University of Alberta Reading Disorders of Inattention and Hyperactivity: A Normalization Project by Gregory James Bowden A thesis submitted to the Faculty of Graduate Studies and Research in partial fulfillment of the requirements for the degree of Doctor of Philosophy Department of Sociology ©Gregory James Bowden Spring 2012 Edmonton, Alberta Permission is hereby granted to the University of Alberta Libraries to reproduce single copies of this thesis and to lend or sell such copies for private, scholarly or scientific research purposes only. Where the thesis is converted to, or otherwise made available in digital form, the University of Alberta will advise potential users of the thesis of these terms. The author reserves all other publication and other rights in association with the copyright in the thesis and, except as herein before provided, neither the thesis nor any substantial portion thereof may be printed or otherwise reproduced in any material form whatsoever without the author‘s prior written permission. For Alison Abstract Attention-Deficit Hyperactivity Disorder (ADHD) is one of the most common psychiatric diagnoses in children. It and its antecedents have received sociological focus since the 1970s, in studies of how diagnosis and subsequent interventions serve to manage deviant behaviours, as well as accounting for experiences of a diagnosis whose legitimacy has been consistently questioned. Taking methodological cues from Michel Foucault‘s exploratory endeavours, this dissertation aims to provide some clarity on sociological conceptions of disorders of inattention and hyperactivity and their relationship to other authoritative claims about such disorders. Sociological explanations of these disorders remain in tension with claims from clinical research about these disorders as objective entities as well as with skeptical claims from popular literature which deny the existence and legitimacy of such disorders. Relying on English-language textual material from the NEOS Library Consortium, focusing on the period 1970-2005, this research examines a deep and broad corpus of statements made about such disorders. By providing a close reading of programmatic texts, and by engaging in critical reflection on their entangled use of descriptive, evaluative, and prescriptive claims, this work obtains some conceptual clarity about descriptions of the mechanisms which pathologize measurable differences among individuals. This work also provides some clarity on what sorts of sociological objects disorders of inattention and hyperactivity might be. Invoking work in the philosophy of health and illness, it concludes that one can grant the existence of disorders of inattention and hyperactivity, but on the grounds that disorder is a social fact and not reducible to physiological explanations. Furthermore, the discursive analysis provided is additional evidence in support of the claim that medicine is an institution of socialization. Treatments for these disorder aim at establishing proper behavior through the individualization of conduct. Alongside any direct manipulation of bodies and minds which occur, interventions for these disorders constitute power relations as Foucault described: the modification of the behavior of others at a distance. The goal of interventions is to modify the behavior of others at the same time as making them responsible for that altered behavior, consequently integrating them into a political economy of rule-following. Acknowledgment If a sociological imagination, as C. Wright Mills upheld, allows one to locate personal difficulties within interpersonal structures, the same awareness also allows one to situate personal accomplishments within the efforts of others. I have the privilege of recognizing the relationships which sustain this work. From the beginning my ambition to make a sociological contribution covered a lot of terrain. Charles Barbour‘s patience and encouragement meant that in the process of thinking my way into and out of questions, those questions became a specific project. Charles taught the lessons of how to write for an audience with care and consideration, and has been a singular and indispensable example of how to be a considerate audience and interlocutor in turn. Thanks Charles. Amy Kaler, Harvey Krahn, and Erika Dyck provided careful reading and challenging questions. Their expertise was useful not only in discussing what the project speaks to directly, but how I might connect this research to that in other fields, with those exercising other methods. My parents, Keith and Linda, have been unfailing with their continuous and generous support. My partner, Alison, has been dependable and caring throughout this work, providing reassurance and enthusiasm during the extended processes of reading, writing, and editing. I would like to thank the examiners for reading and responding to the dissertation, for their participation in the important examination process. The University of Alberta and its Department of Sociology have been instrumental in achieving the goals of this research through the provision of indispensable resources. Finally, I thank the Social Sciences and Humanities Research Council for awarding a valuable Doctoral Fellowship which enabled the production of the research contained here. Table of Contents Chapter 1: Introduction and Context .................................................................. 1 Introduction to the Research Project .............................................................. 1 Curiosity: ADHD and Dilemmas of Interpreting Behavior ....................... 1 The Sociological Analysis of ADHD ......................................................... 4 Research Question ...................................................................................... 6 The Structure of This Dissertation ............................................................. 7 Disorders of Inattention and Hyperactivity: Context ....................................11 Part I: What Is ADHD? .............................................................................11 Part II: Historical Context ........................................................................ 16 Chapter 2: Method - Discourse ........................................................................ 27 Introduction to Discourse ............................................................................. 27 The Research Question ................................................................................ 27 Why Discourse Analysis? ............................................................................ 29 Discourse Analysis and ADHD .................................................................... 30 The Turn to Foucault .................................................................................... 33 The Archaeology of Knowledge .................................................................. 37 What Material and Why? ............................................................................. 42 The Object of Study ..................................................................................... 47 Two Methodological Objections .................................................................. 47 Chapter 3: ADHD and Disorder ....................................................................... 51 Introduction: What is ADHD? ..................................................................... 51 I: Is ADHD Real? ......................................................................................... 52 A Variety of Claims .................................................................................. 52 Physiological Explanations ...................................................................... 54 Sociological Approaches .......................................................................... 58 Philosophy of Defining Disorder ............................................................. 61 Peter Sedgwick ......................................................................................... 66 Definitions of Disorder in Practice .......................................................... 70 II: The Analysis of Consensus Statements ................................................... 71 Consensus Statements .............................................................................. 71 The Question of Validity .......................................................................... 73 HDA and the International Consensus Statement on ADHD ................... 74 Analysis of The Consensus Statement ..................................................... 77 Conclusion ................................................................................................... 86 Chapter 4: The Problems of ADHD: Disvalue, Disruption .............................. 92 Problems of Inattention and Hyperactivity .................................................. 92 Hyperactive Bodies ...................................................................................... 93 Descriptions of Hyperactivity .................................................................. 93 Definitions of Hyperactivity .................................................................... 95 Measurement of Hyperactivity ................................................................. 98 Subjects Out of Control .............................................................................. 104 Excess Energy .......................................................................................