 2000.

There are many, many reasons why we're giving more and more psychiatric drugs to children. Probably the most important reason is simple marketing. The drug companies, like the tobacco industry, like the alcohol industry, are highly competitive, and are always searching out new markets. The adult market has been saturated for antidepressant drugs. How many millions and millions of people can take Prozac and Zoloft and all the other drugs? We have more adults taking antidepressants than the National Institute of Mental Health estimates there are depressed people in the United States. The market is saturated, so the pressures move automatically to other markets. And the biggest next market is children. So you have drug company representatives, you have drug company-sponsored conferences examining this issue, or encouraging this issue of marketing to children.

In addition, you have physicians faced with the problems of managed care. They are not going to get paid for sitting down and talking to the family for a few hours, or doing what I do, which is to sit down with the whole family and anybody who will come, to discuss the life of the child. They get a 15-minute med check. And if they make it 10 minutes, they can get six in an hour, and they can make a good living; they can get on with their business.

But if they stop for an hour to talk to the child and the family, they're losing money and time, and their waiting room is complaining. In addition, physicians have been very hard-pressed to compete in the therapy market. If you think about it, there's no reason to go to a psychiatrist or pediatrician for help with your family problems. If you've got a child out of control, if a teacher can't manage a classroom, there's no inherent reason to see it as a medical problem. Why go to a pediatrician? Why go to a psychiatrist?

Well, what medicine and psychiatry have done is to take essentially behavioral problems-- problems of conflict between adults and children--and redefine them as medical problems. ...

And they've done this for economic reasons? For livelihood?

Doctors need to define these problems as medical for their livelihood, for their authority in the community, for their own sense of identity. What are they going to do with all these millions of children that parents are concerned about? Are they going to say, "Well, actually, I don't have much training in family life, and actually I know very little about the classroom. In fact, I haven't been to a classroom in years. Take your child to an educational specialist. Take your child to a social worker who is familiar with family work." Physicians have never done that as a general means of practice. . . .

So do you feel that giving psychiatric medication to children provides no usefulness whatsoever?

I believe that there is no scientific reason or justification for giving psychoactive agents to children. Let me look at Ritalin. We have a lot of studies showing that Ritalin in fact does subdue children, and that's all we have. Take a healthy animal, like a chimpanzee , who wants to groom its neighbor, wants to play, socialize, wants to explore, and particularly would like to escape--that's a normal animal.

If you give the animal a stimulant drug, it loses all its spontaneous behavior. It stops wanting to socialize. It stops wanting to play. Initiative is crushed. The desire to escape disappears. And instead, obsessive narrow behavior is enforced--probably from a direct effect on the basal ganglia that these drugs have. You get obsessive behavior. So now the chimpanzee is picking at its own skin rather than grooming a neighbor. Now it's pacing a corner of a cage, rather than systematically trying to escape. These drugs make good caged animals.

Now, if you get all that same behavior in a child, if you crush a child's desire to socialize, to play, to escape, to be full of stuff like kids are, and instead you enforce a narrow obsessive focus, teachers will see this universally as improved behavior. They will not say, "Child lost spirit. Child now bearing down hard on pencil. Focusing so hard on work, tearing through paper." But if a study looks for these things, like when an NIH study looked for obsessive behaviors produced by the drug, you find horrible obsessive behaviors. Now the child who wouldn't rake leaves not only has raked all the leaves, but is waiting for each leaf to fall. Now the child who wouldn't play by himself with his Legos for an hour alone before, is doing it for 24 hours and doesn't want to eat dinner. These drugs produce abnormalities that we then call improvements. ...

We have lost track of what childhood is about, what parenthood and teaching is about. We now think it's about having good quiet children who make it easy for us to go to work.How do you respond to the parents who give glowing testimonies about how that drug has helped their child?

In America today, it's easy to go out and get glowing testimony from parents about how wonderfully their children have been doing on Ritalin. There was a caged animal, a polar bear, in the zoo in Toronto, who was pacing up and down and looking uncomfortable, and looking like he'd really like to go back to the Arctic or the Antarctic. And they put him on Prozac, and he stopped pacing. His name was Snowball. He sat quietly and looked happy. And animal rights people gathered to the zoo and protested the drugging of a polar bear to make him into a good caged animal, and he was taken off the drug.

We have lost track of what childhood is about, of what parenthood and teaching is about. We now think it's about having good quiet children who make it easy for us to go to work. It's about having submissive children who will sit in a boring classroom of 30, often with teachers who don't know how to use visual aids and all the other exciting technologies that kids are used to. Or there are teachers who are forced to pressure their children to get grades on standardized tests, and don't have the time to pay individual attention to them. We're in a situation in America in which the personal growth and development and happiness of our children is not the priority; it's rather the smooth functioning of overstressed families and schools. ...

There are no miracle drugs. Speed--these drugs are forms of speed--don't improve human life. They reduce human life. And if you want less of a child, these drugs are very effective. These parents have also been lied to: flat-out lied to. They've been told that children have a neurobiological disorder. They've been told their children have biochemical imbalances and genetic defects. On what basis? That they fit into a checklist of attention deficit disorder, which is just a list of behaviors that teachers would like to see stopped in a classroom? That's all it is. ...

Why isn't the drug, in your view, a useful tool in some circumstances--let's say, in extreme circumstances?

One of the questions that comes up a great deal is, what about the extreme child? In effect, what about the monster child? What about the bad seed child? What about the child that nobody can control? Once you define some children in that category, you open up exactly the Pandora's Box we have now. ... How we treat our most distressed children ultimately will define how we're really going to treat all of our kids. And yes, it's very convenient, with a very distressed child, to drug them into submission, to stop the signals. But it's not only a crime against that individual child; it sets a paradigm, which we have now unleashed on all of our children.

In my practice, I have never had a child brought to me who couldn't calm down in one hour in my office. The most extremely out-of-control children that I've had, you can watch the interaction between the child and the parents. The kid is poking the parent, the parent is poking the kid. The kid is insulting the parent, the parent is insulting the kid. And you can see it. ...

I'm actually seeing two tragic phenomena now on a regular basis. One is where there is a divorce, the parents split up, the children go with the mother, and the mom can't control the boy. Why can't a mom control a boy as readily as the father? In our culture, little boys aren't taught a lot of respect for women, and that big booming voice often gains a certain amount of power that mom's gentleness might not produce. So we have moms who are having trouble controlling their children, and who are giving them drugs. And when the child is with the dad on the weekend, then the child doesn't need any medication, and mom goes to court and sues to make dad give medication to the child on weekends.

But an even more common problem is that mom brings in the child wanting to get some help, and dad is nowhere to be seen. In fact, I can't get dad to come to the office, even though he lives down the block. Because in our culture, dads are not putting their children on a high enough priority. ...

You're going to be saying these things on television, and you're going to make enormous numbers of parents feel enormously guilty and terrible.

One of the really obscene things that has happened is that psychiatry has sold the idea that if you criticize drugs, you're making parents feel guilty. What an obscenity that is. We are supposed to be responsible for our children. . . . If we're not responsible for raising our children, what are we responsible for? If children aren't entrusted to us for the specific purpose of our turning ourselves inside-out to be good parents, what is life about? It is a disgrace that my profession has pandered to the guilt of parents by saying, "We'll relieve you of guilt. We'll tell you your child has a brain disease, and that the problem can be treated by a drug."

That's pandering to the worst desires that we have as parents--all of us--which is to say, "I'm not guilty of this problem." ... I'd rather be guilty as a parent, and say, "I did wrong," than say, "Son, you have a brain disease." Sure, we're all tempted. We're all tempted, when we're in conflict with our children, to hold them responsible. And how much easier it is if we don't even have to hold them responsible. ...

It is a disgrace that my profession has pandered to the guilt of parents by saying, 'We'll relieve you of guilt, we'll tell you your child has a brain disease, and the problem can be treated by a drug.'You've been accused of having something to do with Scientology. Is that true?

... I have nothing to do with Scientology. For approximately 25 years, I have conducted reform work with nothing to do with Scientology. There is no issue whatsoever about me and Scientology. I'm the editor-in-chief of a journal with 40 professional members on it. I'm director of a center with 200 professional people on the advisory council and 1,000 general members. I have taught at Harvard and Johns Hopkins and George Mason. I have nothing to do with Scientology. It's a drug company PR campaign. ... I have the letters. If I had known you were going to go to this level of journalism, I would have brought the letters along where Eli Lilly tries to link people like me to Scientology.

And didn't they attack and make accusations about your wife?

My wife was a Scientologist, and is now so strongly anti-Scientology, that if I even took a phone call from a Scientologist, she'd be on my back. ... I don't want to take on the Scientologists. I've got enough trouble taking on psychiatry. ...

But when people see you alongside Scientologists at a hearing before a state legislature in Arkansas ...

I recommend personally that Scientologists not be brought to these hearings, but I have no control over that. I'm just an expert witness. I have no control over it. ... The average parent doesn't see that it's Scientologists who are against taking these drugs. It is strictly the drug companies and the media who bring up the Scientology issue. ...

Let's talk about the lawsuits that have been filed against the Novartis, the manufacturer of Ritalin.

On Tuesday, May 2, a class action suit was brought against the manufacturers of Ritalin and Novartis, against [CHADD], a parents' group that has been heavily funded by the drug companies, and the American Psychiatric Association--for the fraudulent overemphasis on the ADHD diagnosis and treatment with Ritalin. The American Psychiatric Association, CHADD, and the drug manufacturer are accused of conspiracy. The case has been brought in Texas by the law firm of Waters & Krause, and is now actually in the courts. ... Probably there's going to be a series of related cases, or at least a number of attorneys coming together, around this issue of fraud and conspiracy in the promotion of the diagnosis and the promotion of the drug.

So that will hinge on showing what? Damage to the children?

No damage is required to be shown to the children in this case, because it's not that kind of product liability case. All that the parents have to show is that they spent money on Ritalin, when they were in fact fraudulently induced to think that it would be worth something. ...

So it's based then on the ADHD diagnosis, the DSM-IV diagnosis, as being fraudulent?

It's based on the over-promotion of the diagnosis and the drug as being fraudulent, and involving a conspiracy.

And so the defense will be, "No, this is a wonder drug. This is helping millions of children." Sounds like a stalemate to me in the current sort of atmosphere. ...

There's actually a great deal of evidence for a conspiratorial relationship. According to international law, you cannot directly promote a highly addictive Schedule II drug to the public. Ritalin is in Schedule II along with amphetamine, methamphetamine, cocaine and morphine. And you're not allowed to put ads in the newspaper for that. You're not allowed, according to international conventions, to directly promote to the public. What Ciba-Geigy, now a division of Novartis, has done is to fund a parents' group, CHADD, and the group has then gone and promoted Ritalin to the public. So that's one potential aspect to the situation.

How is it different than another pharmaceutical company supporting the American Diabetes Foundation or the American Cancer Society with funding? How is it different that Ciba-Geigy is providing some funding to CHADD?

One of the big differences in what Ciba-Geigy is doing, say, compared to a drug company who might give money for a diabetes drug to the AMA, is that Ritalin is a Schedule II--a highly addictive drug. And there are special controls put upon it by the US government. CHADD, in fact, has lobbied the US government to try to get Ritalin taken out of Schedule II. They couldn't do anything more valuable for the drug company, and more dangerous to the public, than that. Fortunately, they failed, and they failed in part because of our disclosures . . . about CHADD having so much money from the drug companies. ...

What role did the pharmaceutical industry play in promoting Ritalin and Prozac to the country? ...

Even before Prozac was approved by the FDA, the drug company was sponsoring seminars for doctors throughout the country on the biochemical basis of depression, mentioning over and over again serotonin, which is the neurotransmitter that's affected by Prozac. They didn't happen to mention that there may be 200 neurotransmitters in the brain, and that connecting any one to depression is absolutely foolish speculation. The brain is an integrated organ, with probably thousands of substances participating in its function.

To label one, serotonin--which is, in fact, a widespread neurotransmitter that goes to every single lobe of the brain and affects everything from memory to coordination to cardiovascular function--imagine that that one happens to be the one that's out of balance, because Eli Lilly is selling Prozac.

But people are so eager nowadays for biological explanations. So physicians and the public grabbed on to what is essentially a PR campaign--perhaps the most successful one in the last 30 years in the Western industrialized nations--that if you have a mental disturbance, it's biochemical.

Now they run into problems. Because the next drug that comes along affects a different neurotransmitter, and then the next one affects a different neurotransmitter. And they're all working, because they all cause certain disabilities of the brain that some people experience as an improvement. They either can anaesthetize your feelings, or they give you an artificial high, or simply give you an enormous placebo boost.

Taking a sugar pill gives an enormous number of people the feeling that they're doing better. In fact, taking a placebo can affect physical function.

If somebody has a migraine headache, would you prescribe a drug for them?

I have no objection to the legitimate use of medical substances for defined medical disorders. In psychiatry, none of the disorders are defined clearly in a medical way, and none of the substances are directly addressing the real problem. Now, when you get to something like migraine headaches, you get a great deal of over-medication. You get people being addicted to all kinds of substances. But that's a little different, because, in fact, you can address the pain, and in some cases, perhaps, the physiological mechanisms behind the headache.

But isn't a migraine a case where we don't really understand what causes it? There's no real biological marker, as there is no biological marker for a whole host of medical conditions. But yet we treat it. People are saying, "What's the difference between that and ADHD?"

Well, almost all medical disorders in fact have biological markers of one kind or another, and there are vascular problems associated with migraine headaches. But beyond that, all medical disorders have some definitive physical aspect to them, if only physical pain. Now, there is no such physical aspect to any psychiatric disorder, so we have to look at how did it even become defined as a disorder.

The way you define a medical disorder is, a person comes in sick. They look sick, they feel sick, they have physical symptoms. You may not be able to figure out what it is. But it's a disorder of the body. ADHD doesn't even involve emotional suffering on the part of the child. There is nothing in the diagnosis that says the child is distressed. It's all about distressing behaviors. It's a list of behaviors that distress adults. ... So we've actually taken something which is, literally, a bunch of behaviors that make adults disappointed and uncomfortable about children--often where the children are not distressed, or they may be sometimes--and we've made it a medical disorder. It is such a leap of the imagination that it can only be made in terms of the public's willingness and the profession's willingness to try to make something medical that, in fact, is not. ...

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