Sigh. This again? I’ve written before about documentaries that portray psychiatric medications in a problematic way that tends to promote stigma (A Prescription For Murder and Stigma and the Pathologization of Normal). Now Netflix has come out with Take Your Pills, which looks at the use of stimulant drugs like Adderall and Ritalin for mental performance enhancement.
I started watching this documentary and gave up in disgust. But after I read a critique by Mental Health: Let’s Stamp Out the Stigma, I decided it was important to speak up about it, and to do that I thought it was important to give it another go and watch the whole thing. While a somewhat more balance perspective was conveyed when I watched the film in its entirety, I was still left with a lot of concerns.
The documentary describes psychostimulants as a tool for cognitive enhancement, enabling people to get an academic or career edge, get higher grades, perform in a way they perceive as ideal (particularly in the tech and finance sectors), do more detail-oriented work, and control weight. Medications like Adderall are described as enabling people to “get to perfect” or be “jolted back to life”. One psychologist says that these medications prime people to to expect that a pill will give them what they want. A researcher who was interviewed jumped on the bandwagon, saying he’d tried Ritalin once and it felt like “such an enhancement of my day; it was a good experience”, something it strikes me as irresponsible to say when being interviewed as an expert on the topic.
A university student said that her parents told her she should get a lockbox for her stimulant medication. “It’s RX gold” she said, adding “I don’t think I know anyone who’s prescribed it who doesn’t sell a little on the side”, and “everybody takes Adderall.” One male interviewed said that as a millennial who went to a great college and worked in finance, “it’s impossible to avoid stimulants”, and loopholes would be found and taken advantage of in order to obtain them.
Taking stimulants to be more productive was documented as early as the “pep pills” of the 1930’s. ADHD was described as something that developed out of the marketing of stimulant medications as a way to improve children’s behaviour and grades. The documentary explains that more children are diagnosed with ADHD in the United States than in any other country in the world, and the majority of them are medicated. The implication was that ADHD was a mostly artificial condition created by drug companies’ marketing campaigns. This is certainly not the first time I’ve seen this logical fallacy; misleading advertising does not invalidate the medical condition just because they falsely suggest that everyone suffers from it.
Serious side effects such as addiction are mentioned but the film doesn’t do a good job of contextualizing this as an individual risk vs benefit decision. A political theorist interviewed suggested that stimulants blunt the human experience and creativity (I’ll just say that a PhD in one field does not qualify someone to speak as a subject expert on an unrelated field). One student believed her stimulant medication made her more boring and angrier. These examples provide a very limited context by which to judge the appropriateness of these medications.
A psychotherapist featured in the film said that “just like opiate painkillers are heroin in a pill, ADHD medicine is a very small dose of meth in a pill.” A psychologist suggested that as a society we make a false distinction between licit amphetamines and illicit methamphetamine, and pointed out the chemical similarity of prescription amphetamines and illicit methamphetamine (which has an added methyl group consisting of 1 carbon and 3 hydrogen atoms). To me this was an astonishing display of ignorance from someone whose doctorate in psychology doesn’t necessarily necessarily confer expertise in medicinal chemistry. You know what also differs by a single methyl group? The ethanol that you find at a liquor store and the poisonous methanol that’s in the antifreeze and can kill desperate alcoholics looking for a fix, including a former patient of mine. Never mind a full 4-atom methyl group, think of what happens when you throw a few subatomic neutrons on an atom and create a radioactive isotope. One need only look so far as Wikipedia, which points out that, “unlike amphetamine, methamphetamine is directly neurotoxic to dopamine neurons in both lab animals and humans”; this statement is backed by 3 references from scientific journals.
I cheered a little inside my head when one student who was interviewed expressed concerns about people saying things like “everyone has a little ADHD”, as this delegitimizes the actual illness. Another student with ADHD had chosen to go off of Adderall, even though his mother believed he likely wouldn’t have made it through high school without it. It appeared from the documentary that those with a genuine medical need were actually the most reluctant to take medications.
In a study of college students without ADHD, using Adderall didn’t lead to objective improvements in cognitive performance, but participants did report a subjective sense of performance improvement. A journalist interviewed in the film said that “what you have here is a dynamic of not only people using what is, you know, a dangerous drug… but you also find a bit of an arms race building up where if enough people see that their competition is doing it, they feel like they kind of have to do it too.” The societal pressure to always be competitive and outperform others is well worth exploring, but to me that got lost in the focus on stimulant medications.
I freely admit my own bias viewing this documentary, as I take Dexedrine (dextroamphetamine). I first started taking it for significant psychomotor retardation (slowing of movement and thoughts) that I experienced as a symptom of depression. When that resolved, I cut down on my Dexedrine dose, and my mood worsened. I’ve tried a few more times since then to cut back the dose, and it’s become clear that it’s definitely having a beneficial effect on my mood. My doctor is very comfortable keeping me at a dose of 10mg in the morning and 5mg at noon because it is obviously having a therapeutic benefit. I don’t feel “high” from it and never have. Dexedrine isn’t enough to fully compensate for the cognitive slowing and low energy I experience with depression, and my overall cognitive performance and energy level remain lower even while on Dexedrine than they are when my depression was previoulsy in remission.
So when Netflix portrays my medication as either a performance enhancer or a legal version of crystal meth, it does not sit well with me. There is already so much stigma against mental illness and psychiatric medication, and this sort of messaging is not helpful. There was a really valid point buried underneath the performance-enhancing pill-popping message, and it would be great to see a documentary that truly addresses the issue of societal hyper-competitiveness. Unfortunately Netflix missed the mark.