Current dissertations

Institute of History, Ethics and Philosophy of Medicine

Doctoral candidate

Nadja Struß

Title of the dissertation

ADHD - Genealogy of disorder concepts and the establishment of pharmacotherapy in Germany: a historical discourse analysis

Abstract

Attention-deficit/hyperactivity disorder, AD(H)S for short, is one of the fourth most common diagnoses in child and adolescent psychiatry. Potent drug therapies are available for the treatment of motor hyperactivity and attention problems, which can lead to an improvement in symptoms for the majority of those affected. The oldest drug approved for this indication is the centrally acting indirect sympathomimetic methylphenidate, which was launched on the market in 1955 as Ritalin (C) by the pharmaceutical company Ciba-Geigy (now Novartis Pharma) as a treatment for mild depressive mood. In the 1960s, the first studies were published that reported impressive efficacy of methylphenidate in children with so-called "minimal cerebral dysfunction" (MBD) - the historical precursor of AD(H)S. In 1970, the indication for Ritalin was extended to MBD. As early as the 1960s, the disorder concept of "minimal cerebral dysfunction" was criticized by scientists, as the term suggested a brain dysfunction as the cause of hyperactivity, for which there was, however, no solid evidence. The introduction of stimulants as a drug therapy expanded and intensified the controversy. At the heart of the debate were concerns about medicalization: were patients being offered medical solutions to social and family problems and learning disorders? Was this effective and ethically justifiable?

The analysis is intended to show how the pharmacotherapy of children with behavioral problems was handled, perceived and discussed by experts and the public in Germany. The discourse in the GDR is considered separately, as it had its own pharmaceutical industry. What were the similarities and differences in the discourse in the FRG compared to the GDR? What concerns were there, who were the supporters and who were the opponents of this therapeutic approach? What could have been the reasons why the number of stimulant treatments has risen sharply since the end of the 1990s despite the previously discussed concerns? Material: The source material will be articles published in specialist journals, book publications and reports from the public media in the FRG and GDR, which will be searched for relevant content using keywords. The keyword list is supplemented during the research (snowball principle) until theoretical saturation is reached. The search is carried out digitally in scientific databases, library catalogs and archives as well as manually for non-digitized media.

The analysis of the source material is based on Michel Foucault's discourse theory: discourse produces its own reality, whose set of rules woven by power structures orders the discourse. A discourse analysis attempts to identify the actors of the discourse and to grasp the fields of sayability they create. The statements within the discourse are summarized into discourse positions in order to create a picture of main and counter-discourses. Suggestions for the practical implementation of qualitative discourse analysis in general are taken from Siegried Jäger and historical discourse analysis in particular from Achim Landwehr.