Pills, Prayers, and Peace
August 1, 2002
by Ronald W. Dworkin
During the last decade, a 500 percent increase in domestic U.S. sales of the prescription drug Ritalin was correctly regarded with suspicion by many in the faith community. Doctors seemed to be enticing their patients into a diagnosis of attention-deficit hyperactivity disorder (ADHD) the way farmers coax a horse into its bridle and harness. Some parents with hyperactive children found medication to be an easy method of controlling them. For some adults who took stimulants to gain efficiency, medication shut down the natural conversation they held within themselves (which they called a distraction) so that they could devote all their attention to a job.
Not all people, however, have smooth, round minds. Some suffer from poor organizational skills and are easily distracted. If their symptoms are sufficiently severe, they may be justifiably diagnosed as having ADHD. This situation underscores a growing conflict between religion and medical science, and requires us to discern at what point a normal variant of behavior becomes a real medical problem.
Doctors prescribe Ritalin in borderline cases of ADHD, arguing that if patients improve on the drug, their dysfunction must have had a biological basis, because otherwise the drug would have failed. Thus, from the doctors’ perspective, the fact that improvement follows Ritalin justifies retroactively the medical intervention in the first place. This trial-and-error approach makes medicine, in particular drugs, the first line of defense against all forms of emotional trouble, because the only way to prove that a medical intervention was inappropriate is with hindsight, after a drug trial has failed.
Some religious leaders, however, argue that unless there is a brain lesion or a sign or symptom of physical disability, mental disturbances are problems of culture or mentality, not nature. To think otherwise, these leaders argue, allows doctors to take over exclusive treatment of even the slightest emotional trouble. These same religious activists have properly argued against the ever-expanding treatment of depression. It is wrong, they correctly assert, to medicate people who suffer only from everyday unhappiness. Fortunately, clinical depression has real physical signs and symptoms, and so a kind of natural division exists between unhappiness and depression, which good medical practice recognizes.
There is, however, no such natural division between true ADHD and everyday distractibility. Unlike clinical depression, ADHD currently has no major physical indicators. If forced to use critics’ rigid criteria for mental illness, doctors would be unable to justify treatment even of true ADHD. Moreover, ADHD is a matter of basic functionality, and this area is simply not susceptible to alteration through purely intellectual or spiritual means. Religious critics who dismiss ADHD out of hand err in treating a matter of basic human functionality as if it were a spiritual deficiency and hence a problem best handled through religion.
To be sure, the quest for happiness is part of our spiritual life. This is why human happiness is so contingent on belief, and why spiritual guidance is the only real remedy for unhappiness. At the hospital where I work, I often see religious guides whisper kind words to unhappy patients. The words have a tremendous salutary effect and clearly make the patients happy. Unhappiness is often a problem of perspective, which is why spiritual guides sometimes have more to offer unhappy people than do doctors. Religion has a role to play in the treatment of unhappiness, because the road to happiness runs through the imagination.
Basic functionality, by contrast, does not depend on one’s spiritual condition. Dysfunction is like speech pathology or amnesia in that it does not depend on people’s beliefs about the world and their place in it. No amount of sweet words or pious sayings can cure someone who is pathologically disorganized or easily distracted. Unlike happiness, functionality is independent of belief. It can be improved through nonmedical strategies such as coaching, but not by explaining the meaning of life. This makes it a fitting subject for medical science. Hence it is important for religious critics of ADHD to avoid seeing all variants of mental illness as a beneficial yoke of nature, something best kept away from doctors who want to lift it. For many patients, the diagnosis and treatment of ADHD are liberating. To condemn people, in the name of religion or for any other reason, to a life of disarray is unkind and unjust. Religion has much to offer in the quest for improved physical and mental health, but religious leaders must be careful not to claim more than their ministrations can deliver, lest all their efforts lose credibility and multitudes be denied their help.
Ronald W. Dworkin is a practicing physician and a Senior Fellow at Hudson Institute.