Here’s a story; stop me if you’ve heard it before.
There’s a child, an energetic, enthusiastic child, perhaps hard to deal with in some ways, but all around just beautiful. And then they go to a parochial school – or perhaps they just have a rather strict public school teacher. In either case, the authority figure makes it their wicked mission to suppress all the beautiful children’s personalities into identical, well-behaved zombies in the interest of the idol of order. Only our heroic child remains with their own personality, constantly getting in trouble for it but remaining themselves.
In the next stage of the story, the villain makes their move. A teacher, or a principle or a school nurse can’t handle the child, who admittedly can be a handful sometimes. They suggest the child has ADHD, and put the poor child on medication. Now, with the power of the conformity pill, this child’s beautiful flowering of personhood has been bleached to the same level as all the other children, “proper” and “well-behaved” – which is to say, boring. And perhaps that is “just a “shame – or perhaps a heroic parent removed the medication, or some other “happy ending” intervenes in the third act.
In any case, the story is concluded with self-assured tsking against those who would pathologize childhood and good spirits, and maybe against the overdiagnosis of ADHD … or, if the tellers are bold, the entire concept of ADHD. The moral is clear: Keep the zombie drugs away from our amazing, perfectly normal children.
I’ve heard this story many times. I’ve read this story. I’ve heard this story first-hand or second-hand or as rumor, in in-person conversations and on Facebook posts, from parents and family and friends. Sometimes, people tell me some variation of this when I tell them I’ve started taking ADHD medication – an odd choice, given that few of them are really close enough for it to be appropriate for them to try to undermine my medical decisions. I will say, however, that it doesn’t count in my mind when people tell this story about themselves – that is either second-hand from parents' framing of the narrative, or a different (but rarer than you might think) effect which deserves an entirely different blog post.
But I think that the story as commonly told has some huge gaps. Or rather, that we’re getting the wrong moral out of it by not thinking critically about what’s going on. Obviously, from the fact that I take ADHD medication, I think it is a good thing, often necessary, often useful. In this I include stimulants (even though for unrelated reasons I’m not on stimulants). So of course, I get a different take-away from this story.
This is difficult to explain, because I do know that Adderall and other ADHD medications do sometimes have unwanted personality-altering side effects. I am also not sympathetic with the villain in the story – I am also not a fan of the near-performative overconformity of parochial schools, nor am I enamoured of “strict” or overly “disciplined” environments for children, no matter how their brains work. But in spite of all of these caveats, I still don’t buy into the premise that, in this story, the school used medication to “turn the child into a zombie.”
Here’s the key point: In this story, generally, all the children, medicated or not, are eventually turned into zombies. Normally, whether spelled out or implied, we understand that the school or teacher only has to resort to medication for its zombification for one child, or perhaps a few children. What zombifies the other children? Or, from the school’s perspective, makes them well-behaved? It is not the ADHD medication that makes the unmedicated children behave “like a zombie,” or even the medicated children, but rather some form of social pressure.
So why doesn’t the social pressure work on the protagonist of the story without medication? I do think if they act differently than all the other children without ADHD medication, and then the same as the other children with ADHD medication, that probably means they do have ADHD. And if there’s so much social pressure on these children that all the other ones behave in an orderly fashion, and the ADHD child does not, that probably really is bad for the ADHD child. They’re probably not enjoying their flowery personality in such an environment. They certainly still get all the downsides of the social pressure – without the upside of even having the ability to conform to it.
See, most children are capable of behaving at various levels of enthusiasm and mutedness, chaos and orderliness. The other children in the class know that, in this school, they are expected to behave a certain way. The ADHD child surely also knows that, but they find that they cannot. Their unmedicated behavior isn’t some flowering of their true self or rebellion in favor of being human – it’s a sign that they can’t do something the other children can. It’s a sign of their disability.
The fact that the child’s behavior changes with the medication takes on a new interpretation in this context. The medication doesn’t turn the child into a zombie; it gives the child self-control. In the social siutuation of a “strict” school, the child chooses to use that self-control to conform and act as a “zombie” – for the same reason the other children are conforming.
Here’s where that matters: Imagine what the child could do with that medication, and that improved self-control, in another environment! ADHD isn’t just about whether a child is frustrating to overly strict teachers – that’s just one outward effect, and a relatively minor one at that. In another environment, they will be able to show their personality (like other kids would), but will also be able to use that self-control to accomplish their goals. When they’re older, they’ll be able to finish larger projects, persue their interests, and live more satisfying lives, because far from being overblown or made up, ADHD is a serious disorder that affects much more than the ability of children to become obedient in service to strict adults.
And, of course, if left untreated, many children with ADHD will have difficulty actually behaving well even in a non-strict environment. If a school is so strict it makes the children into conformist zombies, it has gone too far, but children do in fact need some level of discipline, to prevent them from doing harm to themselves and to others. In many cases, the medication not only helps the children conform to overly strict authority figures, but also to reasonable ones, a goal we should all be on board with.
So, if ADHD medication is called for, for yourself or for your children, please don’t avoid it because of this trope.
Now, I’m not a doctor, and I don’t mean to say that you shouldn’t be careful with medication. Zombie-like feeling and behavior can indeed be a sign of bad dosage or a bad medication match. But if by “zombie” you mean what the school would call “good behavior,” there is another, perhaps even more likely explanation: that the social pressures were such that any child who could behave like that would, and now the ADHD child can.
And here’s one way I know something about this: Because I had similar concerns when I started medication myself, as an adult. I asked my friends to pay careful attention to my personality, and whether anything about it changed. I was very concerned about inadvertant personality changes, and wanted my friends to pay special attention to that – while I paid attention to it in myself as well.
The dreaded personality changes never came. But some non-dreaded personality changes did come, with the increased self-control. I became less anxious, and less likely to randomly demand that my friends explain to me how they don’t hate me. And as I gradually increased the dosage – as you have to do with Strattera – I noticed other changes, changes that might have potentially been seen by some as negative or concerning, but which from an internal perspective were clearly positive.
What do I mean by this? Let me tell you what sort of changes I’m talking about. For example, I’ve been less outgoing. I’ve been less outgoing in the literal sense of going out less, and also in the sense of spending more of my at-home time alone, rather than on the phone. But this isn’t because I enjoy those things less; rather, it’s because I’m enjoying my alone time more. It’s because I’m better able to leverage my planning and self-control skills towards goals, goals like saving money and not eating too much.
See, I have historically had so much trouble doing things at home on my own. I have a lot of things I’d love to do more of, things that I clearly know how to do and can do, but which I only get myself started on if other people are around. Leveraging the presence of other people is a common ADHD coping technique known as “body doubling,” and it is one of many techniques to do the types of tasks which ADHD makes difficult – which at some level, is most tasks.
So before I went on medication I would spend as much time out and about as possible. Need to do work? Go to the coffee shop. Need to read a book? Go to the bar. Need to figure out some thoughts? Discuss them with someone. Need to clean my house? Invite someone over to clean it, or even just to hang out with me while I clean it – that works too, and makes me feel a little less bad. I could do with just the encouragement, similar to a personal trainer who may be there more to nag you into exercising than actually educate you about it in any way.
But now I’m medicated, and I’ve finally found a dosage that works for me. It’s not 100% better, of course, but it’s a vast improvement. And that means I’m suddenly getting work done at home. That means I’m occasionally even cleaning my own house. That means that I’m suddenly actually getting use out of my alone time – and so I am taking much more of it.
But sometimes, I worry that this may be a personality change, and a bad one at that. Am I losing my charm? My outgoing nature? I briefly get trapped by the narrative above, which I have heard so many times, and I think, “Oh no! My ADHD medication has made me boring.” But then I realize I could, if I so chose, go out as much as I used to. It’s just that the other options got better. The medication is just helping me.
And I am so grateful for it. Before, it was like I had a menu of fun things I could do for no cost in terms of extreme effort (basically all social), and also a menu of fun things that I’d theoretically like to be able to do, but would be so difficult to wrangle myself into doing them that they were out of the question, beyond special occasions or situations where other people were around. Making myself clean or even practice piano had become analogous to going to a nice restaurant very occasionally to treat yourself. I had to build my day-to-day life out of the easy tasks, which was mostly the social tasks – not exactly fun, and confusing for the people around me.
But now, the whole menu of activities is available to me all the time – or at least more of it. The harder tasks still take some wrangling, but the wrangling is way easier. That means I stay in more, and there’s probably other changes in my personality that in isolation seem negative, both my apparent personality and the way I approach things. But these changes are usually because I can actually accomplish my goals.
And so, I am deeply grateful for my medication, and that is why I am so sad when ill-thought out narratives perpetuate stigma against medication, especially for children who can’t make their own medication decisions. The effects of ADHD medication can be wide-ranging and complicated, so it’s important to think critically in evaluating them. Anti-medication narratives are often emotionally compelling but ultimately oversimplified, ignoring alternative explanations for what happens. So it’s important to actually think them through, and pull them apart.
Hopefully reading this has provided some practice doing so.
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