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.
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 (
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 (
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” (
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 (
We construct the critical analysis of the aforementioned documents mixing sociological discourse analysis and a genealogical approach (
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.
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.
The function that the idea of
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 (
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 (
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
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 (
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 (
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 (
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 (
The epistemology behind school measurement via benchmarking and market standardization has a high elective affinity (
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 (
The possibility to be responsive to and fulfil family ideals is a constant fight against what
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 (
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
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” (
The clinical guide elaborated for the Ministry of Education (
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
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 (
According to
We are not trying to reintroduce a simple dichotomy related to neurosciences, painting it merely as a “bad” point of view. Instead, we follow
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 (
This diagram that describes where ADHD is deployed could be better understood if we follow the critical reflection on the
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 (
As
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 (
At the same time, the biologization of the new attentionism could be understood as part of our
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
This is particularly important given that the lack of political imagination on the left (
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)”.
The authors have declared that no competing interests exist.
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.
The ethnographic observation was performed during 4 months in 2017 in three diverse schools in Chile: A private, a public, and an alternative one.
According to official documents PIE is a inclusive strategy to students with Special Educational Needs, based on the “medical view of the difference” (
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 (
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: (
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.
In the vein of (
Both in the economic and the moral sense.