Speed and Modernity

The pharmaceutical drug Adderall, a mixture of amphetamine salts, is widely prescribed in the United States for treatment of Attention Deficit Hyperactivity Disorder. It is common practice in the United States for psychiatrists and prescribing doctors to work in such a manner which assumes that the loose cluster of symptoms present are due to some inherent deficit of health. This approach to diagnosis posit the individual presenting the cluster of symptoms as inherently unhealthy, and either denies or conveniently omits any possibility of external causation. It is presumed that, through their prescribed dependence on mixed amphetamine salts, they are able to achieve a conditional health, commonly based in subjective accounts of the subject’s ability to refrain from deviant behaviors. Further, its status as a commodified object, only legal in forms mediated through the messaging of pharmaceutical companies’ marketing departments (whom might be known to treat prescribing doctors to a nice dinner from time to time) has lead to a significant conflict of interest. Western medicine’s de-facto monopoly on administering this substance as a cure for deviant behavior constitutes a complex of similarly interested actors: pharmaceutical companies that wish to sell more product, and a nation state that wishes to minimize deviance toward maximum productivity. 

So, the ideal ADHD patient who has a deficit of attention and a surplus of hyperactivity typically consumes one or two tablets a day. This should give them the ability to complete tasks in a more linear fashion than what their symptom cluster usually affords. Thus, in this stage of consumption, the tablet as a social actor ideally imbues the patient with a feeling of control, a psychoactive state that transforms their abilities and allows them to better participate in society in productive and normative ways. This effect creates meaning for the patient, whether this is a simple confirmation that they are neurodiverse, that they simply enjoy the euphoric side effects and new thought patterns, or further, that the disorder that they are diagnosed with is a legitimate and individual problem that can be dealt with solely through the medical realm.

There is also meaning created when the tablet wears off, and withdrawl starts. This is often described as a “crash” similar to the conception of caffeine or sugar crashes, and the response is usually to dose a second or even third time. The absence of the medicine’s positive effects could reify that the disorder is an inherent ailment, a glitch or aberration upon the conditionally healthy body.

Somewhere in this process of purchasing the medicine, the patient may be brought to understand that this medicine is a controlled substance which should be kept away from those that might have an interest in abusing or selling it. This, of course, creates some meaning in  the relation between themselves and neurotypical people: the medicine that allows the patient to function in normative society is understood as something coveted by those that do not have the disorder or those that wish to ‘misuse’ the medicine. Myriad meanings could be communicated through this relation. One is self-doubt of the disorder being “real”, whether that means it is socially constructed or that they are an imposter acting like they have the disorder. On the other side of the coin, these measures could communicate a message of officiality which reifies that their disorder is in fact an individual disorder that requires special consideration, a bending of the controlled substance rules so that they can be conditionally healthy.

The prescribing doctor is ideally an M.D. but could be anyone from a psychiatrist or pediatrician depending on the particular case. In a perfect scenario, the prescriber consults with the patient and parents, eliciting a narrative of the struggles and problems that might potentially constitute ADHD. The prescribing doctor cross references this narrative with various quantitative and qualitative figures from the DSM-V or similar diagnostic manual, and if the thresholds are met, the patient is diagnosed with the disorder and likely prescribed to take Adderall daily. This process of translating lived experience narratives, parental input, and quantitative data like school performance into a diagnosis formalizes the problems faced into a disorder, causation being completely left out of the conversation.

This creates meaning for the patient and the parent which is shown to be culturally mediated, that is, that people from different backgrounds likely receive this information differently depending on their perception of themselves in relationship to institutions of mental health, therapy, and greater society.

The production of the amphetamines takes place largely offshore, in places like Israel for Teva/Barr/its subsidiaries, and India for Aurobindo/Aurolife. These drug conglomerates are some of the main authorized providers of Adderall generics in the United States. Of particular note is the various names that each pharmaceutical company does business under. This could be for various legal reasons such as mergers and acquisitions, but I’d instead like to highlight how this can create meaning (or the absence of).

Adderall, as mentioned earlier, was originally brought to the market by Shire Pharmaceuticals. Because this name brand is cost-prohibitive for most, the FDA grants other companies the right to produce “functionally similar” drugs to be sold as generics. When you are prescribed Adderall by a doctor, the pharmacy will fill the prescription with whichever generic of mixed amphetamine salts they have on hand. This can be difficult to track, especially with a problem set like that of ADHD’s symptom cluster.

On the “second-hand” Adderall market, these generic brand names take on a different lives, different meanings, and different prices, with reputations that precede them (for efficacy or lack thereof).

Teva’s plant in Jerusalem

It is tough to find a simple answer for the question of whether Adderall is a medicine or drug. Personal experience coupled with a review of the literature all point to drug, and yet, it has definite therapeutic value for many. The simple fact that it has addictive potential, alters your brain chemistry seemingly irreversibly, and its value for social control leads me to stick with the definition of Adderall as a drug. It is a drug that has a high value in its use for making the neurodivergent mind adequate for work in our technologically advanced post-industrial world.

The term “pharmakon” is the root for the word pharmacy, but in its original definition, it includes ‘poison’ as well as medicine. This is a useful way to think about pharmaceutical drugs historically, and in my opinion works perfectly well to describe Adderall. After all, since the introduction of amphetamine salts, they were sold with little to no restrictions aside from signing the poison register. Since Adderall can have positive effects as well as negative effects on people, it fits well with the conception of the pharmakon.

Analyzing the consumption stage of Adderall’s social life is important because most perspectives making up the collective consciousness about the drug and the disorder it is prescribed to treat come from the top down perspective of medical doctors and professionals simply doing their jobs.

There are myriad statistics about abuse and misuse, endless narratives of chemical imbalance and how Adderall’s action on the brain is shown scientifically to resolve these problems in behavior, yet it remains to be seen when the actual people whom use the drug to function or those whom have been subjected to using it with little benefit get to have a seat at the table for discussion. Part of this is because ADHD is defined as a disorder that begins in early life, and if diagnosed then, their formative years will be through a psychoactive lens of altered brain chemistry.

My sentiment echoes Peter Conrad’s (1975) paper on Hyperkinesis, a precursor diagnosis to ADHD. It would seem that ADHD, like Hyperkinesis, is leveraged by medical professionals as their answer to the increasingly unmanageable aspects of child rearing in an increasingly accelerating and atomized society. Conrad suggests that this is problematic because it allows for an insular group of experts to make decisions resembling social control, ignoring any simple explanations for symptoms, and depoliticizing deviant behaviors such as refusal. We are further down the spiral of history than Conrad was when he wrote that paper in 1975, but the implications remain the same: the medicalization of deviant behaviors, especially in consideration of diverse and widely differing cultural experiences, constitute social control. While not venturing to make the conspiracy claim, at the very least, our society’s medical apparatuses serves to keep the status quo in place.

The experts aim to solve problems presented divorced of context, and their answer is a drug that absolves the exhausted, overworked parents from emotional engagement with their child, the exhausted teachers from having to police overcrowded classroom behaviors on top of their long list of curricular responsibilities, and lastly the child that simply doesn’t want to sit in a chair or take orders from ringing bells. The knowledge that meanings, habits and practice in using pharmaceutical drugs like Adderall are subject to mediation by their local contexts, all but point us directly toward the need for new models and alternative conceptions of reductive biopsychiatric perspectives.