Special Thematic Section on "Rethinking Health and Social Justice Activism in Changing Times"

The Politics of Error: Rethinking the Power of the Symptom in the Case of ADHD Diagnosis in Chilean Society

Esteban Radiszcz*a, Hugo Sirb

Abstract

This article seeks, mainly, to develop a critical approach to the problem of Attention Deficit Hyperactivity Disorder (ADHD) and, through this, to rethink the problem of activism and militancy in relation to the power of a symptom linked to a corporality that seems to overflow a determined moral political framework. For this reason, we seek to think of a militancy that intensifies error, as a political power, beyond the search for a specific and universal diagnostic associated with what is understood as evidence. We begin with the description of the emergence of what we have called the ADHD Situation. First, using field notes from a collective ethnographic investigation performed during 2017, we describe the ADHD Situation as an ongoing process. Then we connect it to a broader context by examining the role of the school in contemporary Chilean neoliberal society from a genealogical-affective approximation, trying to avoid substantializing readings. In the second section, we develop this connection, describing the production of the ADHD Situation through the lenses of epistemology, ethics, economics, and politics. We also use here a critical analysis of three key documents that help us chart the institutional development of the disorder: The National Mental Health Plan (2017), the National Children’s Health Program (2015) and the Clinical Guide to Attention Deficit (2009). We demonstrate the existence of an epistemological connivance between macrosocial transformations and the community approach utilized in these documents. This provokes us to think about a militancy capable of trespassing the borders of academia, health definitions, and social interventions through the intensification of the power of error as an opening to radical transformations.

Keywords: ADHD, power of the symptom, epistemology, situational analysis, community psychology

Journal of Social and Political Psychology, 2018, Vol. 6(2), doi:10.5964/jspp.v6i2.896

Received: 2018-01-16. Accepted: 2018-09-13. Published (VoR): 2018-12-21.

Handling Editor: Flora Cornish, London School of Economics and Political Science, London, United Kingdom

*Corresponding author at: Psychology Department, Social Sciences School, Universidad de Chile, Av. Capitán Ignacio Carrera Pinto 1045, 7800284, Santiago, Chile. E-mail: eradiszcz@uchile.cl

This is an open access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

The spirit that mobilizes the present work is born of a systematic inquiry into the ways in which it is possible to understand the link between the level of social organization, particularly around economic, political, and moral dimensions of social life, on the one hand, and the plane of individual suffering on the other. In this sense, we are not far removed from a long critical tradition that has taken on the problem of understanding social malaise (Durkheim, 1992; Ehrenberg, 2010; Freud, 2010; Illouz, 2010; Lordon, 2013; Malabou, 2017). At the same time, we seek to construct an affective reading of the social world, in the line developed by Lordon (2013, 2015) and Lara et al. (2017). Marking a difference between feelings and affects, which pass through a higher level of codification in the case of feelings and are grounded in a more specific material reference in the case of affects, we understand affects as differences, transitions between one state and another, linked to environmental factors. For human beings, these are as much historical and structural as biological. Indeed, our capacities, or power (potentia), are a historical-biological composite. Environmental factors produce affect during transitions between one state of our power and another. The historical-biological dimension of this dynamic requires affective genealogies to reconstruct the heterogeneous forces that gave rise to currently operating environmental factors, for example, the moral, biological, and political dilemmas around attention deficit. (Clough, 2010; Deleuze, 2008, 2017; Gregg & Seigworth, 2010; Lordon, 2013).

We will focus on the way in which Attention Deficit Hyperactivity Disorder (ADHD) is understood and managed in key documents of the Health Ministry and Education Ministry, documents which claim a community psychology perspective. Nonetheless, we will first examine the assembling of what we have called the ADHD Situation (Claro Tagle, 2015; Rauthmann, Sherman, & Funder, 2015), linking it with broader social transformations that point to a post-liberal era, understood as the recent transformation of the neoliberal regime. In that sense, we seek a useful way to read and map both the diagnostic and the broad context of social transformations, specifically through the description of an epistemological connivance between the core of neoliberal doctrine, the search for standardization of knowledge about ADHD inside and outside the school, and finally a critical appraisal of the way in which "community" is understood in the official health and educational documents.

ADHD as an especially contested mental health category makes really clear the impossibility of understanding these without a broad sociological frame. Indeed, the “controversy over labelling children with ADHD and medicating them with potent psycho-stimulants has grown as the prevalence of ADHD has skyrocketed” (Wallwork, 2017, p. 257). Still, epidemiology studies state that ADHD is the principal mental health diagnosis received by Chilean children and its main symptoms are said to persist in adult life (Urzúa, Domic, Cerda, Ramos, & Quiroz, 2009; Wender & Tomb, 2017).

In Chile, the prevalence of the ADHD diagnosis is comparatively high among boys and girls of 4-11 years of age in the general population with an incidence of 15.5% nationwide and 18.7% in Santiago versus just 5% globally (Bergey, Filipe, Conrad, & Singh, 2018; Caliman, 2008b; De la Barra, Vicente, Saldivia, & Melipillán, 2012). That is why, in addition to ethnographic approximation, we will critically examine the National Mental Health Plan (Ministerio de Salud [MINSAL], 2017) and National Children’s Health Program (MINSAL, 2013) in Chile. Furthermore, this disorder is mostly related to child behavior in school; therefore, we will focus on the Clinical Guide to Attention Deficit for Educational Institutions (Ministerio de Educación [MINEDUC], 2009). This clinical guide for diagnosing and treating ADHD in schools literally indicates that it affects critical areas of the educational institution.

Methods [TOP]

We construct the critical analysis of the aforementioned documents mixing sociological discourse analysis and a genealogical approach (Gordo López & Serrano, 2009). We also use three field notebooks of collective ethnographic observations recorded in three schools during 2017i (Gordo López & Serrano, 2009; Ruiz, 2009, 2014).

In the following sections, we will describe the emergence of what we have called the ADHD Situation. First, using field notes from a collective ethnographic investigation performed during 2017, we describe it as an ongoing process. We then connect it to a broader context by examining the role of the school in contemporary Chilean neoliberal society from a genealogical-affective approximation, trying to avoid essentializing or substantialiting readings. Then, in the second section, we develop this connection further, describing the production of the ADHD Situation through the lenses of epistemology, ethics, economics, and politics. Finally, we will explore what kind of consequences these political changes and this diagnostic model could have for the comprehension of what a community is and for social activism.

The Development of the ADHD Situation: From the Ongoing Process to the Affective Scenario [TOP]

“They Have Something That Doesn’t Exist” or The Fabrication of Evidence [TOP]

One of the first observations that seemed important in our collective discussion about the ethnographies we performed was the apparent evidence of the presence of ADHD. It was surprising and paradoxical because in all three schools, but particularly in the one with the largest School Integration Program (PIE Spanish initials)ii, teachers and other professionals believed that ADHD wasn’t a really existing disease but a name for disorderly kids. But, at the same time, they said to us that it would be completely “evident” which children “have” ADHD and which didn‘t have it. We asked them not to say which children were diagnosed in order to test that “evidence”. Of course, both inside and outside the classroom it wasn’t so obvious who had and who hadn’t been diagnosed. Instead, we formed here our first hypothesis: this purported “evidence” could be a particular manifestation of a larger mechanism, one that could be analogous to the function of what more generally is conceived as evidence in evidence-based medicine and psychotherapy.

Class as Normative Order of the Attentional Flux [TOP]

The function that the idea of evidence fulfils is the positioning of the individualistic point of view as the legitimate one. In a sense, it is similar to what Lahire (2013) or Ehrenberg (2010) show about the supposed return of the individual in sociological theory, to the extent that this could be understood as a point of view of the sociological practice itself rather than a shift in social ontology. This operation could be understood as the core of what we call here epistemological connivance, a non-explicit or even unconscious, i.e., tacit agreement that everything that we can study and intervene in are discrete substances, characterized by their completeness and self-determination (Lordon, 2013). That being the case, it then follows that a child with ADHD is evident because the child is considered “one thing” and the ADHD another. It is the presence of one discrete thing in another that is evident, and the relationships of this admixture with classrooms, classmates, families, and the society, in general, are posited as accidental inconsequential details in the life of the diagnosed child.

As we understand it, the situational approach implies a completely different point of view. If the child with ADHD is supposed to be evident, then we try to follow which elements compose this evidence. We adopt a pre-individual and fluid perspective. From an ethnographic perspective, a class is not an aggregate of individuals, it is at the same time an organic composition and more important for us now, an assemblage of fluxes. In particular, attention acts like a flux.

This statement is not a novelty at all regarding the different ways of problematizing attention. From scientific psychology (Ortega, 2014; Sadek, 2016; Sangüesa, 2012) to economics (Beller, 2006; Citton, 2013, 2014a; Franck & Degoutin, 2013), passing through several approximations from the social sciences (Bergey et al., 2018; Comstock, 2011; Stiglitz, 2006), attention has been understood as a flux. We want to emphasize this in order to avoid the individualization of suffering, even as a strategy to criticize the dominant point of view (Singh, 2013).

Taking account of attentional flux, organizing a class involves a recurring appraisal of what constitutes adequate flux. When does a class start? This question is directly linked to what is tacitly considered as an expected or adequate flux of attention. Of course, a class doesn’t begin with the ringing of the bell. This is a great example of what Goffman and symbolic interactionism call the ‘definition of the situation’, understood as a working consensus about the issues at stake and the corresponding behavior (Goffman, 2006). The agents in the scene need a minimum certainty about what they have and what they can do. Any symbol that we can find in the ongoing situation (e.g. gestures, voices, positions, movements, etc.) can be understood as environmental factors that produce affects which compel agents to perform or not perform an action. In that sense, a class starts when the external signs of attention are mainly centered on the front of the classroom, i.e., on the teacher and the board. We try to emphasize that this is not a conscious reading of the situation. From an observational point of view, this is closer to a “state of body” to paraphrase Bourdieu (1999), in the sense that this is something that various agents seem recognize together, as a body, almost spontaneously.

Nonetheless, anyone who has taught a class once knows that attention is subject to variations. That’s why it is so easy to associate it with flux. At the same time, this implies a variation threshold (Deleuze, 2008) where the presence of other foci of attention is acceptable. The persistence of certain behaviors (e.g., an interruption) or a remarkably violent conduct (e.g., a disruption) mark the limits of an acceptable contest for the expected attentional flux. In that sense, a class constitutes a normative order related to appropriate or adequate flux. The variation threshold is associated with the organic composition of the class itself and, at the same time, with the affective regime in which the school is inserted.

Two Fixations: Name/Behavior and the External Signs of Attention [TOP]

An ADHD Situation emerges from a school-class situation when two fixations are produced. Again, from an observational standpoint, the purported evidence of a child with ADHD is the construction of the evidence itself. As we were physically (and symbolically?) on the opposite side of the room from the teacher, we could observe what was happening literally behind their back, including the circulation of the social workers and other professionals from the PIE inside the classroom.

In classrooms with an average of 40 children, lots of things are happening when teachers are not able to watch the students and make decisions regarding the adequate flux of attention. Even if these "new classrooms" have other adults (PIE professionals), there are many opaque fluxes: whispers, jokes, images (a lot of images in cell phones or similar clandestine electronic devices), rumors, love, sadness, rage, fears, etc. There are also opaque misbehaviors, bodies which are able to stop acting in the exact moment when the teacher turns around and faces the class again. What happens with the evidence of a child diagnosed with ADHD is exactly the opposite. In the midst of a wider situation made up of little misbehaviors, an interpellated conduct is fixed with a name due to a relative inadequacy, a failure to show the external signs of attention in the precise moment where it is required. This could be related as much to a kind of overreaction in relation to an opaque bullying situation or silent collective joke as to the continuation of a conduct beyond the limits of opacity, claiming the attention of the teacher or another adult with authority. Then, as different children said to us, their name would be linked with misbehaviors even if they were just arriving at the classroom or they were not present at all. As far as we can see, what is considered as evidence is basically the reduction of a situation to an individual cause, the misidentification of the relational clash of forces with a substantial causality.

This can lead us into a discussion of the second fixation. As far as we can see, the prevailing exigency is regarding external signs of attention more than a specific academic performance. The presence of the PIE professionals demonstrated this paradoxical situation. On the one hand, we can read in official documents that ADHD impacts the academic performance of children (the declining of which is considered one of the first indications of attentional problems) and that the PIE is a way to integrate students with “special learning necessities” (NEE, Spanish initials), including ADHD. On the other hand, we can observe the everyday intervention of PIE professionals as an attempt to keep the attentional flux inside the acceptable variation threshold, through an individualized and silent relationship with one student diagnosed with ADHD (assistance) or through making loud orders, joining to the teacher in the labor of discipline.

Assistance and discipline work together for the maintenance of the external signs of attention. We talk here in Foucauldian terms, i.e., assistance as a non-authoritarian way to conduct conducts, which implies an emphasis on the preeminence of the benefits for the conducted, and discipline as vigilance associated not only with punishment but also with the further intention of forming bodies able to comply with a norm of conduct (Foucault, 2006, 2012). This means that a micro-social operation is connected to the wider diagram or strategic situation of power where it occurs (Deleuze, 2014; Foucault, 2005). In that sense, we wish to expand the notion of the situation, understanding that those everyday life scenes are deploying within a larger affective scenario related to a historical development (affective genealogies) as much as governmental rationalities (Anderson, 2010; Castro-Gómez, 2015). Particularly in Chile, it seems that the insistence on the external signs of attention, associated mainly with easiness and respect for a clear authority, could be linked to an affective sensation called positional inconsistency (Araujo & Martuccelli, 2011, 2012).

The School in Contemporary Neoliberal Chile: The Anxiety of Positional Inconsistency [TOP]

Araujo and Martuccelli (2011, 2014) describe positional inconsistency as the feeling "that every social position may suffer active processes of destabilization due to the transference of tasks related to the level and quality of their social integration to individuals” (Araujo & Martuccelli, 2014, p. 33), which means that Chilean socio-economic structures compel the individuals to manage collective affairs such as health, education or retirement income on their own. They describe it as “a structural phenomenon of primary importance in contemporary Chilean society” (Araujo & Martuccelli, 2011, p. 164), which at the same time is an effect of structural changes. Thus, the authors stated that the “relational hyper-actor as the modality of the individual in Chile must be put in context” (Araujo & Martuccelli, 2014, p. 33). When individuals are compelled to manage their entire social security on their own, they must become a “relational hyper-actor”, i.e., they need to put themselves in contact with a lot and diverse kind of actors and institutions in order to survive in a society characterized by a constant insecurity and the extreme reduction of the public sector. This comes mainly from the neoliberal transformation initiated by the Chilean civilian-military dictatorship and consecrated and deepened with the return of the democracy. This neoliberal transformation demonstrates a profound ambiguity, varying between the destruction of institutionalized social solidarity and the (contradictory) expectation of the democratization of society (Araujo & Martuccelli, 2014). Nonetheless, we think that it could be useful to think about it not only as an effect but also as an affect.

As we said before, affects imply a pre-individual reading, another dimension of social reality one might say. From our point of view, the so-called positional inconsistency is not a consequence of some changes that occurred in the past, rather, this past is a force still working in the constitution of structural and personal relationships. The map here is different; we don’t have human actors facing structural challenges, we have bodies in the middle of affects and affective environments. In that sense, this economic and political legacy is constantly mobilizing historical bodies in different directions, contrasting with the idea of individuals as a production of institutional interpellations (Araujo & Martuccelli, 2014). In a certain way, there is no individual as a product, but relations of singularization, i.e. singular social folds (Lahire, 2013).

The main difference from an individualistic approach is that the relationship with the past is not a causality, one which produces and interacts with substances (individuals or institutions), but a force still insisting and acting at each and every moment. On the one hand, we have the contemporary composition of the Chilean school, in the midst of a generalized anxiety about education as almost the only way to avoid poverty (Radiszcz, 2017b; Sir, 2016). And, on the other hand, we see a very close connection between the expectations of democratization and the development of new information and communications technologies, mainly in the 1990’s (Mayol et al., 2013). We try to show this in the first draft of an ADHD map (Figure 1), as neoliberal exigencies and rhizomatic connections.

Figure 1

Building an ADHD map.

With this figure, we aim to establish that the main forces named above (expressed here as “neoliberal exigencies” and “rhizomatic connectivity"), act on different areas of the ADHD situation. Family, school, teacher, and child exist in the midst of affective-historical forces. At the same time, each singularity inclines the affects in diverse ways: with openness, restriction, exigencies, and expectations. The neoliberal exigencies imply, as we said, the necessity to manage individually the affairs related to health, education, retirement, etc., which will force very long working days but given the low incomes, it will produce high rates of private debt. At the same time, Chilean integration in the globalization as an open-market country imply a deep impact of technologies in everyday life, concerning what we called rhizomatic connectionsiii, making possible to think in new ways to make profitable what is built as an attentional deficit. Between a social reality with a lot of pressure in individual lives and with a fluid use of new technologies, the bodies of children seem to be crossed by a paradoxical order, which forces children to have a highly still body in a time of increasing mental stimulation. This is critical for children and their families due to the position of the school in Chile.

Given the lack of social solidarity in contemporary Chilean institutions, education becomes the only legitimate way to avoid poverty, in accordance with the consolidation of meritocratic discourse during the 90’s (Araujo & Martuccelli, 2012; Barozet, 2006; Mayol et al., 2013). This implies a restrictive and individualized approximation to life in society, and it has been at the center of the politicization of social malaise, as arose in the student protests, first in 2006 and then in 2011iv (Mayol et al., 2013). This anxiety is expressed at the institutional level, too. Here, the school itself (and, of course, the university) is increasingly pushed to meet a wide range of performance indicators, including “inclusion indicators”. Thus, ADHD, as a special learning necessity (NEE), is currently a way to generate economic resources for impoverished schools via PIE (Radiszcz, 2017a, 2017b).

The epistemology behind school measurement via benchmarking and market standardization has a high elective affinity (Weber, 2002) with the individualized conceptualization and governmental management of society (Foucault, 2006). It compels families to be extremely careful about their choices regarding childhood education and to intensely surveil childhood behavior, in order to give children individual weapons for social competition and survival. Thus, children themselves feel the obligation to focus their attention, trying to accomplish the required posture (external signs). This exigency introduces limits to their imagination about various ways to produce themselves materially and symbolically. Feelings of guilt and indebtedness to their parents are combined with the intention to be considered a non-problematic child.

That’s why the deficit of attention is mainly understood as a failure which must be repaired. Even when it is considered, by some researchers, as a different cognitive style (Aboitiz & Carrasco, 2009; Aboitiz et al., 2006), or when some organizations of parents of children diagnosed with ADHD express that this is a different way to be human, ADHD is still linked with the possibility to make this difference profitable and, in that way, non-problematicv. Children seem to have two alternatives: normalize, through therapies, what is constructed as their deficit or use it as a productive trait, i. e., utilize inattention as a particular form of creativity to incorporate into specific areas of the labour market in the future, related to a kind of attention useful according to the new demands of the rhizomatic technological connections. In both cases, this seems to be stimulated by an active quest to stop being problematic. This affective search for being non-problematic is interesting because, in a certain way, it allows us to think of a bond between the discourse of failure associated with ADHD diagnoses (with the following stigma) and the discourse of gift, privilege or hidden potential (Radiszcz, 2017b). This spectrum between failure and gift as a hidden potential is also associated with the main trends in the way as current neurosciences based therapies understand human being and its relationship with the profitability of differences instead of just its normalization (Ehrenberg, 2018). In ethnographic conversations with children taking ADHD pills, we did identify a strategic dimension linked with a regularization of academic performance, which means improvement to a high enough level to avoid further problems. They did not seem to pursue outstanding scores nor a kind of general optimization. They were, however, generally more concerned about their family’s expectations and efforts on their behalf

The possibility to be responsive to and fulfil family ideals is a constant fight against what Juguetes Perdidos (2014) calls “totalitarian precarity”vi. These efforts are focused on the school and educational performance because it seems to be the only legitimated way, not even to be successful, but just to not be poor. From the affective standpoint, the situation is also composed of historical forces, not as a causal relation, but as a constant mobilization of bodies and institutions. We can now map the more general link between the moral, biological and economic factors contributing to the ADHD Situation. In doing so, we try to rethink the possibilities for a militancy at the border of and outside the academy, and beyond a reified notion of community.

Attention Disorder: Epistemology, Politics, Moral Order [TOP]

The Values of Attention [TOP]

A certain epistemological connivance links the anthropological imagination of neoliberalism, the normative exigencies of the school, family expectations, child behavior, and the guilt associated with these efforts. This connivance is related to a universe of delimitated individuals, substances, mechanical interactions, and causal relationships. This epistemological frame is also manifest in the way that the notion of community appears in official documents. The following quote from the last Chilean Mental Health Plan (2017) illustrates correctly what the problem is:

The Integral family health model as much as the community-based mental health model understand health as a social good and the health network as the coordinated action of the service providers’ network, the organized community, and intersectorial organizations. Both models – states the official document – stimulate a modality of relationship between the health team members and people, their families, and the community of a territory where i) people are in the center of the decision making process; ii) people are recognized as members of a diverse and complex socio-cultural system in which the members are healthcare assets (MINSAL, 2017, pp. 37–38).

Of course, this notion of community shows ambiguity. It doesn’t appear only as a determinate substance, it is also associated with adjectives like "organized", referring to the inner, creative power of the neighborhood. In another part of the text, community is linked with intervention practices, composing an even more dynamic concept. The complications begin when the “models” are discursively applied in concrete situations. In these moments, “people”, “family”, and “community”, for example, seem to be clearly distinct realities or substances, reducing all the acknowledged diversity and complexity to mechanical relationships between clearly distinct elements. This makes it more difficult to read what is going on within the borders of those apparently discrete, uniform elements, including by the organizations trying to intervene in a given community.

As we stated above, what is considered evident is, in fact, the result of the construction of that evidence, a process which is immediately disavowed, which masks itself through its very operation. That’s why the mere notion of evidence is often associated with relatively violent practices of exclusion of other kinds of knowledge, including others’ ways to understand what evidence is. In Chile, in particular, it has been acknowledged that the communitarian modality of inclusion in various public policies from the 1990’s to the present, has signified a confrontation between the “political dimension of social-communitarian psychology (PSC, Spanish initials), represented by concepts such as emancipation, autonomy, and citizenship [and] paternalistic public assistance programs, social control, and dependency” (Wiesenfeld, 2014, p. 12). In a certain way, the epistemological suppositions and logic underlying neoliberal public policies define the contours of possible interventions, but never exhaust the assemblage of forces that constitute a given situation. A careful reading of the internal complexity of the discrete substances involved and their interrelation is required. The notion of situation, utilized in our analysis of three educational programs, avoids exploring the relations between the “thing” (kids, for example) and its context (the school or the home).

The clinical guide elaborated for the Ministry of Education (MINEDUC, 2009) states, according to the psychiatric description of the disorder, that the problematic behavior occurs in two or more contexts or situations, indicating a given conduct is manifested in certain situations and not in others; it has a substantial and independent existence. The description of ADHD in that clinical guide was made following the DSM IV indications (American Psychiatric Association, 2001) which states that the disease can develop before the age of 7, whereas in the more recent DSM V it cannot develop until the age of 12 (American Psychiatric Association, 2014). The document establishes that this disorder troubles abilities crucial to successfully navigating educational institutions, those concerning the capacity for self-control and adaptation to immutable rules, both explicit and implicit. Even if the clinical guide does acknowledge the existence of cultural differences in the manifestation of the disorder, it also offers the following list of culturally-independent “frequent associations”: i) Short attention span, with great susceptibility to distraction by any stimulus; ii) Hyperactivity and uneasiness linked to excessive levels of energy; iii) Difficulties following instructions; iv) Rash actions to reach something without evaluating the consequences; vi) Impulsive corporal, emotional, verbal, and cognitive behaviors“ (MINEDUC, 2009, pp. 12–14).

If we follow this practical description, as a description intended for application in schools, we find some affective links that the epistemological connivance tends to hide, especially in the aftermath of the diverted conduct when the given attention problem involves a problem with obedience. The ADHD Situation emerges in the middle of the diagram in Figure 1 (Deleuze, 2014). As a representation of the composition of the strategic situation (Foucault, 2005), it describes the encounter of multiple and heterogeneous forces. In this perspective, what actually emerges as a problem and a valuevii within this disorder is attention itself.

Attention as a moral value has a long history that we cannot widely cover here, but we can briefly highlight its links with diverse epistemological matrices. From the XVII to the XIX Centuries, philosophers first and then psychologists were concerned about the problematization of attentional problems. Here we can find different projects and models in competition trying to define what is the problem when we are talking about attention (Caliman, 2008a, 2008b, 2012). Attentional problems were associated, for example, with the development of the Will and also with a capacity that we can train in order to increase our power as human beings, among other perspectives. Following Caliman (Caliman 2008b, 2012), between the XVII and XVIII Centuries, attention was considered as an intrinsically mobile capacity, even in that time an excessive attention in just one kind of activity could imply a health problem both for children and adults. At the same time, attention was defined as a capacity that could be mastered. Later, between the XVIII and XIX Centuries, feelings and emotions were considered as problems that impeded a more focused attention, and the ability to focus one’s attention came to be conceived as an adaptive issue.

According to Caliman (2008a), it was between the end of the XIX Century and the beginning of the XX Century when a strictly neurophysiological model was developed. The problem with attention since then will imply a failure of inhibition, meaning a certain excess of movements. In other words, a disturbance of the civilizing process in Elias’ sense (2010): an error, a failure in self-discipline, which means at the same time an adaptation problem (Stiglitz, 2006). In spite of the emergence in the middle of the XX Century of various critiques against this monolithic scientific discourse, at the beginning of our current century Caliman (2008a) identifies the rise and consolidation of what she calls a “new attentionism” strictly attached to the neuroscientific and biological discourse (Caliman, 2008a, p. 643).

We are not trying to reintroduce a simple dichotomy related to neurosciences, painting it merely as a “bad” point of view. Instead, we follow Malabou (2017) in trying to perform a closer reading of this new discourse about psychic suffering. The problem appears when the possibilities of an insubstantial materialistic approximation to the brain is reduced to a substantial and mechanic causality. And this is what seems to happen with most of the politically useful approaches of psychiatry and neurobiology in the post-(neo)liberal era. Thus, new attentionism tends to naturalize and biologicize the moral discussion related to the adequate training of attention, and in so doing depoliticizes the new attentional exigencies and affective demands linked with the affective and political genealogies of the contemporary era (Caliman, 2008b, 2010, 2012).

This conceptual problem seems to permeate and influence the action of so-called civil society, too. Indeed, as in other mental health diagnoses, ADHD organizations, families, and individuals frequently pursue a clearer diagnosis, even if they want to say that ADHD is not a disease but an alternative way of thinking or behaving (Bergey et al., 2018; Stiglitz, 2006; Zepf et al., 2017). As a result, some of them are developing a kind of “evidence-based activism” (Rabeharisoa, Moreira, & Akrich, 2014). The problem with this kind of activism is that the search for a more precise medical diagnosis could restrict a broader perspective, reinforcing the biological perspective of the new attentionism. Instead, we want to stress the importance of the intensification of what could be understood as errors or failures, in order to map in a better way what is happening in our current time through “individual” symptoms.

Performance: Attention, Adaptation, Obedience [TOP]

This diagram that describes where ADHD is deployed could be better understood if we follow the critical reflection on the attention economy (Beller, 2006; Crary, 2014), linking it with a genealogy of ADHD (Caliman, 2008a, 2008b, 2010, 2012; Comstock, 2011). On one hand, we have the moral problem of disciplining the Will and the naturalization of the association between certain behaviours and the brain. These converge with the economic shift of the 1970’s, adding an economic/structural dimension to the attention problem and situating it, specifically, in the midst of so-called cognitive capitalism or semiocapitalism (Berardi, 2003; Fumagalli, 2010). We can find an archaeological trait in Simon’s work (1969) that is relevant to the new economy and to organizations that are characterized by the importance of information gathering and processing machines. He stated that in an information-rich world, attention becomes scarce, and therefore it becomes necessary to carefully manage its focus inside organizations. Nonetheless, it wasn’t until the 1980’s and 90’s, with the spread of cybernetics and the internet, that this became a clearly relevant issue (Celis Bueno, 2017). Even a complete theory on the economy of attention emerges (Beller, 2006). At first it was associated with attention in publicity and at the point of consumption (Jhally & Livant, 1986) But now, in scientific psychological experiments and neurobiological theory, attention itself becomes a valorising activity (Aboitiz et al., 2006; Celis Bueno, 2017; Citton, 2014a, 2014b; Ortega, 2014).

Even more interesting is that attention can be profitable, both through therapies or pills designed to increase focus on determined activities, as well as through the exploitation of what is conceived as diverse cognitive styles associated with creativity, in the sense of a hidden potential (Mollon, 2015; Sangüesa, 2012).

As Caliman (2010, 2012) shows, the moral problematization of attentional conduct was always associated with what is understood as obedience. That idea is not so far removed from what we could observe inside the classroom, where assistance and discipline converge to produce obedience as manifested through external signs of attention. Nowadays, the moral problem of obedience converges with a simplistic appropriation of new discoveries about brain functioning, producing the naturalization of new attentionism. Given the underground epistemological connivance, this biologization remains uncontested by both governmental programs and mainstream organizations that work on ADHD. This seems to align with a whole range of understanding that regards attention as a potential source of profit, since the need to focus it, on the one hand, and the celebration of wild and unpredictable cognitive styles on the other, contribute to the ideological and material maintenance of capitalistic accumulation. Precisely here, facing this description which tends to close on itself, the power of the symptoms seems to be relevant; we should instead follow the diverted conducts to contest this new kind of uniformization (Liebert, 2017).

The Power of the Symptom: Activism in the Permanent Crisis [TOP]

This map is a work in progress; it will probably always be unfinished. Connecting apparently distant realms, behavioral problems in school could reveal some unexpected relations with the uses and problematizations of attention in society at large. What exactly are the children adapting and/or resisting adapting to? Given the “totalitarian precarity” of and the anxious place occupied by Chilean schools, the prevalence of ADHD seems to be related to the use of mental health diagnoses as a way to simultaneously collectivize and depoliticize individual discontent (Ehrenberg, 2010), associated with the chronification of the crisis of political imagination in Chile and the world.

At the same time, the biologization of the new attentionism could be understood as part of our biohistory, where man might modify “life itself” with his knowledge, even in unwanted ways (Foucault, 2005; Rose, 2012). Here is where our new politics and scientific maps should follow carefully the diverted conducts, avoiding reified external readings. That’s why ontology is really important for political activism. As Rabeharisoa et al. (2014) show: the production of knowledge itself has become part of the struggle. In a certain way, the organizations fighting for more precise definitions of their malaise and for the recognition of their own experiences generate 'experiential knowledge' capable of contesting official knowledge and reconstructing medical frameworks (Rabeharisoa et al., 2014, p. 120). Nonetheless, they remain by and largely unable to include social conflict in their schema for knowledge production (Rabeharisoa et al., 2014, p. 126). This evidence-based activism seems to derive from a kind of militant activism for itself, searching for recognition and greater visibility of their own disorder. It thus becomes essentially a form of struggle for a depoliticised, better diagnosed, and more livable medical condition. However, “a politicised collective illness identity can emerge when people's understanding of their condition contradicts the ‘dominant epidemiological paradigm’ of the illness perpetuated by medical, scientific, and government institutions” (Edwards, 2014, p. 54).

We suggest, then, that following the power of symptoms could imply the intensification of the contention between medical knowledge and experiential knowledge, and through this contest redefine the boundaries of the politicisation of this ‘collective illness identity’. An activism in the midst of crisis must resist a substantialist ontology, in order to be able to draw affective maps which allow us to regard the power of diverting intrinsic to the symptom as a possibility to explore new imaginable arrangements, resisting the post-liberal era as a “war on the imagination”, to paraphrase Liebert (2017).

This is particularly important given that the lack of political imagination on the left (Keucheyan & Elliott, 2013) results in a remarkable difficulty to read what is going on in a non-representational dimension. Thus, as a methodological exercise, following what escapes from a given diagram, the error in the form of a symptom, has sociological, psychological, and political relevance. And, particularly, tracing the emergence of the ADHD Situation back to the diverting behaviors, allows us to link these with the moral, biological, and economic problematization of attention itself. This work continues now following the persistence of the behaviors inside and outside institutions and along the trajectories of actually lived lives. In so doing, we hope to delineate -in cooperation with people, families, and organizations- new cartographies of the modalities of dealing with the physical and cognitive exigencies of contemporary Chilean neoliberalism, helping in this way to develop a militant knowledge on the edge of the academy, and beyond inside-outside and intellectual-anti-intellectual dichotomies.

Notes [TOP]

i) The ethnographic observation was performed during 4 months in 2017 in three diverse schools in Chile: A private, a public, and an alternative one.

ii) According to official documents PIE is a inclusive strategy to students with Special Educational Needs, based on the “medical view of the difference” (Torres, 2013, p. 127), working with precise medical categories. Since 2009, through this program, schools with a determined number of PIE’ students obtain a special public subside (Radiszcz, 2017a).

iii) We utilize the concept of rhizomatic for 2 main reasons. First, because the new technologies impact producing a world densified with many dimensions at the same time (e.g. when children are in the classroom and at the same time they are chatting, playing and sharing things with people in different parts of the world). And, second, because the impact of technologies are not only associated with specific areas of the economy, instead, it rebuilt the way to do things in a broad sense, affecting several areas from art to precarious employment, trought the entrepeneurial discourse. See (Deleuze & Guattari, 2002)

iv) During 2006 the biggest protest since the return of democracy exploded. It was conducted by high school students mostly, and came to be known as the "Penguin Revolution" because the school uniform used by most primary and secondary school students in Chile resembles a penguin’s “suit”. The protests included street demonstrations and the occupation of numerous school buildings. Their principle complaints had to do with the inequity of the Chilean educational system alongside the maintenance of the juridical legacy of the dictatorship in education. In 2011, mostly the same generation, now slightly older, occupied the universities, this time raising their demands to include an end to for-profit educational institutions. Chile has one of the most expensive and segregated educational systems in the world. For further details: (Domedel & Peña y Lillo, 2008; Mayol, 2013; Rodríguez & Tello, 2012).

v) The majority of ADHD organizations in Chile try to give advice about the most effective and harmless therapies, linked with the core idea that having this diagnose is not “necessarily” a disease. In an informal interview with a member of the mental health organization “Locos por nuestros derechos”, they said to us that the current ADHD organizations are not really politicised. Moreover, there are few of them and they are mainly online virtual communities.

vi) In the vein of (López Petit, 1996), (Berardi, 2014), or (Lorey, 2016), the Argentinian collective understands precarity as an existential condition, and also an affect that mobilizes bodies in heterogeneous contexts and scenarios.

vii) Both in the economic and the moral sense.

Funding [TOP]

Programa de Apoyo a la Productividad Académica en Cs. Sociales, Humanidades, Artes y Educación, Vicerrectoría de Investigación y Desarrollo, Universidad de Chile.

Concurso Fortalecimiento de Productividad y Continuidad en Investigación (FPCI), 2017, Facultad de Ciencias Sociales, Universidad de Chile, Proyecto "Trayectorias de malestar en niñas y niños diagnosticados con TDAH: experiencia subjetiva y social de un sufrimiento multiforme".

Concurso Redes Internacionales entre Centros de Investigación (CONICYT), 2017, REDES 170095 “Disruptive behaviours in childhood: a comparative perspective between Europe and Latin-America - Laboratorio transdisciplinar en prácticas sociales y subjetividad (LaPSoS)”.

Competing Interests [TOP]

The authors have declared that no competing interests exist.

Acknowledgments [TOP]

The authors want to acknowledge to the complete LaPSoS team for the interesting and encouraging dialogues. Of course, any mistake or omission is the responsibility of the authors.

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