By Alan Schwartz Simon & Schuster Audio, 2016 Review by Christian Perring on Sep 5th 2017
Alan Schwartz is a journalist who gained a reputation for covering the problem of concussion in football, with high rates of brain injury and dementia among former NFL players. In his latest book he addresses the growth of the diagnosis of ADHD and the use of medication in children and adults. His position is clear and plausible: while ADHD is real, it is massively overdiagnosed in the USA and too many people are taking medication for it. Schwartz does an excellent job covering the history of psychiatric thought about attention deficit and hyperactivity, collecting details that few have covered previously, and providing a comprehensive overview. He pays particular attention to the work of John Conners who initially devised a checklist for physicians to diagnose the disorders of attention, and made a lot of money from it. At the end of his life Conners became alarmed at how much the diagnosis of ADHD had grown and the dangers of ADHD medication, and he urged the psychiatric profession to be much more cautious in diagnosing the disorder. It's a powerful example of a psychiatrist's second thoughts about his effect on society.
The writing is journalistic with plenty of stories of individual people who have been diagnosed with ADHD, who have taken medication used to treat the disorder, family members of those people, or psychiatric researchers and clinicians. He helps the reader identify with their perspectives and understand their experience. But he builds a case of the corruption of science and medicine by the pharmaceutical industry, who push their products and distort the truth in order to maximize profits. It's particularly striking how they pay some celebrities to speak in favor of taking medication for ADHD but do not require that there is any disclosure of the financial transaction at the public appearances. Schools push for difficult students to get medicated in the belief that it is an easy solution. Social pressures from many different directions have caused a surge in the use of ADHD drugs, and they are being misused. If only the diagnosis was performed carefully and the use of medication was carefully monitored, we would not have the problems we do. Schwarz does paint the psychiatrist Joe Biederman, who strongly advocated for the diagnosis of childhood mental illness, as a villain, flawed in his judgment due to his zeal and ambition. Big Pharma seized on his research so they could promote their products to more consumers. But for the most part most people involved are well meaning if naïve, and psychiatrists are shown to suspend their critical faculties when they are doing well out of a drug fad.
The ultimate result is that the USA has a major problem of overdiagnosis of ADHD and many people suffering from problems of ADHD medication. ADHD Nation surveys the problem and the history of social commentary on the problem. Maybe it will contribute to a more skeptical view of ADHD and a more careful approach by psychiatrists and physicians to diagnosing it and giving out meds.
The unabridged audiobook performed by Jonathan Todd Ross is done well, giving a clear and energetic reading.