Lois Holzman Ph.D.

A Conceptual Revolution

Danger! A Frightening New Mental Illness

If you doubt the danger of diagnosis, you might have sluggish cognitive tempo.

Posted Apr 12, 2014

A friend from South Africa contacted me today to see if I had read the article about a new diagnosis, sluggish cognitive tempo. I hadn’t. My first thought was that she must be referring to some parody of diagnosis in The Onion. But I followed her link and it was to The New York Times. What I found in “Idea of New Attention Disorder Spurs Research, and Debate” truly frightened me. This was no parody.

Even as ADHD diagnosis and medication is finally getting serious critical investigation, reporter Alan Schwarz tell us that “some powerful figures in mental health are claiming to have identified a new disorder that could vastly expand the ranks of young people treated for attention problems. Called sluggish cognitive tempo, the condition is said to be characterized by lethargy, daydreaming and slow mental processing. By some researchers’ estimates, it is present in perhaps two million children. Experts pushing for more research into sluggish cognitive tempo say it is gaining momentum toward recognition as a legitimate disorder — and, as such, a candidate for pharmacological treatment.” 

It seems to me that it’s time to stop identifying such people as “experts in mental health.” They have nothing whatsoever to do with health. Thir business is illness. They’re illness makers. What they do is create illness—not merely mental (whatever that is supposed to mean) but social, cultural, political and ethical illness.

I don’t know how else to describe what is being done by illness characterizations such as this one offered by one of Schwarz’ experts:

 “These children are not the ones giving adults much trouble, so they’re easy to miss,” Dr. McBurnett said. “They’re the daydreamy ones, the ones with work that’s not turned in, leaving names off of papers or skipping questions, things like that, that impinge on grades or performance. So anything we can do to understand what’s going on with these kids is a good thing.” 

(Another expert recommends caution because “we haven’t even agreed on the symptom list”—rather revealing about how this so-called science works: make up an illness and then claim to have found evidence for its existence in some of the things people do; then sell a drug that stops people from doing those things.) Note above the ‘it goes without saying’ comment that it “is gaining momentum toward recognition as a legitimate disorder — and, as such, a candidate for pharmacological treatment.” 

What are we doing to our children—and, consequently, to everyone? How have we let an illness model transform what childhood—and, consequently, family life is? How has understanding “what’s going on with these kids” (if, indeed, anything is going on with them) become identical to diagnosing them as sick? 

But I'm not blaming them. We all share responsibility. I’ve been writing and speaking for quite a while here and elsewhere about our society’s need to take a hard look at how we have a diagnostic way of life and what it’s doing to us. During the DSM-5 controversy there were thousands of professionals and non-professionals who spoke out about both the silliness and the dangerousness of calling bereavement and forgetfulness illnesses. I am sure they will do the same with sluggish cognitive tempo. But I fear that without addressing and transforming the pervasive and more pernicious diagnostic way of seeing the world that we’ve all been socialized to—we’ll soon have to daydream in secret, until we no longer have anything to daydream about.

The philosopher Ludwig Wittgenstein (a superb daydreamer) had many words of caution to philosophers that psychologists and psychiatrists would do well to heed. You can see some Wittgensteinian gems at my Readers Poll (click on the slider).

More Posts