Openmind September/October 2005
Sami Timimi, a child psychiatrist in Lincolnshire, has written a book called Naughty Boys which everyone involved in the care of children should read. Sami was born in Iraq and came to the UK when he was fourteen. As I know from my own experience, even if you come to a foreign culture knowing the language, the history and the literature of that culture, you still don't understand the subtleties not just of what you aren't allowed to say but what you aren't allowed to see. You soon find yourself like the boy in Hans Christian Anderson's story The Emperor's New Clothes. While the rest of the populace are admiring the sumptuous brilliance of the Emperor's garb you're saying, 'But he's naked.' In Sami's case the Emperor is his fellow psychiatrists, members of a profession which never forgets or forgives any member who betrays them. They haven't forgotten or forgiven Ronnie Laing and they won't forgive Sami. However, Sami considers that the fate of millions of children in the developed world being more important than his own career.
These are the children who, without their permission, have been made the subjects of an immense natural experiment, like the natural experiment that was conducted on foetuses whose mothers were prescribed thalidomide. This far bigger natural experiment will show what the long term effects are of a stimulant like Ritalin on the developing brains of children. In America over 1.6 million children have been prescribed such a stimulant while in Britain the figure is over 345,000. Some of these children are as young as two. Sami commented, 'Early in the twenty-first century we in the West are living in the bizarre paradox of Western governments spending billions each year to fight a war of drugs with the right hand whilst the left hand hands out millions of prescriptions for cocaine-like stimulants to its children.'
These children, who are overwhelmingly boys, have been diagnosed with a new disease, unknown until recently, called ADHD (Attention Deficit Hyperactivity Disorder) where, according to the psychiatrists' Diagnostic and Statistical Manual, 'the essential feature is a persistent pattern of inattention and/or hyperactivity-impulsivity.' There have always been naughty boys around, boys who cannot or will not conform to what adults want. Sami wrote, 'I kept seeing these referrals describing "monstrous", "bizarrely behaved" "out of control children", then I would see them in the clinic and they would behave like angels. . I asked my colleagues to explain to me what diagnoses like ADHD, conduct disorder and Asperger's syndrome were, what was going on physically in these children, and how they "knew" which child had a conduct disorder caused by family problems as opposed to ADHD caused by an immature frontal lobe (in other words a physical problem in the development of the brain.) They couldn't explain this to me and didn't know how to differentiate physical from emotional or other environmental causes. Shockingly, I realized that the whole profession is built on subjective opinion masquerading as fact.'
Sami found that a simple conversation with the parents and the child more often than not resolved a problem in the home or school and the disease disappeared. He also found that, 'Many of the families [he saw] have a far more sophisticated understanding of the psychosocial causes of behaviour problems than most psychiatrists and paediatricians I meet these days.'
After I came Britain in 1968 I was continually astounded by the naivety of the consultant psychiatrists, most of them men and older than me. I studied them closely and came to see that psychiatry was an extremely conservative profession where those entering it were students who wouldn't question what they were told and would adhere to the customs and morals of the white English middle class even though the student mightn't come originally from such a group. Only minimal questioning of the concepts and methods of the profession was allowed, and the psychiatrist used these concepts and methods to maintain an impenetrable barrier between himself and his patients. It seems that little has changed since then.
In Naughty Boys Sami shows how ADHD is a problem only in the developed world. Other cultures bring up their children differently and badly behaved children are not a problem. It seems that psychiatrists need to give up looking mythical immature frontal lobes, learn how to converse with their patients, while preparing for what ever happens to the Ritalin generation as they become adults. There is already some evidence from the USA that children who have been taught that the way to solve problems in living is to take a drug find it easy to switch from Ritalin to the illegal drugs which make solving life's problems unnecessary. The Emperor really has no clothes.
Sami Timimi Naughty Boys Palgrave Macmillan, London, 2005.