Chapter 31: I Never Saw the Trees – What Medications Can & Cannot Do

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Okay, so this deep dive, I gotta say this chapter we're tackling this time around, it's

really got me thinking.

Yeah.

It's all about medication and ADD and I was really struck by how the author doesn't just come out and say yes or no on meditation.

Right.

It's much more about all the nuances like when and why and is it always the right first step?

Absolutely and that's what I found so interesting right from the start.

You know the author makes this really clear distinction between the use of medication which is presented as pretty straightforward

and then the employment of it which gets a lot more complicated.

Yeah.

So it's like okay using it might be simple but deciding when and how and if it's the best initial approach that's where things get tricky.

Right and that's what I think a lot of our listeners are grappling with.

I would agree.

Like it's not just a black and white issue.

No.

So let's dive into that complicated part.

Okay.

One of the first things the author brings up is this idea that sometimes it feels like medication is over prescribed.

Yeah.

And it's not always about what's best for the child.

It's more about managing a child to make things easier for the adults around them.

What are your thoughts on that?

Well the author calls it a legitimate perception and it's hard to argue with that.

There's this really powerful example in the chapter of a child being told that they have to be on medication in order to go to school.

Wow.

And that really makes you stop and think like whose needs are actually being met here.

Is it really about the child's well -being or is it about making them fit into a system that might not be designed for their needs?

That's a great point and it's not just isolated cases either.

No it's not.

The chapter mentions this huge increase in Ritalin use in Quebec like almost four times higher since 1990.

That's right.

And if you link that statistic with what Professor Paradis was saying about schools increasingly pushing for medication,

it starts to paint a pretty concerning picture.

And then you add in the fact that there are fewer resources for special education across North America, less funding for teachers and psychologists and social workers.

It makes you wonder if the rise in medication is just because there are more ADD diagnoses or if it's because we're not providing enough support in other areas.

It's like we're opting for the quick fix instead of addressing the root causes.

Exactly.

And that's a huge part of what the author is trying to get us to think about.

Yeah and the author also talks about how some of the strongest opposition to medication comes from people who don't really understand the neurological basis of ADD.

I remember that part.

There's that anecdote about the radio host who was saying Ritalin was new and untried.

Oh yeah that was a good one.

It just shows how easily misinformation can spread, especially when the reality is that these medications have been around for decades.

Right.

And the people who are most against it are often the ones who don't understand the science.

They just see it as bad behavior.

They might say the kids are spoiled or blame the parents.

Exactly.

It's like they're missing this whole layer of complexity.

Yeah they're not seeing the underlying neurological differences that are a hallmark of ADD.

Right.

And it's so interesting how the author then contrasts that with the experiences of people who have seen or felt the positive impact of medication.

Oh is that too?

It's like their perspective is totally different.

Completely.

I mean how can you argue with someone like that 54 year old woman who said I never saw the trees after starting Dextreme.

Oh my gosh.

Yeah.

I mean that's just such a powerful image and the fact that this effect lasted for three years on a low dose.

It really speaks to how transformative medication can be for some people.

It's not just about focusing better.

It's about experiencing the world in a whole new way.

It's amazing.

Yeah.

And then there's the 40 year old man who said he felt like he could finally assert himself after just three weeks on Ritalin.

It's not just about school or work performance.

It's about fundamental aspects of who you are and how you interact with the world.

Yeah.

And it's so important to highlight those positive stories.

Yeah.

Because they show that medication can really make a difference in people's lives.

Right.

And there are so many other examples in the chapter.

So many.

Like people who were finally able to finish their writing projects or the university student whose migraines went away or even that teenager who suddenly found herself watching the educational channel and having a calm conversation with her mom.

It's amazing how it can manifest in so many different ways.

It really is.

But the author is also careful to point out that it's not all sunshine and roses.

Right.

It doesn't work for And there can be side effects.

Definitely headaches, loss of appetite, sleep problems, anxiety.

It's not a magic bullet.

Right.

And even when there are benefits, they might not be as dramatic as some of those stories we just talked about.

Exactly.

And that's why the author uses that analogy of each person being their own guinea pig.

Because everyone's brain chemistry is different.

So you can't predict how someone is going to react to a medication.

You have to find what works for each individual person.

And that can be a long and frustrating process.

It can.

But it's important to remember that there are options.

And that's where a good doctor comes in.

Right.

And speaking of misconceptions,

the author does a really good job of addressing some of the common fears people have about these medications like addiction.

Yeah, that's crucial.

Because there's so much misinformation out there.

And the author makes it clear that taking these medications as prescribed for ADD is not the same thing as substance abuse.

And they even suggest that in some cases, stimulants might actually help prevent addiction by addressing underlying biochemical imbalances.

Yeah, that's an interesting idea.

And it builds on what was discussed in the previous chapter.

Right.

It's not just about masking symptoms.

It's about potentially correcting something that's off kilter in the brain.

So the chapter then goes on to talk about the main types of medications, methylphenidate, which is Ritalin,

and dextroamphetamine sulfate, which is dextrine.

Right.

And the author explains how they work without getting too technical, which I appreciate.

Me too.

It's really helpful for people who aren't scientists to understand the basics.

Exactly.

So essentially, they stimulate the cerebral cortex by influencing the levels of certain neurotransmitters in the brain.

Yeah.

And those neurotransmitters are involved in attention and focus.

Right.

And the author uses that sleeping cop analogy from chapter five to illustrate how these medications can help.

Oh, yeah.

I love that analogy.

It's so vivid.

It is.

So basically, the idea is that when the cerebral cortex is working properly, it's like a sleeping cop.

It's there to maintain order and control.

But in people with ADD, that cop is often asleep on the jaw.

So the brain is kind of chaotic, and it's hard to focus because there are all these distractions and impulses coming in.

Right.

But these medications help to wake up that sleeping cop so it can do its job of inhibiting those distractions and impulses.

So it's not just about boosting attention.

It's about reducing the noise and chaos in the brain.

Exactly.

And that can lead to a feeling of calmness and purpose because you're not constantly being bombarded with distractions.

That makes so much sense.

And the author also points out that neither Ritalin nor dextrine is inherently better.

It really depends on the individual.

Yeah, one person might respond better to one than the other.

It's all about finding what works best for you.

And there are other medication options too.

Right.

Like other stimulants, low -dose antidepressants.

Right.

The author mentions those, but the focus is really on the general principles of drug treatment rather than getting into the specifics of every single medication.

Which is good because it keeps things from getting too overwhelming.

Yeah,

and one of the most important principles the author highlights is the importance of individual choice.

Absolutely.

That's huge.

They're very clear that the decision of whether or not to take medication should ultimately rest with the person being treated.

Especially when it comes to children.

Especially with children because they're not always able to advocate for themselves.

Right.

And the author talks about how forcing a child to take medication can make them feel like they're sick or broken.

Yeah, it can really mess with their sense of self.

Exactly.

And even if the medication does help them function better,

it's not going to be a truly positive outcome if they feel like they had no choice in the matter.

Right, it has to be their decision.

And adults need to be really careful about imposing their will on children when it comes to something as personal as altering their brain chemistry.

It's about respecting their autonomy.

Absolutely.

And that leads into a discussion of the bigger picture issues within the education system.

The author acknowledges the challenges that teachers face, especially with large class sizes and limited resources.

And the pressure to get everyone performing at a certain level.

Right.

And they criticize the tendency to use medication as a quick fix to manage kids who don't fit the mold.

It's like we're trying to make the kids fit the system instead of adapting the system to meet their needs.

Exactly.

And that's where that term chemical straight jacket comes in.

Yeah, it's a powerful image.

And it really makes you think about the ethical implications of medicating children just to make them easier to manage in a classroom.

And then there's the parental perspective.

The author totally gets how desperate parents can feel when they're trying to help their child and they see medication as the only option.

I can only imagine.

But they also really caution against doing things that take away the child's autonomy.

Yeah, like secretly giving them medication.

Like that example of the parents putting Ritalin in their son's drink.

That was disturbing.

It's really scary to think about parents doing that.

It is.

And the author's very clear that that's not OK.

Right.

It's about respecting the child's right to choose and focusing on their long term development, not just short term gains.

And building a strong and trusting relationship with your child.

Yes, because if the relationship is good, the child is more likely to be open to help even medication if they need it.

It's about creating a safe and supportive environment where the child feels heard and understood.

Exactly.

And the chapter also talks about the role of the prescriber.

Right.

Emphasizing that there's no one size fits all approach to medication.

It's not like a cookbook.

Right.

You can't just say, OK, this kid is 10 years old and weighs this much, so they need this dose.

It's much more nuanced than that.

Yeah.

You have to start with a very low dose and gradually increase it while carefully monitoring the child's response.

And looking out for any side effects.

Exactly.

And the author suggests that a lot of the negative side effects people experience are actually due to prescriber error.

Like giving too high a dose.

Exactly.

And it's important to remember that you can always adjust the dose or stop the medication altogether if it's not working.

Right.

It's not a lifelong commitment.

No.

And the goal of medication should be to help the child focus, not to control their behavior.

That's such an important distinction.

It is.

The author warns against pushing the dose higher and higher just to get the child to be perfectly quiet and obedient in class.

Yeah.

Because that can end up suppressing their natural energy and curiosity.

And it's not fair to expect children to tolerate side effects that adults wouldn't put up with.

Exactly.

It's about finding a balance that helps them function well without sacrificing their well -being.

And then the chapter shifts gears a bit and talks about adults with ADD.

Sharing some observations from an adult ADD conference where it sounds like a lot of people were disappointed that medication wasn't a cure -all.

Yeah.

It's easy to fall into that trap of thinking that a pill is going to solve all your problems.

Totally.

But as the author points out, medication can help with distractibility and focus.

But it doesn't magically fix things like low self -esteem or relationship problems or unhealthy lifestyle habits.

It's a tool, not a magic wand.

Exactly.

And it's important to address those other issues as well.

And to be aware of your emotional state.

Because if you're struggling with anxiety or depression, those things need to be treated too.

Yeah.

Because stimulants might not help in those cases and could even make them worse.

So it's really about taking a holistic approach to treatment.

Yes.

And that's a major theme throughout the chapter.

The idea that medication should never be the only answer.

Right.

The author is really adamant about that.

They say that over -reliance on medication is a huge problem and that it doesn't lead to lasting change.

Because as soon as you stop taking the medication, the problems come back.

Right.

And they argue that ADD is not just a medical illness.

It's much more complex than that.

Yeah.

It's influenced by your environment, your relationships,

your lifestyle.

Your psychological well -being.

It's about so much more than just brain chemistry.

And while it's tempting to just take a pill and hope it fixes everything,

the author is really pushing us to do the harder work of addressing those other areas of our lives.

And then they bring in the perspective of psychologist Thomas Armstrong.

Oh yeah.

Who believes that medication should be a last resort.

After all other options have been tried.

And it's interesting to see how the author's own views have evolved over time.

It seems like they were initially more gung -ho about medication.

But now they're leaning more towards Armstrong's approach.

Right.

Although they do acknowledge that there might be some exceptions, like in a crisis situation where a child is really struggling and willingly wants to try medication.

But even then the focus should always be on the bigger picture.

Yeah.

On supporting the child's overall development.

And helping them to understand and manage their ADD in a way that works for them.

And speaking of the bigger picture, that brings us back to that quote from the 15 year old girl who said, it's not the me that I'm used to.

I was just thinking about that.

It's kind of weird to see my mind working differently.

That's so profound coming from a teenager.

It really is.

And it speaks to the potential impact of medication on identity, especially for adolescents who are already going through so much change.

The author talks about how medication creates this artificial state that can affect moods and thoughts.

And that can be really confusing for someone who's still trying to figure out who they are.

And there's that concern from Stanley Greenspan that medication might interfere with the process of developing a solid sense of self.

Which is a really important consideration.

It is.

And again, it comes back to the importance of choice.

Right.

If the teenager chooses to take medication, it's more likely to be a positive experience because it means they're acknowledging their challenges and taking ownership of their treatment.

And it shows that their parents trust and support them.

Right.

Which can be so important for their self -esteem.

Absolutely.

And the chapter also cautions against jumping to conclusions about cause and effect when someone starts taking medication.

Like assuming that just because a teenager's communication with their mom improves,

it means the medication has solved all their problems.

Exactly.

It might be a factor, but it's not the whole story.

Right.

There might be other underlying issues that need to be addressed.

And the author uses that example to highlight the importance of looking at the whole picture.

Yeah.

At the family dynamics, the individual needs the way everyone is interacting with each other.

Because medication can't fix everything.

No, it can't.

So in the last part of the chapter, the author tries to grapple with this question of why medication is so dominant in the treatment of ADD.

Yeah.

Why is it the go -to solution?

Even though we know that other approaches are important.

Right.

And they touch on that North American tendency to look for quick fixes.

Yeah.

We want the easy solution, the pill that will make everything better.

And they bring in that observation from Sherwin Newland about how laboratory findings are increasingly dictating clinical practice.

Like the tail wagging the dog.

Exactly.

And the author points out that this is partly because pharmaceutical companies have a lot of money to invest in research on drug treatments.

While non -drug approaches are often underfunded and under -researched.

What's not that medication is bad, it's that we need to be more balanced in our approach.

We need to consider all the options and make sure that people have access to a wide range of treatments and supports.

So to wrap up this deep dive into the chapter, I think the key takeaway is that medication can be a really valuable tool for people with ADD.

It can be life -changing for some people.

But it's not a simple issue.

No.

There are so many things to consider.

Individual choice.

Right.

Making sure the person is fully informed and making the decision for themselves.

And having realistic expectations about what medication can and can't do.

Exactly.

And the need for a comprehensive approach that addresses all the factors that contribute to ADD.

Yeah.

Like psychological well -being, family relationships, lifestyle choices.

It's about so much more than just taking a pill.

Right.

And this chapter does a great job of laying out all those complexities and encouraging us to think critically about how we approach treatment.

So to leave you with a final thought to ponder, given everything we've discussed today, what would a truly holistic and supportive environment for people with ADD look like in our society?

One that goes beyond just relying on medication and embraces a wider, more integrated range of interventions and supports?

That's a great question.

What do you think?

I think it would involve a shift in our mindset.

Away from seeing ADD as a problem that needs to be fixed and towards seeing it as a different way of being in the world.

A way of being that has its own strengths and challenges.

I like that.

And I think it would also involve providing more resources and support for people with ADD and their families.

Absolutely.

We need more funding for research into non -drug treatments.

And more training for teachers and other professionals who work with people with ADD.

And we need to create a culture of acceptance and understanding so that people with ADD feel comfortable seeking help and support.

Yeah.

So that they can thrive and reach their full potential.

Exactly.

Thanks for joining me on this deep dive.

It was my pleasure.

I'm sure we've given our listeners a lot to think about.

I hope so.

And we'll see you next time for another deep dive into the world of ADD.

Sounds good.