ADHD AND OTHER SINS OF OUR CHILDREN (SHORTER VERSION)

Simon Sobo MD

A critique of the runaway freight train that psychiatric diagnosis (followed by medication) has become. In this case kids are being put on speed. What is going on?

Abstract

A case is made that the symptoms of ADHD represent the behavior of children who have great difficulty connecting to expectations. In the classroom, they don’t feel part of the group. Unlike the other students, they aren’t doing what the teacher is directing them to do--they are out of the flow. Trapped, lost, helplessly anonymous, even if they began the morning with good intentions, once boredom and restlessness take hold, all bets are off. Those who fear the consequences of making a disturbance drift off into daydreams, or look around the classroom for almost anything that might entertain them. Those with more spark, can’t sit still and make a lot of noise. Depending on how well, or not well, they have been brought up, boys, more often than girls, can be particularly disruptive.

Bored trapped children have always acted this way. The challenge of how to motivate children so they don’t feel subjugated when an activity is not about them, when the expectations of others are the agenda, has challenged educators and parents for as long as children have been forced to go to school. A variety of factors can contribute to difficulty concentrating, not least of which is the fact that getting any child motivated to learn, work, and be responsible is always a challenge. Enormous outpourings of parental time and energy may be expended on children trying to inspire, cajole, threaten, lecture, or bribe them, all for the purpose of getting them to stick to what they are supposed to do, meaning stop dilly dallying, gain self control, act with consideration for others, and like it or not, do tasks demanded of them.

Any parent raising a child soon learns that getting from point A to B is rarely a straight line. In America, every generation has a new philosophy of child rearing that advocates different strategies. Books, newspapers, and magazines are filled with good advice, which is a sure indication there are no simple solutions.

Traditionally, it was assumed that the successful development of the capacity to learn how to work begins very early, with good habits inculcated as soon as possible, and later reminders repeated as necessary. Like spinach, cod liver oil, or manners at the table, parents had an agenda that clashed with their children’s will. They were considered failures if they could not win their children’s obedience. Whether Freud was correct that the first battlefield is specifically toilet training, or whether there are other, equally important, confrontations in which the parents' and the child’s will collide, somewhere between 1½ and 3 conflict is unavoidable.

In the past, shaming the child, inducing a fear of punishment, many of today’s forbidden parental attitudes were comfortably practiced. They were never proudly proclaimed, but whether acknowledged or not, they were assumed to be an unfortunate necessity. Spare the rod. Spoil the child. The trick was how to instill proper fear without breaking a child’s spirit. It was not unlike turning a wild bronco into a proud steed. How do you transform an often demanding, easily frustrated little package of misdirected energy into a young gentleman or lady, dedicated to feeling self satisfaction from a job well done, and bringing pride to his or her parents and teachers?

How do you prepare children to keep a cool head when a task is challenging, or competition is keen? How much guilt is useful before it backfires or, is received as ‘blah-blah blah’? Encouragement is essential but it can deteriorate into empty cheerleading, or worse, false happy talk that is thinly disguised nagging.

Keeping a step ahead of children is the first rule for both parents and teachers, but it isn’t always easy. Harnessing a force of nature is never a sure thing. When children dominate they can return to their natural state, a frenetic entropy that can be observed in schoolyards whenever they are playing a game without rules. Two or three generations ago, completely unsentimental views of children’s natural tendencies were commonplace, and acted on. For instance, grammar school students were asked to sit with their hands clasped on the desk straight in front of them. “Attention!!!!” sergeants in the army scream at their young recruits. Good first and second grade teachers usually had a certain firm tone that the students understood to mean “no more fooling around.” Here and there, even in the past, inspiring teachers could go easy on the rules and didn’t need a commanding voice. However, the average teacher policed the classroom for any signs of noise or movement. If needed, a sharp comment from them could snap a student out of his reveries. Evidence for the necessity of discipline was easy to find. In the event that a teacher stepped out of the classroom, chaos erupted like a volcano.

Connecting to a child at home so that he or she “listens” precedes the greater challenges in the classroom. If parents fail to accomplish this at home the problems will only get worse at school. There are numerous ways this can go amuck, particularly in modern times. It was once understood that children need a safe nest when learning to fly. Fathers and mothers used to stay together in loveless marriages, not always, because the family, per se, was sacred, but because divorce was considered too disruptive for the children. That is no longer the case. Unfortunately, marital discord in an intact family can be just as undermining. In some homes the tensions at home are so overpowering that there is little energy left for school’s requirements.

The difficulties are not always on the surface, and the results can be complicated Withdrawn depressed parents, broken by circumstance, can convey a helplessness that plays havoc with a child’s ability to feel mastery and concentration when meeting school’s challenges. Drugs, alcohol, incest, physical abuse a long list of horrendous home environments, can make school requirements irrelevant. Severe chronic physical illnesses in a family member can do the same thing. But the opposite can also occur. Occasionally, school becomes a haven, the one place where the child finds purpose. Often the explanation is a sensitive teacher who has taken a liking to the child and set them on their way to a career of accomplishments

Poorly functioning day care centres can get a child off to a terrible start, especially if child care workers come and go, or children are moved from one centre to another. Some parents desperately search for the right place, hoping to approximate a stable underpinning that will foster the bonding that will be so crucial when effort is called for. In some families overwhelming pressures to excel can be brought to bear on a student. Repeatedly being a disappointment to one or both parents, can hurt deeply enough so that tuning out can bring relief from the anxiety and pain of trying and failing. On more than one occasion I have seen a situation when one of the two children is the star, and the other, almost by necessity has given up. Some parents are angry at the world, sometimes at teachers and authority figures in particular. If their children develop ADHD, teachers and principals better watch out. They will be blamed for not curing the child’s illness.

The problems can also be less dramatic. Every parent knows the appearance of a distracted child. The moment they start to lecture, one look at the child and they know he, or she, has gone to another place and time. Some loving mothers have great difficulty being forceful enough to get their children in line. It is not unusual to find ADHD children who misbehave with their mothers, ignoring all admonitions. As they get older they may get nasty. They do not behave this way with their father. They wouldn’t dare. It can also go the other way. Fathers are the sugar daddy and the mothers are the successful taskmaster. Some children, particularly in divorce situations (where parental guilt may be enormous) can wrap their parents around their pinkie. We also must mention the “baby of the family.” Standards get less and less with each child until finally the baby is overindulged, expecting to be given rather than asked to perform. The consequences become clear over time

Obviously, there are many ways that children can become a casualty of unsuccessful parenting. ADHD is only one of the by products. Because the impairment is similar regardless of what caused it, we may question whether it is appropriate to paint with broad brush strokes, to label the problem as a single ‘illness’. There are arguments for and against. But one unfortunate result of the illness model as an explanation for these kids is that doctors (or, ‘experts’ as they call themselves) have stepped forward with a simple ‘cure’. No surprises here. If all you have is a hammer every problem becomes a nail. By assigning a diagnosis, and supplying a sciency explanation for the phenomenon, the problem reduces to what doctors do. They give drugs.

We cannot entirely dismiss this approach. A small number of those labelled with ADHD, may have something physically wrong with their brains. An example, at the extreme, is mentally retarded or brain damaged children, who, for obvious reasons, have great difficulties sitting still for hours at a time and staying on task. Historically, neurologists believed that a minimal brain dysfunction was the culprit. They looked for minor neurological defects that might bolster their argument. It is not unreasonable to expect that some children, today labelled ADHD, may have a still undetectable genetic or biological problem, yet don’t have clear-cut neurological symptoms. But, ADHD has become a major social phenomenon, a catch all for most distracted children not paying attention in school, or doing as expected. It has long since expanded beyond neurologists and the idea of ‘minimal brain dysfunction’. Millions upon millions of children are now routinely labelled by their family paediatrician with ADHD. Indeed, by the time a doctor gets involved, a child’s teacher has probably made the diagnosis and knows the cure.

This would all be fine if solid research supported the argument that ADHD is a biological illness. But the evidence is sparse or ridiculously exaggerated. Not that there haven’t been thousands upon thousands of articles seeming to confirm that ADHD is biological. However, the fact is that the cause is still unknown (Surgeon General Mental Health Report; National Institutes of Health, 1998). Moreover, for an illness whose aetiology is repeatedly and confidently claimed to be biological, there is not a single biological test that can be used to determine whether or not a child has ADHD. Nothing in the urine, the blood, the spinal fluid, no X rays or CAT scans or MRI. Poppycock flourishes when we need answers to a problem, but don’t have them. It also is a tool of aggressive salesmen. Expert doctors trump the opinions of ordinary physicians who don’t have time to give long and complex thought to all of their patients’ problems.

The most striking evidence against the argument that ADHD results from a biologically caused deficit in the ability to pay attention, is the simple fact that most of these children have no difficulty keeping their attention focused on activities that are fun. Many can sit for hours with video games that require extraordinary focus. I evaluated a student who told me his mind completely fogged over when he had to read something for school. Without his medicine he could go over a page a hundred times and absorb nothing. “Really?” I asked, “You aren’t able to read anything?” “Well,” he told me, “there is one exception.” He was totally into mountain biking. Each month his mountain biking magazine arrived and he devoured that without medicine. Also supportive of this argument-unique charismatic teachers, who make educational material fun, can sometimes succeed with these students.

The medical cure for ADHD patients’ inability to confront drudgery is stimulants, which have a long history of working pretty well for this purpose. Most of the drugs work similarly to cocaine. In the 19th century cocaine was the most popular miracle drug in the world, regularly used and extolled by the likes of President McKinley, Queen Victoria, Pope Leo Xlll, Thomas Edison, Robert Lewis Stevenson, Ibsen , Anatole France and a host of other renowned members of society.[1] Sigmund Freud wrote the following about it, “You perceive an increase of self-control and possess more vitality and capacity for work.”[2] According to the Sears, Roebuck and Co. Consumers’ Guide (1900), their extraordinary Peruvian Wine of Coca “...sustains and refreshes both the body and brain....It may be taken at any time with perfect safety...it has been effectually proven that in the same space of time more than double the amount of work could be undergone when Peruvian Wine of Coca was used, and positively no fatigue experienced.”

After he read this article, my son, who was then at Yale, told me that one afternoon he was complaining about the work he had before him, two finals and three papers that were due. His schoolmate piped in, “I got some Ritalin, want it?” The daughter of a friend said the same thing was going on at McGill.

They are not alone. Here is a headline from the NY Times:[3]

“Latest Campus High: Illicit use of Prescription Medication, Experts and Students Say”

“Ritalin makes repetitive, boring tasks like cleaning your room seem fun” said Josh Koenig a 20 year old drama major from NYU

“Katherinen Plyshevsky, 21, a junior from New Milford NJ majoring in marketing at NYU said she used Ritalin obtained from a friend with ADD to get through her midterms “It was actually fun to do the work,” she said.

Freud realized he had made a big mistake advocating the use of cocaine when he witnessed the horrible effects it was having on some of his friends. The downside of this miracle drug was also well described by Robert Lewis Stevenson who wrote Dr. Jekyl and Mr. Hyde during seven days and nights while he was high on cocaine. For many years, Stephen King wrote all of his novels while high on stimulants. He has said that the Kathy Bates character in his ‘Misery’ (a nurse who has literally imprisoned him) represented that habit.

Besides ADHD diagnosed adolescents, and their friends, who sometimes borrow their meds when they have to do chores that they dread, stimulants (“greenies”), according to David Wells (Wells et al, 2003), and more recently Mike Schmidt (2006) have long been part of the professional athletes’ equipment, helping them to step up to the plate with confidence. It changes their state of mind from a passive, reactive, position to a take charge proactive stance. Or as one basketball player put it, “Give me the ball. I can make the shot.” This taking charge, ‘I can do it’ feeling, when approaching tasks, is a key element in most people’s perception of whether they are up to a challenge, and whether it is ‘work’ or pleasurable.

The use of medication should not be dismissed out of hand. From a strictly practical standpoint, stimulants are very often helpful. But the propaganda surrounding their use, generated by ‘experts’, lacks intellectual integrity. Considering the controversial nature of this issue, who pays for experts’ work, should ordinarily disqualify them from claiming to speak objectively. Billions upon billions of dollars are at stake for drug companies, depending on whether or not ADHD is proven to be biological. Are those sufficient motives for their paid experts to, not only lose proper scientific caution, but become aggressive about selling a point of view that profits their sponsors? The former editor of the New England Journal of Medicine (NEJM), Marcia Angell, wrote an editorial entitled. “Is Academic Medicine for Sale?” (Angell, 2000). She followed this with an impassioned book, “The Truth About the Drug Companies: How They Deceive Us and What to Do About It” (Angell, 2004). The editor of the British equivalent of the NEJM, the Lancet wrote in the New York Review of Books, “Journals have devolved into information laundering operations for the pharmaceutical industry” (Horton, 2004).

Despite these criticisms recusing themselves has not been pursued by "experts." Indeed, the opposite has been the case. They churn out article after article placing pressure on non-experts to follow their "guidelines.” The effect is, unfortunately, that most doctors (including some very nice, well meaning psychiatrists, family doctors and paediatricians) in the United States follow these guidelines unthinkingly, given that they are written by professors who hold prestigious positions in many of the finest universities in the United States. Medical practitioners, like everyone else, are very busy and must go on faith for many of their decisions. We can also not ignore groupthink, which has a way of determining acceptable and unacceptable points of view.

There is also a problem with the DSM IV paradigm.[4] DSM IV was meant to define and categorize clusters of symptoms in a clear-cut way. While that has its merits, it has also encouraged an illusion that these clusters are like strept throat, a disease that can be cured with a drug like penicillin. There we understand the cause and the cure is a rational response to it. Despite the public’s general impression, and the assured pronouncements of the experts, we do not possess that kind of understanding in psychiatry in general and ADHD in particular. Modest, tentative formulations would be far more appropriate.

In good part, this chapter is a description of my upbringing (and I imagine many others like mine) and how we were motivated by our parents to forsake our more natural ADHD tendencies and do well in school. It describes a far from perfect environment, but one, nevertheless, that was culturally coherent. Purpose was clearly defined, a quality in far shorter supply in our more chaotic modern existence. It is much harder for parents to create this today, lacking a cultural milieu which fosters it. I believe my memories (and speculations!!) may be helpful as a contrast to current very different perspectives about how parents approach their children. One thing is clear. The problems that ADHD imply will not go away with a change in diet, tough love, soft love or any other bit of magic, even the magic offered by those claiming to speak in the name of science. I believe that bad science, science totally lacking science’s clarity about what is known and not known, is worse than sensible, if imprecise, literary speculations and reasoning.

A MEMORY

Fifty-three years ago. I’m ten years old and I am trying to listen to a sermon in the synagogue. The rabbi has a firm, sweet, modulated voice, commanding, wise, a radio voice they used to call it. The problem is I can’t listen. He fades right out. At best I’m good for two or three words, maybe a sentence but after that I’m gone. I’ve been stuck in the same seat for hours. I stayed with the rabbi for the first five minutes but now it is ten minutes after he lost me..

Very lightly my feet begin to tap on the floor. The sound is barely audible. A worshipper across the aisle, a man in his 50’s glares at me. Only silence is allowed in the synagogue.

I stop tapping. I sit still. But not long after that I move around in my seat. At most, the only sound I am making is from the wool of my jacket rubbing against itself. It doesn’t matter. The man’s anger goes up another notch.

I sit absolutely still. But within a minute or two, unconsciously I stretch my fingers and crack one of my knuckles. This brings a look that could kill. He is joined by his wife who views me with utter disgust. They seem to have found a mission for the morning. Educate me in the ways of God. The first communication:

Or else!

It has never occurred to me to find out what ‘or else’ might actually be. My parents wisely left that to my imagination, a far more effective tool than actual punishment.

So I take their disapproving stares seriously. I try harder to listen to the rabbi, this time as hard as anyone could try to listen to another person.I have no better luck. A few sentences and I am gone again.

I finger a cuticle on my thumb, rub it, and start to pick at it. I nip at a tiny piece of the cuticle, which winds up tearing in the process. It smarts. It oozes cherry red. I suck on my finger, than take it out to see if blood is forming. It isn’t, but I suck the finger again, just to be sure. The rabbi’s voice becomes passionate. He may be nearing his finale. Suddenly I can listen without difficulty.

I’m wrong. The rabbi is shameless. He is fond of mini crescendos, playing in the foothills before taking a shot at the lofty heights of the majestic.Only a false ending is the one thing I cannot put up with. He won’t fool me again. I’m really gone.

The person across the aisle glares at me more than he has all morning. What am I doing now? I have been 1000% silent and still. I have bothered no one.There is no choice. I take on the expression of several of the most pious listeners in my row. Devotion emanates from them and by osmosis soon my expression resembles theirs. He has won. I have joined the others.

But, my furtive eyes reveal the truth. They dart around the room.

High up the stained glass windows portray Moses holding the Ten Commandments menacingly above his head. He looks stern, just like the man across the aisle. However, the windows are very beautiful. Moses’ deep blue robe glows lit up by the sun. His eyes have a luminescent intensity that shoots straight out at the congregation. Straight at me. A serpentine black line twists and turns, wiggles its way across the window. On to the next panel, then the next, ‘til the line comes to an end. I find another line and follow it but that soon grows old.

A hair is growing out of a mole on the back of the neck of the person in front of me. It’s gross but it’s kind of interesting. Until, it isn’t interesting. It’s just gross. I’m beginning to run out of ways to make the time go faster.

In a prison, rules are a very serious business. In the synagogue they are taken more seriously then any other place I know. Actually, it is worse than prison. The silence rule doesn’t apply there. Here it is total. The only exception is when you pray.

No talking unless you are talking to God.

Rule two. You cannot get up and go somewhere else when you feel like it. Like it or not you must remain in your seat, stand when you are told to stand, sit back down when they tell you to be seated. And I have described how when you are seated you can’t move around. Which is torture. I like to move around. So do all my friends.

Being dressed up isn’t helping the cause either. I’m beginning to sweat. My starched collar is too tight around my neck. If I could open my collar that would definitely help. That isn’t allowed. This is God’s house. His rules. The only time I saw an open collar was when Mr. Gordon had a heart attack. The sick are allowed to do all kinds of things that everyone else cannot do. God is fair. He allows this. But I have no excuse, so the collar is to stay buttoned and tight. Rule 3. Rule 4, 5, 6; in addition to no noise, no whining, no questions. Unnumbered rule but the most important one; synagogue is a sacred place so act accordingly.

I whisper to my mother,

”What time is it?”

She puts her fingers to her lips.

I persist.

She mouths the words.”10 AM.”

”Ten?” I whisper back.

”Shhh.”She turns back to the rabbi.

Two hours ‘til the services will be over. I look around for something else to do but I can’t find anything. I keep looking around. The man in front of me adjusts his skull cap. He’s wearing a watch. 10:02.

Ten-o-two! Jeez. Only two minutes have passed.

I saw this movie on TV. The hero is alone in a dungeon. He’s not been outside his cell in twelve years. The only sound he hears is a drop of water every five or ten seconds. At times the hero (maybe it was Errol Flynn) studies each drop as it forms on the ceiling, exuding out of mildewed stones into a fully formed droplet. Drip. The process is repeated… Drip. Everyday the same, the same, the same. I estimate the drips in a minute: eight on average, times 60 minutes, times 24 hours, times 365 days. Over 4 million in a year, around 50 million over 12 years.

Drip.

Camera on a mouse positioned safely against the dungeon’s wall, slowly moving forward, sniffing, looking, and listening for danger, eyes shooting pictures in every direction, whiskers acting like feelers as he moves forward. Our hero is delighted to have company. For Errol Flynn almost anything different would be like finding a pot of gold. Two hours is like two years when you’re 10 years old. Anything other than the sermon, or the hairy mole, the stained glass windows, or the wood grain of the seats in front of me. Anything not old would be gold.

It wasn’t always boring at the synagogue. Sometimes it was fun. We’d invent games. For example every time we got to the Shmonah Esrai, a very long prayer which is read silently, we raced each other to see who’d finish first. No cheating. You had to read every word.At one point you have to bow, knees first, then your chest parallels the floor, then down goes your head, then up comes your head back to the standing position. Some of the pious danced their bow, some bowed in a courtly manner. Others just did it business like. We would go so fast that we looked like we were part of a choppy Charlie Chaplin film. We zipped through the prayer ‘til finally, at the end, we were like race horses coming down the stretch. Mark won last time but this time I was going to beat him.

I finished. My head popped up to look around at the others. Yes! I won! They were still at it. It was like finishing an exam early, triumphantly bringing it to the teacher, trying not to look show-offy, but sneaking a look at the other students still nervously scratching out answers with their pencils.

The adults in the congregation also sought victory in the Shmonah Esrai. Lips moving silently, the faithful reverently bent their knees. Down again, up again, they swayed to a familiar rhythm brought from Eastern Europe many years before. These were modern men dressed to the nines, white on white shirts, gold cufflinks and tie-pins, hair in place, Vitalis carefully applied.

They were visiting an earlier time and place. A soft echoing moan, almost a melody could be discerned. They prayed, chanting as their fathers had chanted, and as their grandfathers and their great grandfathers had chanted. Dovened in exactly the same way, the same voice, the same beat, the hum- -in this process the voices of father and grandfather were returned to their sons. The dead visit us in recognizable physical characteristics, the same eyes, the same lips, the same smile- my father and youngest son both lift their right eyebrow in response to a quip. Prayer was the most sacred place to meet. Their children’s imitation reincarnated the departed.

Father and son, father and grandson were together again, together in obedience, together in their sway.It wasn’t just family. It was tribe. Every Shabbis the same ancient words were repeated, exactly the same way, with the exact same rhythm, repeated as they had been repeated for five hundred, perhaps a thousand years. The next generation would also do it that way, and the next generation and the next, each part of a chain, doing their part to keep it going, make it continue exactly the same forever.

It was a glimpse of eternity. The inspired were transported. The scattered, fleeting impressions of daily life dissolved. The noise of everyday life can easily engulf the unwary. If only during this prayer, everyday troubles were left behind. It was like the inevitable insight at a funeral when the noisy, aggravating, unjust pursuits of the real world become illusion, placed in perspective as the nonsense they are in the larger scheme of things.Our temple had been lovingly built. It brought the faithful a chance to visit with God. They reminded themselves of his magnificence. They sang songs of praise. They pleaded with him.

Fortunately for us kids the issue was who could finish the Shmonah Esrai fastest. No cheating; you had to read every word…There were other pleasures. Some of the prayers had beautiful melodies. They were sung in Hebrew, in His language. I didn’t understand a word. With the exception of my mother no one I knew could speak Hebrew. But, we knew how to read it, and how to sing it. Joining with the others, singing out, the rush of a crescendo could bring goose bumps, and with it a needed sense of conviction. It is true. God lives. He rules! That was worth singing about.

And sing we did, in sweet loving unison. Quite to my satisfaction I could operatically nail the high notes. Sometimes, hearing my voice ring out, I felt almost like the cantor himself (though no match for Art Garfunkel, 12 years old and already a legend at the synagogue, the only one of us to be the private student of Cantor Koussevitsky.) Art Garfunkel’s soft, sad, almost heartbreaking voice seemed to come from another realm. I heard an elderly woman whisper to her neighbor that God had given this voice to the world as a gift, the sound of heaven miraculously emerging from a small frail boy. He was to be, if only during a song, a bridge over troubled water.

But the sermons. Any sermon, even the best sermon, within 10 or 15 minutes I usually had had enough. I had no manoeuvring room. I was trapped.It reminded me of the study periods in the auditorium at school. Like assistant principals all over New York City at the time, Mr. Burke was hired muscle. He stood in front of the auditorium making sure we understood that he was going to nail us if we were anything other than serious. We needed to be reminded every day that standing behind our women teachers was power, real power. It gave bite to their bark. Mr. Burke watched us very closely. You didn’t want to go to his office. Stories of his punishments had been repeated many times among the students. One look and you knew they were true. The tight wrinkles across his forehead told you. So did his barely disguised clenched fists. Daring you. Daring you to make trouble.

There were only two choices when his eyes moved in your direction, look like an angel, or stare at the ground. It would never occur to us to wonder about the source of Mr. Burke’s need for revenge. Why was not important; it was a given. The main thing was making sure he didn’t turn his fury on you. Brazenly looking him in the eye, even for a moment, would be asking for it. Certainly doing what heavy weight championship boxers do before the handshake, staring each other down wasn’t an option. Mr. Burke did the staring. You had to sit very still. Whispering to your neighbour was a punishable offence.

Sermons were uncomfortable even without Mr. Burke backing up the rabbi. At school you didn’t have to question if you were bad or good. It didn’t matter. The rules were clear so you knew how to stay out of trouble. But a sermon? You might walk in feeling fine but in those days a skilful rabbi could make you rethink just what kind of person you really are. He could make you wonder about all the ways that you didn’t live up to your ideals. Or he could create new ideals that you hadn’t even thought of before. He could lure you into promising yourself, and more importantly, God, that you will try harder to be better. That’s a dangerous combination. It asks the ultimate question, whether deep down you are really good.

For the first 13 years of my life I believed that at every moment I was watched by God. And not just what I did; he knew my every thought. Telling my children about this, we all agree it was almost surrealistic. An omniscient, omnipotent, omnipresent Being monitoring me (and everyone else). It now seems absolutely wild. Back then it was absolutely true. You never really questioned it. God’s presence was a fact of life. With God as judge you perpetually prepared for your trial. So being good was the only way to go, and when not good, sincere remorse was necessary.

On and on the rabbi’s voice continued. It was like being stuck in a car, crowded together for a long trip. Remember this was fifty years ago, before there were SUVs, everyone comfortable in his own captain’s chair. Before Sony Walkmans or Gameboys, before car air-conditioners, back then going on a trip could be more of a trap than a trip. It would go on forever. “Mom are we there yet?” When was the rabbi going to realize enough was enough?

I wasn’t the only one in this predicament. All the children at synagogue had been ordered to sit still. Mark’s mother had him sitting on his hands hoping that would stop them from flapping around. Or making spit balls. Allen’s hands were held tightly together, out in front of him, where his mother could see them. Mark tried to stare straight ahead. He tried his best to listen. But his eyes were like mine. They darted here and there in search of action, hoping to catch someone else’s eyes also darting around, and the two of you could share a brief moment of rebellion. Which we did. But, it was just that split second…

The rest of the time it was prison. Prison is a bleak place. It means you’ve finally lost. Total capitulation, the fight’s over. They get to call all the shots, unless you want to escalate it from being behind bars to being put in shackles. Anything to break the monotony, any stimulation at all might have done the trick. It might restore the balance more to my liking - a joke whispered to my sister, a noogie in the arm of my brother, getting up and walking around, tapping my feet, making a funny face at Mark… Anything!

Now it seems like it would have been easy to regain some form of control. Then I gave no serious thought to mounting a protest. The icy stares of my mother could put a quick end to even a peep, to any and all shenanigans, not to mention the fear that God himself might be offended and then I’d be in real trouble.

We are taught to be good

The ability to sit still and quietly apply oneself for extended times to unwelcome tasks does not come naturally to human beings, especially children. It is a virtue and despite claims to the contrary, virtues do not blossom without careful care. For although there may or may not be excesses of worthiness in us, planted there by our genes, by nature, by the goodness in all living things, long lasting virtues only flourish when they are cultivated.

Our parents get the first crack at building our character, at teaching us what is expected. Who can forget Pinnochio’s long nose as punishment for his lying, or his father’s broken heart when he cut out of school and went to the pleasure palace? The three little pigs and the wolf who blew their house down- what a fine hero the diligent pig was, the one who didn’t play all the time and planned for the future. His neat little brick home saved the day, which was fully acknowledged by the other two lazy piggies. And my friend the choo-choo train that kept saying “I think I can. I think I can” and just kept climbing and climbing until over the hill he cried out “I thought I could. I thought I could” - I can still hear the happy rhythm of my mother’s voice as she proclaimed the choo-choo’s victory.

But other methods are needed. In the 40’s and 50’s and even the early 60’s parents did not think of themselves as their children’s friends. That awaited adulthood, and maybe even then, a parent was still a parent, the voice of the right way to do things. This was an era before psychobabble. No one cared about making children feel guilty. It was a parent’s job to do exactly that. They had to prepare their little ones for the future. Like an untrained pet dog, children could easily become obnoxious. Innocent play could become annoyingly noisy, and there was the grabbing, and squabbling about who was entitled to what, and whose turn it was, and who hit whom first.

This era was well distanced from Jean Dubuffet, and Jackson Pollack and later the aptly named counter-culture and all those who extolled the natural, the child, letting go, creativity, Zen, spontaneity, as a superior state of consciousness. On the contrary, in Queens, where I grew up, letting go wasn’t a real choice. No one doubted that parents were in charge, or that they had things basically right. They had a mission. They had to civilize us. We were like wild broncos. Our parents had to calm us down, jump on our backs and hold on ‘til we became comfortably ready to follow their directions. Little by little parents tried to teach their wunderkind how to not act like a child, how to forego the pursuit of pleasure and pay attention to what was expected. Preparing their children for ‘life’ was how parents showed their real love, not with loads of candy and gifts and hugs, but by doing what was needed to keep their children on task. Parents did not give a second thought about whether they were cool. They knew they were party poopers. They knew nothing of quality time. The essence of parental identity consisted of doing whatever had to be done, bribing, cajoling, threatening, whatever it took to remind their charges to not stray too far from the chosen path.

Yes, hugs and kisses, fun, and parties, were part of the mix. That mix varied from home to home. But special occasions were just that, occasions. Christmas (Hanukah for us) and your birthday added up to two occasions a year. Reward was never a given, never assumed. Unconditional love would have been considered a goofball notion in the 50’s. Instilling virtue was at the very core of child rearing and education. It was not considered an easy goal to accomplish. Otherwise the lessons would not have been so incessant. No opportunities were wasted at school. Spelling, penmanship, grammar lessons took every opportunity to educate the child ‘The early bird gets the worm,’ ‘a stitch in time saves nine,’- over and over, encapsulated wisdom was hammered home, until these truths became reflex, until they were on an entirely different plane than a good idea, or a word to the wise, until they became eternal truth. And we had it easy. In the generation before mine, when misbehaviour occurred, a student might have to write one of these sayings a hundred times on the blackboard as punishment for his/her misdeed.

And it did not let up at home, especially dinnertime. Ah, the hearth and home, the family bonding together, communicating, recuperating from their daily stress with mom’s loving meals. Not where I lived. Phrases such as ‘children should be seen and not heard’ were not considered unjust but rather assumed to be necessary weapons to resist anarchy. No curse words, not even ‘Shut-up.’ ‘Respect,’ that was mentioned a lot. I got that lecture whenever there was an edge to my voice. ‘Please’ and ‘thank-you,’ and ‘may I?’ were golden words. Our dinnertimes could get tense, especially with my forever-bad manners. But this was not an occasion to question the basic model of good and evil. Just who is good, and who bad was, was obvious. Policemen, chaperones, teachers, camp counsellors, authorities of any and all varieties- rule makers represented the good. Comportment, demeanour, posture, proper attire, waiting your turn, forming a line, sportsmanship, all were part of the same package, all part of a sensibility that valued discipline as the road to success.

During the 40’s, in my parents’ social set, having your child toilet trained as early as possible was something to brag about. Similarly, scheduled feeding as opposed to demand feeding of infants was the fashion. You did not run to comfort an infant every time it cried. Once again, character building, a fear of spoiling the child, dominated thinking. By today’s standards, it must sound like the Gestapo occupied my home. During the 60’s when I was a wild-eyed rebel in my 20’s, living in Berkeley, I was sure of it. But the truth is, when I was a kid, I never doubted for a moment that my parents wanted anything other than the best for me. And frankly, my home was fairly typical. I played ball, or did whatever I wanted most of the time. There simply were certain times, when I had to obey those in charge, in school, around my parents, and in synagogue. It was assumed that I would do my homework, but that was basically it. The rest of the time I was free to be me.

Of course this was before the revolution, before the 60’s when everything in America got turned upside down. That we could swing in a diametrically opposite direction does not really contradict the original importance of the older stance, for all along there was another way to look at things, a counter-current opposing virtuous intentions. God fearing Christians identified it as the devil, there since the beginning of time whispering temptation in our ear. That was the whole point of the sermons, the whole point of discipline. Christians understood that the war against Satan had to be waged perpetually. Jews were less specific about where evil came from but right and wrong was no less clear. Right was obeying the rules. Wrong was doing whatever you felt like doing even if it meant breaking the rules. Rules were not up for discussion.

The linchpin of this system of values was God. In ways that were not necessarily thought out he made the laws. Psychologically a lot is accomplished when this occurs. You are offered a deal. Obey me and you have a protector, a leader mightier than all other forces. It goes further. He is all knowing and all good. He is just. Putting the rule maker on a sanctified plane transforms fear of authority into respect. The obedient feel righteous, “saved,” perhaps, at times, in a state of grace. Those who follow God share in his exalted idealized state, or will when they are rewarded in Heaven.

Freud agreed that character building derives from a war but, as an atheist, he gave it a different spin. Children’s natural inclinations and parents’ intentions for them are on a collision course. The price paid for locking up the pleasure seeking self isn’t trivial. He argued that the basic cause of neurotic misery, of all kinds of crippling inhibitions has to do with the things that animals do freely and openly but that human beings must control. Although we rise above our animal bodily drives, our bodily imperatives, our oral, anal, and genital urges have to be regularly satisfied. He thought the drives utilizing these parts of the body were of great importance in stirring up conflicts. He derived their energy from sexuality. I don’t think he was correct about this, but the basic point remains. Animals screw and eat and defecate openly. When, they come across a stranger the first thing they want to do is smell it’s asshole and genitals.

Society demands that we be civilized, that we learn the right way to satisfy ourselves. Animals know nothing of euphemisms, or anxiety. Their fear is fear. It fits the occasion, and then it is gone. They do not have to hide their sexual secrets and longings. They do not have to try to be better. They sleep when they want to and without difficulty. They are unaware of anything being asked of them. Like a counter culture mantra, they simply are. They know how to be. In Queens, the worst thing in the world was to be like an animal.

My parents, particularly my mother, used the tried and true as her main weapon to keep us focused. Her willingness to sacrifice, her distilled virtue never seemed put on. Centuries of practice had perfected her identity, her embrace, her hold on us. It was hopeless to resist. She inspired us. She reached a deep place that clarified our direction. She was part of an army of millions, subtle and not so subtle Jewish American Sarah Bernhardts, her theatre arguably most effective when she believed in it, when we became her dream. It was done quietly, no nagging, nothing other than praise, but when you did her proud she was enthralled. Disappointing her dreams for my future would be like sticking a dagger in her heart.

I clearly remember from my childhood visits of aunts and uncles and discussions that lasted deep into the night. High court was called into session in our living room. Being judgmental was not a negative quality. On the contrary it was the evening’s entertainment. They would sit in judgment of cousins, aunts and uncles, retelling old stories, sometimes going back generations, recounting and debating their sins, sometimes with great eloquence, or brilliance, or compassion that brought a hush to the room as they elaborated the reasons for a misdeed, and whether or not the individual in question could be forgiven. And sometimes, when they disagreed, the arguments would become passionate. It was the breeding ground for future Allen Dershowitzes. This jurisprudence was practiced before 60 Minutes, and 24 Hours and a whole slew of TV shows made exposes of celebrities and high officials into a satisfying catharsis. It was before the latest angle on shame, reality TV offered the humiliation of ordinary folks for the delectation of tens of millions of Americans. The new hunger to connect to real people on TV wasn’t necessary. TV had not taken over quite yet. Real people were regularly part of life and put on trial in living rooms across the land.

I do not want to be deceptive. The moral system enforced during my childhood was not particularly terrific. It, for instance, took me well into adulthood before I was able to figure out why I was so self critical even though I was rarely, if ever, criticized by my parents. I didn’t notice what an outsider might have seen immediately. They got across what they wanted to by criticizing others for qualities they saw in me that were unacceptable. Had my parents directly accused me of these faults I might have argued with them, or made excuses, or felt attacked by them, and maybe thought they weren’t very nice and loving. But I got praise and more praise. By disapproving of behavior done by others they could lay it on thick, leaving me to reflect on it, draw my own conclusions, and claim ownership. Mission accomplished. I would try to eradicate the bad sides of myself.

And there were other cute little devices. I was often praised for qualities far beyond my abilities. When I would object it fell on deaf ears. Eventually it became clear that I was to try to reach beyond myself and make their praise a reality. I don’t know if they were aware of their methods, whether they were consciously and cleverly devious, or whether they blindly repeated child-rearing techniques used by their parents and perfected over the centuries. But it worked.

Actually it was amazing. With God vaguely in the background of moral sentiments, even self criticism could take on a quality of nobility. It was somehow gratifying to hold oneself to the highest standards, a pride taken in suffering that an outsider might call kvetching, but which we, in our strange Jewish masochistic way, got moral points for taking on our shoulders. The more suffering, the purer the soul. It wasn’t exactly noblesse oblige. We were after all aspiring middle class, not aristocrats but…

My family was not alone in our complicated ways of teaching values. Jewish guilt was so complicated for most Jews to figure out, placing us in a labyrinth so confusing for those with a bad case of it, that getting rid of irrational guilt was made a high priority for psychiatrists trying to return composure to their Jewish patients. In so far as Jewish intellectuals and psychiatrists influenced more general ideas in America, they may have placed guilt and “being judgmental” in an overly pejorative light among liberal child rearing and educational thinkers. I’m not sure of this but I wouldn’t rule it out. Century after century the driving energy for Judaic practice was obedience to God’s laws. Century after century the most brilliant Jewish minds were devoted to elaborating on the fine points of the Torah, correcting, arguing over earlier interpretations and misinterpretations of God’s will, forever refining moral expectations. The brightest young student might be matched up with the daughter of the wealthiest man so that he might devote his life to learning and arguing Torah. To be free to cultivate the wisdom of Solomon was considered the most blessed existence. This outpouring of intellectual energy at the top of society was proportionate to the central role of morality in every Jew’s life.

Being a sinner meant being an outcast. It was the most serious state of unhappiness and alienation. Clearing the conscience was essential to feeling properly connected to your life. Catholics went to confession to unburden themselves. On Yom Kippur Jews fasted and made promises that they would do better.

For those no longer involved with a living God, one who listened and watched, and judged, renewal could no longer come from being more observant. Modern thinkers went for the jugular. Seeking to be free of guilt they attacked most guilt as “neurotic.” The intricate web of family relationships, the silent and complicated, the implicit sticky emotions that cause so much angst and misery were described as symbiotic, enmeshed, judgmental.

The Jewish guilt schtick soon enough became good for a laugh on Broadway, and many a psychoanalytic session was spent trying to rid the soul of the cloying imprisonment of maternal martyrdom and expectations from us that would make it all worthwhile. However, there are many variations. Catholics of my generation told me about the nuns at school smacking their fingers with rulers when they stepped out of line. That kind of crime and punishment created different complications. And there were many other ways of getting the message across. But whatever the particulars of child rearing that each culture used, and there were many, each knew that character building was a never-ending struggle against children’s natural tendencies. Victory against temptation could never be assumed. Learning how to subdue and transform the natural, the beast, our heart of darkness, finding a way to ignore Satan, required effort. To return to Freud’s perspective- murder, stealing, lying, unallowable sexuality, sins of every variety make up the stuff of our entertainment in films, books, theatre, and newspapers. When he was on, Mick Jagger orgiastically celebrated his sympathy for the devil. His fans wanted to go there with him, for the devil always throws the best party in town.

But, even those who have committed their souls to a staid existence, deep in the night, they visit this wildness in their dreams. Freud understood the reason. Side by side with virtues our psyche demands a steady supply of vice.

We define particular behaviours as vices and guard against them, precisely because inside each of us we want to act on them. They are a basic part of our makeup. Ninety plus percent of our genes are shared with rats. The neo cortex is evolutionarily placed on top of the older ancient parts of the brain. Both parts of the brain function. The psyche will forever be divided, will forever be in conflict with itself. The animal, the natural, the cave man in us, temptation of all kinds and varieties, is opposed by our conscience. Each is determined to be victorious. One demands yes, the other elaborates on no. We are asked to be good, to say no. Sometimes we are not good. We prefer freedom, passion rather than virtue. Sometimes it is the only way to feel alive. When that occurs trouble is sure to follow.

There are extreme religious groups like the Amish in Pennsylvania who allow very little entertainment, whose whole bearing communicates that they distrust any and all loss of control. Raucous laughter, noisiness- they don’t like any kind of kidding around. In modern America most people do not feel that way. They see no difficulty with fun-everything in its time and place. But the Amish are probably closer to my grandparents’, or great grandparents’ point of view. A few generations back, our predecessors did not consider entertainment a regular part of the daily fare. There was too much work to get done. There were no nightly TV or radio shows, no movies. To be sure children were allowed to play, but out of necessity they were also expected to help their parents. Entertainment was a treat for adults as well. There might be pleasures stolen here and there, but generally, it was reserved for a weekend night when nothing would be expected the next day. Take a look at old family photographs. There were no grins. Not even on the children’s faces. Take a look at a photograph of Billy the Kid. Even he wanted to be seen as serious. That was once considered cool. Grinning was for idiots.

Unlike today, in this very different world, back then, people, with the capacity to entertain, were not considered special in the larger scheme. Indeed the pied piper was feared not welcomed for their children. In the old country, proper people considered people in show business little better than prostitutes or n’er do wells. In America parents worried that their son in college might come home with a show girl. Thomas Mann in Confessions of Felix Krull compared artists to con men. Certainly imagination, exaggeration, fiction, possibly a comfort with outright lies may be necessary tools for the aspiring story teller. Wandering minstrels were sweet in the Mikado, barkers at travelling carnivals were champions of the pitch, charmers of ungodly talent. But they were not welcome in the home. All wanderers were suspect. It wasn’t just rich society people. It was how the average person thought. Values were perceived as permanent endowments, rooted by years and years of belonging to a community.

Our modern hallowed qualities, originality, creativity, individualism, self expression were the very opposite of desirable. Too much freedom was the surest way to a fool’s paradise, to mind games in the service of chicanery. Tolerance was a desirable virtue. But a relativistic moral perspective was no perspective at all.Everyone in the community knew the rules.

In the old country you knew where a person came from. You knew his parents, his aunts and uncles and grandparents. Any one of them had the right, the duty to protect the family’s name. You were part of a greater whole. Individuals’ behaviour reflected not only on themselves but on the rest of their family, perhaps for generations to come. A person’s word was more valuable than nice sounding talk. Art? Artists? Artifice? A person too in love with fiction was not of the real world. He was a dreamer. The ability to have fun was not held against you. It was probably a plus. The ability to bring pleasure to others was certainly a good thing. A lovely singing voice, a capacity to find humour in ordinary happenings could lighten everyone’s load. But a person who wanted too much fun was going to get in trouble. He was the kind of person who would hang out on street corners or at the local pool hall. Parents worried that their children could turn into someone like that. In Freudian language, the Pleasure Principle had to mature into the Reality Principle. Yes had to be met with a lot of no’s. Ulysses, James Joyce’s or any other variety was not a hero. He was a lost soul away from his family. "Yes yes yes yes" meant adventures had gotten out of control.

Most of psychiatrists’ work among the middle class used to consist of making sense of the tangled inhibitions that result from the war between desire and the forbidden. Freud felt neurosis was a terrible price to pay for civilization. He also thought it was a necessary price. There was no choice. Not everything that a fully free man might choose to do is good. Freud’s earliest reputation was earned by his revelations about father-daughter incest, real or imagined. Following the carnage of World War I he wrote Beyond the Pleasure Principle speculating that man may have not only the stupidity to kill, but an animal instinct to kill. We share it with our biological predecessors. It will never go away.Times change. It may take a village to raise a child but there are no longer villages. Our jets and jeeps bring us to far off places where the soil under the feet is sacred, where families have remained in that exact place for hundreds, perhaps thousands of years. It is not our soil. Nothing is. Even in our own land, we are wanderers. The average American moves twelve times in a lifetime. You Can’t Go Home Again was written by an American. In many parts of the world people never leave home.

The kids sent to psychiatrists today are less likely to be tangled up by inhibitions. It’s more often the opposite. A lot of children are sent to psychiatrists because of their lack of inhibitions. They have problems controlling their impulses. It is not unusual for such children, when they get into trouble, to be devoid of fear (as in “Uh-oh wait ‘til my parents find out.”). Nor do they necessarily lose their bluster when a trip to the principal’s office is threatened. Many are not rattled at all. ADHD kids are known for their bravura. Some say they do this to make up for their poor self image. Some say this bravura is exactly the problem. They haven’t learned that in certain situations being reined in is the only way to get where you have to be. Sometimes, in America, if the principal has spoken too harshly to a child, or physically grabbed him to bring him under control, parents are ready to sue.

Following the successful inculcation of 60’s (all you need is love, nature is good) beliefs, generating fear became an unacceptable motivator in the modern educational lexicon. Children were recast as basically good, as lovers of learning when properly inspired. This meant no more Mr. Burkes teaching with their countenance ‘obey or you will be in deep doo-doo.’ It was said that using fear threatens a child’s self esteem. I assume that deep inside, some of the kids now brought to a principal’s office know they are screwing up, and their ‘self-esteem’ isn’t the greatest. But, then, self-esteem is very different from what it once was.

During my childhood feeling good about yourself was connected to staying out of trouble. And this was connected to the larger picture. Ultimately, you would be endowed with self esteem by being obedient to God’s rules, kind of stick with what you are supposed to do and you’ll be okay. You will be protected by God. You will go to heaven. He will be on your side because he knows you are good- something like that.

Self-esteem rested on faith that God existed and the belief that being on good terms with him guaranteed eventual justice. Or else, after many, many years of effort, many years of staying on the long but true path you will have proven to your parents, or the community, that you are a good person. But mostly, back then, it was proving it to God. Self esteem was not related to how close you could get to a vision you had of yourself perfected, or, to being cool, or to putting on a great public performance (perhaps emulating a wild rock star who trashes all that is held sacred, or casually ignores it). In my 20’s in Berkeley it was said that we must find God in ourselves. Everyone was a God if he or she found the inner voice. Not so in the 50’s. It was being on the same page as the rules. God was the perfect one. Not us. We lived under the cloud of original sin, guilty until our virtue might prove us innocent.

Operating within a context where God’s will must be done, used to give parents backbone. It made nuanced strategies superfluous. Whether to guide children to the right path through ‘time-outs’ or “you’re grounded” or by ‘showing you mean business’ might or might not be effective for a given child, but overall it was less important than the socially agreed upon absoluteness of the moral order. There was no need for child rearing ‘experts’ in magazines, on TV, in newspaper columns, in best selling books to educate parents about the latest and ever changing certainties of ‘scientific’ child rearing (with the implied threat that anything else was child abuse). In the old system what parents did with their children was a natural outgrowth of the larger purpose. Moral purpose shaped and encompassed all behaviour. I suspect that it was the critical ingredient that kept me from having ADHD. It would not have worked if it were reserved only for children. Indeed, one of my most powerful rationalizations when I broke a rule, was remembering instances where my father didn’t live up to the rules. Portraying his commandments as “Do as I say not as I do” became a convenient excuse I could slip myself when needed to downgrade him and give myself leeway.

Phillip Roth said his final goodbyes to Columbus with Portnoy’s Complaint, the hilarious detailing of his masturbatory rituals. Turning this dirty secret into comedy seemed to break a kind of spell. Amazingly it soon accelerated. I stepped out of this world of my fathers long ago. But so did my parents. Judging from what I can observe, so have most liberal Americans. “Is God Dead?” Time magazine asked in a 1966 cover story. Most would say no, but he certainly changed to a kinder friendlier kind of God-also one less in the center of life. Most American find the Muslims daily preoccupation with God completely foreign. I do (Although not completely. There are fascinating details about the 9/11 terrorists- how they covered pictures of women in swimming suits in their hotel room. But some also used their charge cards to visit pornographic sites. I remember those days when I was religious, at 13 or 14 years old masturbating yet again, then promising God, swearing to God that this would be the last time. Then doing it again. I did not, however, blame the infidels for my temptation.)

I recall those years now as I write this, but as recently as a month or two ago my former life ruled by God would have seemed to have happened so long before, that it is almost as if it were centuries rather than decades ago. It is almost as if it weren’t me but another person who lived within God’s domain. I suppose that means that as much as I might like to sentimentalize my Jewish heritage in bagels and lox and black and white cookies, if I met my grandparents for the first time they would seem peculiar to me. (Although even they did not pray three times a day as prescribed by Jewish law.) I suppose it also means that the Muslims’ view of us as infidels would not seem strange to my grandparents. They would agree that our popular culture has become bizarre, especially the prominence of sexuality, but also the completely looser, less strictly defined ideas of proper religious practice. Indeed I can’t imagine the mind set behind a story my father-in-law, now 84, told me about his bar mitzvah.

This was the big day, the beginning of his identity as an adult, specifically the beginning of a life where he would become morally responsible for his acts, the crucial difference between an adult and a child. It was a time of great pride for his family. He was reading from the Torah, the book supposedly given by God to the Jewish people. For thousands of years Jews have thanked God for this gift. As I noted above they have argued over its meaning in the most serious way. What is it that God meant by this passage? What did he mean by that? What does God want us to do? Loving prayers are sung as the ark is opened and the Torah, dressed like a king in satin and silk, is brought before the congregation. Reverent prayers are sung by the congregation to God as the Torah is once again dressed and returned to its holy spot at the center of the altar. As children we were told that every vowel, every syllable, of this very long scroll must be written by hand. One mistake and the inscriber must restart from the beginning. We were told that dropping the Torah meant years of repentance.

This was my father-in-law’s big day standing before the Torah. Instead of kissing his tallis and then touching the Torah with it, my father-in-law bent over, put his lips on the Torah, and gave it a smacker. Without a moments hesitation the rabbi slapped him on his head. It wasn’t a tap either. He can still feel that blow. Did getting hit by the Rabbi in front of everyone on his Bar Mitzvah day ruin his life? Did it poison his disposition? I don’t think so. You should see him work the crowd at his country club. To this day his nickname remains Sunny.

But the story is even more amazing when it is contrasted to the synagogue I visited in the 80’s in Connecticut (after many years away). Kids, dressed in jeans were running up and down the aisles as if they were at a playground. And no one minded. Since then a new rabbi has been appointed. He is less of a hippy. In fact he is straight as an arrow. But his greatest virtue seems to be his incredible ability to make the kids feel at home. He is a terrific hockey player.

It isn’t just our rabbi. I have been to community meetings in Connecticut where ministers were dressed in shorts. They too were regular guys.

I like to think of myself not as a sinner but as a good person. For a while, as I moved out of my youth, defining myself politically was enormously important. But then political correctness became a joke. And as all of that has faded I see how those abstract concepts, substituted for the old system. The high moral discussions of my parents’ evenings (or if you prefer gossip about cousins) were replaced by debates about women’s rights, or gay rights, the environment, or political solutions to the problems of African Americans. So much effort was expended to refine our beliefs, prove we were pure of heart. I have to admit these ideals were also a way to prove that we were better, that people with the wrong political beliefs were bad people. It wasn’t just the victory of good over evil that I sought, or the political debates that I wanted to win with my brainy arguments. Somehow abstract high end ideals filled in the blanks of the demands elaborated by my conscience.

Looking back at those years I have come to appreciate how much passionate ideals can become a cheap and easy way to feel superior to the rules, a way to get away with misbehavior, a way my generation used to get out of an awful lot of do’s and don’ts. (Over the years I have also taken note of how frequently people with fantastic high ideals or politics are bastards in their personal lives) When I am very hard on myself, I have to admit my idea of a good life ultimately has been reduced to having an enjoyable life. Perhaps I am being too harsh. I want to feel superior to our “have a nice day” culture and, in truth I have taught my kids that there is more to life than pleasure. But still, often times I have to admit that “meaning” in my godless life can be reduced to a “you only live once” mentality. I greatly value a fine meal and a terrific vacation with my family, a house with a view, a good movie or show or book, or music or art. I like pursuing pleasure. And I am not displeased that America has become more like France and less like England. We now treasure and indulge our senses. Not just sex. We like great food, dance, music. But then England has become more like France and less like England. I don’t know if, like the French, the English now sneak into lines, rather than remain masters of the queue, or value deviousness while mouthing excitingly high sounding philosophy. I just know that while I have always admired the English I am intoxicated by the possibilities of Paris. For most of my life, if I had to be stranded on a desert island, I would prefer a French chick to a sensible English young lady.

I am confessing this because I don’t want my explanations for ADHD (eventually the goal of this piece) to be dismissed as self-righteousness. Perhaps in my 60's, I have become a fuddy-duddy- the kind of old fashioned, out-of-it kind of person that in my 20’s I swore I would never become. Perhaps, as my libido has quieted, I would prefer an English lady. Perhaps not. Be that as it may, I will argue that much of ADHD can be explained by the historically unprecedented ability of so many members of our society to gear their lives towards the fulfillment of pleasure, by a deterioration in our moral fiber, by a pervasive need for immediate gratification, immediate sensation, less talk more action, bam, bam, bam MTV. Our editors despise words formulated in the passive tense, despise characters who yield their will power, who settle into routines in which they are absorbed into a conventional sensibility. Unlike the religious people of my youth who, above all, valued convention, who knew that the way to nirvana was dissolving “me” in the larger permanence of the group’s rituals, in contemporary culture, rituals represent ossification. They “say” nothing.

Forever is de facto not a good thing. It is not American. It is against progress. We want characters that stand out, that want change and bring change, that make a statement, that are unique. America insists on verbs, insists that we keep things moving. Our news is delivered in sound bites. Our reporters went wild when it briefly appeared that the Iraq war might last more than a few weeks. We don’t like talking heads at the movies. Parisians look down their nose at yesterday’s fashions. We discard old ideas as old fashioned. We need to get on with it quickly, smartly zip along our charged up path ahead. That said, despite my belief that ADHD has very much to do with these issues, the evidence, not my thesis, must determine what ADHD is and how it should be treated. So let us get to work.

Sin and ADHD

First a few interesting statistics about adults diagnosed with ADHD and their sense of moral responsibility. They have many more lifetime sexual partners (18.6 vs 6.5) than the average person, and tend to stay with each partner for less time than other adults do. They are less likely to employ contraception and have a far greater risk of teen pregnancy (38% vs 4%). Fifty-four percent of adults with ADHD do not have custody of their offspring. Adults with ADHD are also at a higher risk of contracting sexually transmitted diseases (16% vs 4%).5

There are striking differences between those with ADHD and the general population with regard to driving an automobile. Adults with ADHD were reported as using fewer safe driving habits, being more likely to drive before licensing, and having more accidents (and more faults) than other drivers (2 to 3 for ADHD adults vs 0 to 2 in the control group). There is a far higher percentage of ADHD adults with 2 or more crashes than in a control group (40% vs 6%). The same is true for 3 or more crashes (26% vs 9%). They also had more citations for speeding (4 to 5 vs 1 to 2), worse accidents ($4200 to $5000 in damage vs $1600 to $2200), and a greater percentage of crashes with injuries (60% vs 17%). Drivers with ADHD had more suspensions/revocations (mean 2.2 vs 0.7) and license suspensions (22% to 24% vs 4% to 5%). 6

A Utah survey done by a Dr. Paul Wender found approximately 24 % of male prison inmates to have ADD/ADHD with classical clinical findings . 7 Other studies and his own experience led Dr. T. Dwaine McCallon, M.D. Asst. Chief Medical Officer, Colorado Dept. of Corrections to believe that “upwards of 40% of the residents in a medium security prison have the findings along the Tourette/ADD spectrum.”) According to him, “if you separate out the non-violent, impulsive criminals (whom I term my basic, charming and even lovable car thieves and traffic offenders), the percentage is much greater…”8

The medical view of kids with ADHD is that it is a biological illness unrelated to child rearing. ADHD kids are born with it. Parents haven’t done anything wrong. They are innocent of all charges that would have been levelled against them in the past for raising wild kids. By law we have banned religion in our schools. And we have marginalized religious preoccupations in our understanding of behaviour. It has become improper for professionals to classify what is going on with a kid in moral terms. A public school teacher who carried on about God would be out of a job. When a kid is in trouble, teachers do not think of contacting the family’s clergyman. They think doctor.

I appreciate the esteem granted to my profession. The ideal doctor is trained to be dispassionate, to use a scientific point of view to get at the truth. The rules of science, the discipline of science, allow us to arrive at cold hard facts whatever the implications. In our modern liberal concept of reality we will settle for nothing less. Doctors and all professionals must leave moral spin out of formulations about cause and effect. We pay good money to reap the benefit of this way of looking at things.

But, while religion has no place in classifying an illness, what if we are not talking about an illness? That, as I suggested earlier is the core of the argument. We get so used to approaching issues in a modern way that it never occurs to us to step back and question the assumptions behind our viewpoints. Let us start with this. Who made doctors experts on child rearing? It is a relatively new concept. Doctors were once assigned the role of treating illnesses, not provide a perspective about misbehaving children. When did we make them all knowing about child rearing? Was Dr. Spock’s book that good? Okay Freud talked about the importance of childhood experiences but few people accept Freud today. Just how far have we come with our scientific knowledge about how the brain works? If we can scientifically explain ADHD then the discussion is over and doctors should replace moral pedagogues as the best way to approach wild kids. But, if we don’t have the scientific knowledge, then what?

I am not an anti science, anti technology person who wants ‘holistic’ or alternative care for patients because science is inherently anti human. Quite the opposite, I would be thrilled if the treatment of psychiatric patients could be reduced to the application of well researched and confirmed scientific findings, which in turn would lead to logical and well thought out treatment. I would relish writing prescriptions that are as effective, as antibiotics are for strept throat. When scientific methods lead to the understanding of a phenomenon there is nothing like it in getting the job done. Antibiotics, which we take so for granted, are truly miraculous, as is the polio vaccine, cholesterol reducing agents, and many other life saving medicines. We rightly appreciate firemen as heroes because they put their own life on the line. But, if we want to talk about heroes who have literally saved ten, perhaps hundreds of millions of lives, we cannot ignore scientists as our true miracle workers. Indeed all reported miracles performed on earth by Jehovah or Jesus pale when compared to what our scientists have been able to accomplish. Never mind walking on water. They have allowed human beings to fly from here to Texas. They have taken some of us to the moon. Good or bad, science is clearly the most effective way to understand reality and effect change.

But making decisions about child rearing on the basis of ‘science’ is not the same thing as scientific investigation. Preference for science in our approach to our children is a value decision, particularly when the prestige of scientific methods is often used to justify attitudes that stretch far beyond what is scientifically known, which brings us to the main point. Should we, or should we not trust the judgment of those who advocate that ADHD is fairly well understood and their recommended treatments are solidly supported by knowledge.

This is a shortened version of the complete article. A slightly different version will appear in Rethinking ADHD: An International Perspective Editors: Sami Timimi and Jonathan Leo most likely published in 2007 The web address of the full version of “ADHD and Other Sins of Our Children”, ( which includes a lengthy discussion of the scientific claims made about ADHD) can be found at http://www.geocities.com/ss06470/ADHD.html

Summary

1. It has always been known that it’s difficult to get children to do what you want them to do rather than what they want to do. When children are forced to sit quietly in situations that fail to engage them they daydream or become fidgety, and disruptive.

2 Our culture has changed radically, from one in which moral concerns were at the center of experience, to a more pleasure oriented, stimulus bound existence. Being bad was always exciting for young people. Temptation is not new. But since the counter-culture smashed the rules, being bad has been particularly good. When this sensibility predominates it is easy to get bored and distracted when work rather than fun is the agenda.

3. Like everyone else I swing back and forth on the issue of independence, pleasure and vice versus virtue. I stand accused of rooting for the sinners in movies like Chocolat and Footloose where religion is rightly seen as the enemy of pleasure and self-expression. Moreover, I am in awe of people like Michael Flatley the man with the ‘Feet of Flames’ creator of River Dance, winner at 17 of the all Ireland flute championship, once a golden glove competitor, who, growing up in Chicago, was an ADHD diagnosed Irish charmer. He paid no attention in class and still is not willing to pay his dues to those with authority. I am in awe of many other diagnosed and undiagnosed people with ADHD who are talented and living free. I am not in awe of people who will make a mess of their lives because they never learned how to comfortably do things that they don’t like doing. This article jumps back and forth arguing for and against discipline.

4. Children with a variety of physical defects in their brain have trouble concentrating on tasks, learning the rules that are supposed to govern their behavior, and behaving in the way expected of children with a normal capacity to synthesize, integrate, and act with self-control when confronted by rules and tasks. Children with nothing physically wrong may have the same problem. I believe that the vast majority of the millions of children diagnosed with ADHD have nothing physically wrong with their brain.

5. Beyond the specifics of claims and counterclaims about biological causality, I am itching for a debate in which doctors, patients and society might properly address not only the use of stimulants, but what their widespread use implies about increasingly common difficulties parents seem to be having raising children motivated and focused on work when it is required of them. It is a challenge for every parent. It always has been. The question is whether we are doing worse than we used to do or, whether we have simply reached a point of affluence when pleasure seeking can be safely pursued without jeopardizing our children's lives and livelihoods?

6. Throughout the chapter I take a trip down memory lane. I think it is a valid way to get perspective, not only on one’s own childhood, but, also on the problems kids face today. It is useful if done honestly. When revisited in recollection our lives offer vast new opportunities for discovery. The past is the ground on which we stand, the foundation, the basis for what we do now and all the nows to come. Parents should regularly try to understand what went on in their own childhood. They should learn most of what they have to know from their own parents, sifting through, rejecting, accepting, and maintaining the dialogue. It is a decent antidote to the points of view of experts, who wave their scientific ‘findings’ indiscriminately and often without a solid basis in fact.

References

Angell, M. (2000) Is Academic Medicine for Sale? New England Journal of Medicine 342: 1516-1518.

Angell, M. (2004) The Truth About Drug Companies. New York: Random House.

Barkely, R.A. (2005) Attention Deficit Hyperactivity Disorder, Overview: Handbook for Diagnosis and Treatment. New York: Guillford.

Hearn, K. (2004) Here kiddie, kiddie. available at http://alternet.org/drugreporter/20594/.

Horton, R. (2004) The Dawn of McScience. New York Review of Book 51, Vol4..Mental Health:

A Report of the Surgeon General Chapter3. available at http://www.surgeongeneral.gov/library/mentalhealth/chapter3/sec4.html

National Institutes of Health (1998) Diagnosis and Treatment of Attention Deficit Hyperactivity Disorder National Institutes of Health Consensus Development Conference Statement November 16-18, 1998 Page7 Available at: http://www.consensus.nih.gov/1998/1998AttentionDeficitHyperactivityDisorder110PDF.

Schmidt, M. (2003) Clearing the Bases. New York: HarperCollins

Sobo, S. (2001) A Re-evaluation of the Relationship between Psychiatric Diagnosis and Chemical Imbalances. Available at http://www.geocities.com/ss06470/index.htm

Wells, D. and Kreski, C. (2003) Perfect I'm Not: Boomer on Beer, Brawls, Backaches, and Baseball. New York: William Morrow

Footnotes

[1] See “History and uses of the Coca leaf” http://www2.truman.edu/~marc/webpages/andean2k/cocaine/history.html

[2] The Life and Work of Sigmund Freud, Volume I (1856-1900) (New York: Basic Books, 1953), p. 82-83

[3] “Latest Campus High: Illicit use of Prescription Medication, Experts and Students Say:” NY Times Page B8 3/24/00.

[4] See Sobo, Simon “A Reevaluation of the Relationship between Psychiatric Diagnosis and Chemical Imbalances” http://www.geocities.com/ss06470/index.htm

5 See Adult ADHD: Recent Advances in Diagnosis and Treatment. Adler, L A , Cohen, J http://doctor.medscape.com/viewprogram/2054 (2002) Section 5

6 Ibid

7 McCallon, D "If He Outgrew It, What Is He Doing in My Prison?" ADD Consults (2000) http://www.addconsults.com/articles/full.php3?id=1103

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8 Ibid