What the Rise of Ritalin Says About Views of Children's Behavior

Show: FRESH AIR
Date: SEPTEMBER 10, 1998
Time: 12:00
Tran: 091001np.217
Type: FEATURE
Head: Arthur Sze
Sect: News; International
Time: 12:06

BARBARA BOGAVE, HOST: This is FRESH AIR. I'm Barbara Bogave in for Terry Gross.

In a typical poem by Arthur Sze you might read about Buddhist monks carrying fax machines, the physics of redshifting, mushroom hunting in the mountains of New Mexico, or a child in Hong Kong drinking Coke out of a formula bottle, who has all her teeth capped in gold.

The poet Carolyn Kaiser (ph) says of his work that: "Arthur Sze possesses the gravity of the great Chinese poets, as well as the levity of a Japanese Zen master."

In his writing, Sze draws on his many cultural influences. He's a second-generation Chinese-American who lives in New Mexico, where he teaches creative writing at the Institute of American Indian Arts.

He's also known as one of the foremost translators of Chinese poetry in this country. His new book "The Redshifting Web," is a collection of his poems from 1970 to the present. I asked Arthur Sze to read an excerpt from his poem called "The String Diamond."

ARTHUR SZE, POET; AUTHOR, "THE REDSHIFTING WEB: POEMS 1970-1998":

An apricot blossom opens to five petals
You step on a nail and even as you wince
A man closes a mailbox
A cook sears shredded pork in a wok
A surgeon sews a woman up but forgets to remove a sponge

In the waiting room
You are staring at a diagram
And sense compression of a nerve where it passes
Through the wrist and into the hand
You are staring at black and white counters
On a criss-crossed board
And have no idea where to begin

A gardener trims tumeisa (ph) in a driveway
A roofer mops hot tar
A plumber asphyxiates in a room with a faulty gas heater
A mechanic becomes an irrational number
And spirals into himself

And you wonder what inchoate griefs are beginning to form
A day keeper sets a random handful of seeds and crystals into lots

BOGAVE: Arthur Sze, welcome to FRESH AIR.

SZE: Thanks.

BOGAVE: I like how in many of your poems, as in this one, you set up descriptions of incongruous events that are all happening simultaneously, sometimes all around the world. I'd like you to talk about that and the thinking that went into this poem.

SZE: Well, the structure to "The String Diamond" is really inspired by an ancient board game, and it's best known by the term "GO" which is the Japanese name, though the earliest version that I know exists in ancient China. And the board the two players play is a criss-crossed board, a series of lines. And the two players use black and white stones. And the idea is to kind of create these zones of control.

And I was drawn -- attracted to the GO game because it really resembles my experience of the world; that we live in a world now where it's more synchronistic and structured. There are different simultaneities. There are different worlds coming together. And rather than experiencing a straightforward linear narrative like past, present and future, I feel that I'm more aware of different things interacting with each other at the same time.

And so for me, the structure of the board game gave me a way to develop a poem that could bring in different worlds that are closer to my experience of how we live today. And so "The String Diamond" kind of changes shape from section to section, but it has that idea of simultaneity and that sense of openness to the world.

BOGAVE: There's a third part of this poem "The String Diamond," which is a list of endangered species. It's the most wonderful sounding names...

SZE: Oh, thank you.

BOGAVE: ... "relict trillium, tan riffleshell, humpback chub, large-flowered skullcap." I had to stop when I was reading the poem and read them aloud just to listen to them. What was the impetus to make the list?

SZE: I had, if you can believe it, I had out of "National Geographic" a list of like 535 endangered -- all of the endangered species. And I was just fascinated with the sounds of the words, first of all, and the names of these plants. And it struck me that it was an amazing list, that here on this sort of grid, or map, that National Geographic had sort of drawn up and inserted in one of their issues was a sense of things that were vanishing from our world, very important species.

And what I wanted to do was create this list without any further commentary, to give the reader a sense of things that were just here today but gone tomorrow. And the equivalent to the board -- the board game of GO is a beginning player tends to put one stone down right next to the other, one after the other after the other. And that's a sure way to lose if you play the game GO. What you do is you move stones around and use the empty spaces.

And so for me, it became an image of loss of things in the modern world that without our realizing it are vanishing every day around us. So I took that list of 535 endangered species and, if you can believe it, over the course of a month I played with that list and I winnowed down and I got it down to about 75 words and species that really interested me. And then it was down to like 50 and 40, and I think there were about 30-some that ended up on this list; a kind of litany.

BOGAVE: A lot of science turns up in your writing, specifically physics. Are you a scientist first before a writer?

SZE: I'm not. It's fun for me to mention that I'm a science drop-out. I'm Chinese-American. I grew up in New York City. My father and mother grew up in Beijing in China. And they came to America during the Japanese occupation, actually, in the late 1930s. My father went to MIT. He had a long career as a chemical engineer. He retired.

I grew up in New York City, and then Garden City in Nassau County. And like a lot of Asian Americans, I was very, very good at math and science, and I applied to MIT and I was accepted and I went there in 1968. And life has such amazing twists and turns, you know, you can't predict. And I found myself totally bored in a classroom, and I found myself writing. And pretty soon I was writing all of the time and I realized that this is what I wanted to do with my life; that language and poetry was so exciting to me, I just had a passion for it.

And even though I realized I was good at math and science, I turned my back on that. I transferred to the University of California at Berkeley and went West, and had an individual major in poetry.

So I grew up with a lot of background in math and science. And I think in my early years of writing poems, I liked to use a lot of words that really were based in nature, like "blood" and "moon." And my feeling today is it can be a sign of a really good poet if you can take, like, "bathtub" or "chicken wire" or "scissors" and be able to make them poetic.

And so it took me a long time to sort of face my own background in science, and particularly in chemistry and physics, and to begin to incorporate them into poems.

So I think over the course of my evolution as a poet, I've become very comfortable using that form of knowledge, because it's something that I grew up with and I try to make the best use of it.

BOGAVE: Have you succeeded in making "bathtub" poetic?

LAUGHTER

SZE: Well, just the idea that I think a poem can transform or illuminate out of our, you know, day-to-day or mundane world. I like the idea that a poem isn't reserved for some special occasion; that, for instance, I can look out the window right here in Albuquerque, New Mexico and see a parking meter on the street or a car parked there, and that they can be part of the source of poetry; the whole world is there.

BOGAVE: Did your family expect you to become a scientist?

SZE: I think that was their big hope, that I would follow my father's footsteps and become a chemical engineer. But life has, you know, wonderful twists to it. A number of years ago -- my father's retired; my mother and father live in Portsmouth, New Hampshire -- and a number of years ago, my father had an operation. And I went to visit him in New Hampshire, and we were actually alone in the hospital room, and he turned to me and he said: well, you know, I had hoped you would follow a career in science or, you know, chemistry, chemical engineering, but when I was a teenager growing up in China, the one thing I wanted to do was to become a poet. And everyone said: no, you have to learn science. You have to contribute to China, to the cause. We need you to contribute to the country.

So I found it as a wonderful kind of kharmic-like return. You know, I had never known that my father had wanted to be a poet as a teenager, and here it's something that I chose. So I think, you know, it took a number of years, but they're very happy with what's happened, too.

BOGAVE: What language did your parents speak at home?

SZE: They spoke Mandarin, and I grew up speaking some Chinese in my family, but I couldn't really read or write it. I studied that formally at Berkeley.

BOGAVE: I think many of us have this idea that since Chinese is an idiographic language, somehow this leads Chinese speakers to think more in images. Is that a misconception?

SZE: That's probably a misconception. I think, you know, the Chinese language is very complicated, and certainly there are some basic forms like "sun" or "moon" that are based on pictographs, on drawings of those images in nature. But there are also sound elements, and the way the language evolves over time gets to be very complicated.

So I hate to generalize, but I do feel that the Chinese language and Chinese poetics has been very important to me as a poet. I've translated a lot of classical Chinese poets. And Chinese poetry likes to make very clear, strong images, and to even make the images or let the images carry a kind of emotional weight.

A poet from Tong Dynasty, China, like Wong Wei (ph) can talk about sunlight shining over a piece of green moss. Now, that's an image, but in the context of the poem it has a tremendous emotional weight. It's a moment of seeing the world in a whole new way.

So I feel like I've learned very much from the Chinese language and Chinese poetics.

BOGAVE: Do you think about how the poetry looks on the page? And I know there are certain forms and that dictates the length of lines in some poetry, but then free verse is pretty much undictated, I imagine.

SZE: Right.

BOGAVE: How do you decide?

SZE: I think free verse can have its own organic structures, and I really like that. I think free verse isn't just sort of writing here and there, but a poet has to find his own sense of inner-structure or organic structure and use that to harness the poem.

This sounds like heresy, but I write on an old IBM Selectric typewriter, and I like writing on an electric typewriter. It's about the speed that I associate or free associate with. If I write by hand, I find my wrist and my fingers getting tired after an hour or so. But if I write on an electric typewriter, I can write for a couple of hours and my fingers aren't tired.

And I can also see how long or short the line is, and I like that sense of having an intuitive understanding of if it's a long line, then it involves more of the breath behind the words; or if it's a short line, to me it feels more like dropping vertically; some kind of deepening.

And those possibilities are always there in a poem, but I feel like I am aware of them as I work on an electric typewriter. And it helps me shape the poem.

BOGAVE: I'm thinking of a poem of yours called "The Moon Is A Diamond." It's about a man -- you are, or the speaker in the poem, is plastering a house with a man and talking to him. And I feel that I know this person through the poem and that I know what it's like to look at his house, and the chilies hanging off of his house in New Mexico. I feel that I'm there. Is that enough for a reader?

SZE: Absolutely. I feel like a poem can celebrate a person, a situation. This poem happened one day out of the blue. I did construction work in Santa Fe with this man named Flavio Gonzalez who was 72. And he turned to me -- we were just having a break from construction work one day, and he said: you know, I think the moon is a diamond.

And the moment he said that, I just was blown away. I just thought: here is a whole poem; here's a whole vision of the world that has a kind of mystery and vitality to it. And I wanted to celebrate him. So here is "The Moon is a Diamond."

(READING)

Flavio Gonzales, seventy-two
Made jackhammer heads during the war
And tells me about digging ditches in the Depression
For a dollar a day
We are busy plastering the portal
And stop for a moment in the April sun
His wife, sick for years
Died last January and left a legacy
A $5,000 hospital bill
I see the house he built at 15
The restras of red chili hanging
In the October sun
He sings "Paloma Blanca" as he works
Then stops, turns
I saw the TV photos of the landing on the moon
But it's all lies
The government just went out in the desert and found a crater
Believe me, I know
I know the moon is a diamond

BOGAVE: My guest Arthur Sze, reading from his poem "The Moon is a Diamond." He's the author of six books of poetry. His new book "The Redshifting Web" is a collection of his poems from the past nearly 30 years. We'll take a break now and then talk some more.

This is FRESH AIR.

BREAK

Back with poet Arthur Sze. His new collected poems is called "The Redshifting Web."

Often landscape and landscape of the southwest where you live is -- shows up in your poems. Did you gravitate to New Mexico because of the landscape?

SZE: Sometimes the truth is a wonderful surprise. When I graduated from Berkeley in 1972, I knew that I did not want to go to graduate school, and I had a little money saved, and I went and traveled around Mexico. The poet I studied with at Berkeley, Josephine Mile said: oh, you should go through New Mexico on your way back to California. Robert Creeley is living in Placitas. I have a good friend named Stan Noyes who lived in Santa Fe.

So I actually hitchhiked from -- I walked over the bridge from Juarez into El Paso in September of 1972, and in one day I hitchhiked up to Santa Fe. And I called this friend of a friend, Stan Noyes, and talked to him. And he mentioned that the poetry in the schools program was starting up in New Mexico, and if I stayed I would have a good chance of working as a poet in the schools.

So I really came here totally on a fluke. I had initially planned on this would be a place to stop off on my way back to California. That was 1972. It's 26 years later. Obviously, I found something here in New Mexico and I love being here.

I think the landscape is extraordinary, and in many ways because I came to New Mexico via Mexico, I felt like I was still somehow outside of America. And that felt really good to me. It felt like a very unusual place.

BOGAVE: You teach creative writing at the Institute of American Indian Arts. Are the students exclusively American Indians or mostly -- 83 percent I think I read somewhere?

SZE: They are mostly American Indian. The Institute of American Indian Arts is federally-funded, and unfortunately, like the National Endowment for the Arts or the Humanities, it's suffered major budget cuts over the last few years and is struggling for survival.

There are 100 students and they represent 70 tribes from across the United States. And they're all ages -- from 18 to 80 years old. So it's an amazing place. If I think of the tribes that some of my writing students are from, they're from all over the country -- Klingit, Haida, Aleut, Navajo, Hamis-Pueblo, Choctaw, Mohawk, Ojibway, Menomenee, Paiute. It's an amazing diversity of students. And it's an extraordinary place.

They are charging tuition now, and students who are non-Indian can enroll at the Institute of American Indian Arts. And interestingly, there have been a number of women from Japan who in recent years have been interested in learning about American Indian culture and art, who have come to the institute and enrolled.

BOGAVE: The student body is so diverse. Do they bring with them huge diversity in what they expect of poetry or their experience of poetry?

SZE: Actually, I think many students who come to the institute have, like society at large, a feeling like: oh, poetry is something difficult; is something -- you know a lot of the students when they come to my poetry I class are very nervous. They feel like they're slightly intimidated: oh, a poem; that's going to be difficult or something.

And then when I explain to them they should really write from their heart. They should write very clearly. They should use visual images. They should pay attention to the sound, what they don't say as well as what they say. But just focus on the language, which is really powerful. They get very, very excited, and some of my best poetry students, who have gone on and published books now, were ones who, like, tiptoed into class and were really nervous and uneasy. And just in the course of a year, they would just be totally transformed and be so excited about writing poetry.

BOGAVE: So much of writing poetry is truly seeing and appreciating with clarity what you are seeing. And that seems to be a central -- at the center of Buddhism also. How do you describe the intersection between your interest in Buddhism, or perhaps your beliefs, and that vocation?

SZE: I think they really come together. I think poetry is about paying attention; about really seeing something clearly. And the practice of Zen is there could be sitting meditation or walking meditation, but it's to try and get to the essential nature of things.

And a moment of revelation in Zen Buddhism is never gradual. It's quick. It's not like you get some revelation over the course of two hours, like a blossom that's unfolding. It's like somebody opens a door or a stone gets flipped. It's very quick. There's that flash.

And I think that's something that I like to pursue as a poet. There are certain moments in the course of every day that we live that certain unexpected things happen. And if we're in tune to them, I believe that you can really see the world in a much larger and deeper way.

BOGAVE: Arthur Sze, it was really fun talking to you today. Thank you.

SZE: Thank you.

BOGAVE: Arthur Sze's collected poems is called "The Redshifting Web."

I'm Barbara Bogave and this is FRESH AIR.

This is a rush transcript. This copy may not
be in its final form and may be updated.

TO PURCHASE AN AUDIOTAPE OF THIS PIECE, PLEASE CALL 888-NPR-NEWS

Dateline: Barbara Bogave
Guest: Arthur Sze
High: Poet Arthur Sze. He has a new collection of poems, "The Redshifting Web: Poems 1970-1998" (Cooper Canyon Press). Sze is a second-generation Chinese-American. His poems reflect his many different influences: science and math, Asian ancestry, Buddhism and the American Southeast where he lives. Sze is a Professor of Creative Writing at the Institute of American Indian Arts.
Spec: Arthur Sze; Art; "The Redshifting Web: Poems 1970-1998"
Please note, this is not the final feed of record
Copy: Content and programming copyright 1998 WHYY, Inc. All rights reserved. Transcribed by FDCH, Inc. under license from WHYY, Inc. Formatting copyright 1998 FDCH, Inc. All rights reserved. No quotes from the materials contained herein may be used in any media without attribution to WHYY, Inc. This transcript may not be reproduced in whole or in part without prior written permission.
End-Story: Arthur Sze

Show: FRESH AIR
Date: SEPTEMBER 10, 1998
Time: 12:00
Tran: 091002NP.217
Type: FEATURE
Head: "For Kings and Planets"
Sect: News; Domestic
Time: 12:20

BARBARA BOGAVE, HOST: This is FRESH AIR. I'm Barbara Bogave in for Terry Gross.

Ethan Canin's timely new novel tells the story of two friends who meet during their first semester in college, and the betrayals and blessings that strain their friendship in the years after.

Book critic Maureen Corrigan says that "For Kings and Planets" will remind lots of readers why they were relieved to leave their own school days far behind.

MAUREEN CORRIGAN, BOOK CRITIC: Last week, somebody saw me toting around Ethan Canin's "For Kings and Planets," and asked whether it was any good or not.

"It's a great novel," I said. And I made that pronouncement with such utter Old Testament certitude, my friend would never have suspected that at that point, I'd read only about 10 pages of the book. But sometimes you just know. Sometimes there's an unexpectedness of insight, a richness of character and mood so early on that unless a novel's plot runs out of gas, you just know it's going to be great.

And there was something else about the beginning of "For Kings and Planets" that made it immediately irresistible to me: it's nerve. In the first few pages, we're introduced to an earnest young Midwesterner and a charismatic and cultured fellow who meet against the fantastic backdrop of New York City. The narrative voice is retrospective, full of yearning and regret for lost illusions.

Sound familiar? Any new novel that has the chutzpah to help itself to the identifying ingredients of "The Great Gatsby" had better be good.

The main character of "For Kings and Planets" is burdened with the name of Orno Tarture (ph). He's a Missouri farm boy who applied on the sly to Columbia University and to his terror got accepted. When the novel begins in the fall of 1974, Orno and his parents have just pulled onto the Westside Highway after three days driving across country. Orno's father hugs the wheel of his Chrysler like a man on a tractor. His mother wears a flower dress and a Polaroid camera on her shoulder. And all three are agog at the blazing skyscrapers of New York.

A few days later in one of his first lecture classes at Columbia, Orno is daunted by the sea of bodies, 220 downturned heads of hair, 220 notebooks, the frightening obliviousness of other people's hopes.

Night after night, Orno, a middling student, sits alone in the library trying, as the narrator tells us, to defeat panic with diligence. The only buoyant element in Orno's first grim semester is Marshall Emerson, a fellow freshman who already affects the jaded suavity of a George Saunders. Marshall's parents are both professors and he himself possesses a photographic memory that absolves him from hard study.

Because Orno is that rarest of curiosities in New York City -- a decent guy who believes his fellow human beings are basically good -- Marshall adopts him, taking him along to meetings of an undergraduate literary society, where drunken wannabe poets learn to strike poses, and even inviting Orno home to his parents' East Side brownstone for Thanksgiving.

After meeting Marshall's father, the renowned Professor Emerson, wide-eyed Orno turns to Marshall's sister and says: "Your father's amazing."

"My father works at being amazing," she replies, giving us an early hint that sinister forces are roiling beneath the Emerson's urbane facade.

But you'd kind of expect, or at least hope for that. You'd also kind of expect that the mercurial Marshall would combust at some point. And that Orno the hayseed would learn to wear smoking jackets and to become embarrassed by his unsophisticated parents.

All of these are predictable developmental stages during college. What a reader doesn't expect, and what helps make "For Kings and Planets" such a remarkable story, is Orno's gradual recognition of the strengths and beauty of his own ordinariness. Orno is what Nick Carraway might have become had he had the guts to stick it out in New York, get help, and finally grow out of his hero worship of that death-driven golden boy Gatsby.

"For Kings and Planets" is such an elegant title. You'd anticipate its pages to be full of the stuff that dreams are made of. But instead, Canin rights a moving romance of the mundane. That gossamer title actually refers to teeth.

BOGAVE: Maureen Corrigan teaches literature at Georgetown University.

Coming up, a pediatrician reflects on attention deficit disorder and the rising use of Ritalin.

This is FRESH AIR.

This is a rush transcript. This copy may not
be in its final form and may be updated.

TO PURCHASE AN AUDIOTAPE OF THIS PIECE, PLEASE CALL 888-NPR-NEWS

Dateline: Barbara Bogave
Guest: Maureen Corrigan
High: Book critics Maureen Corrigan reviews Ethan Canin's timely new novel, "For Kings and Planets," which tells the story of two friends who meet during their first semester in college, and follows the betrayals and blessings that strain their friendship in the ensuing years.
Spec: Ethan Canin; "For Kings and Planets"; Art; Media
Please note, this is not the final feed of record
Copy: Content and programming copyright 1998 WHYY, Inc. All rights reserved. Transcribed by FDCH, Inc. under license from WHYY, Inc. Formatting copyright 1998 FDCH, Inc. All rights reserved. No quotes from the materials contained herein may be used in any media without attribution to WHYY, Inc. This transcript may not be reproduced in whole or in part without prior written permission.
End-Story: "For Kings and Planets"

Show: FRESH AIR
Date: SEPTEMBER 10, 1998
Time: 12:00
Tran: 091003NP.217
Type: FEATURE
Head: ADD & Ritalin
Sect: Medical
Time: 12:40

BARBARA BOGAVE, HOST: Since 1990, the number of children and adults diagnosed with attention deficit disorder or ADD has risen from about 900,000 to nearly five million. The drug most commonly prescribed to treat ADD is a stimulant called Ritalin.

In this decade, Ritalin use has increased by 700 percent. Lawrence Diller says this is a problem of epidemic proportions, and one unique to this country, where 90 percent of the world's Ritalin is used.

Diller is a behavioral pediatrician. He evaluates and treats children and teenagers with a wide variety of developmental, learning and behavior disorders.

Back in the '80s, he started noticing more and more parents and adults coming to his office asking about ADD and Ritalin. He also began prescribing the drug more and more. In his new book, "Running on Ritalin," Diller examines some of the cultural assumptions and trends that are contributing to the rising use of Ritalin to treat people who don't necessarily meet the exact medical requirements for an attention deficit diagnosis, but who nonetheless are having coping with school or life.

I asked Lawrence Diller how he tests his patients for ADD.

LAWRENCE DILLER, BEHAVIORAL PEDIATRICIAN; AUTHOR, "RUNNING ON RITALIN: A PHYSICIAN REFLECTS ON CHILDREN, SOCIETY AND PERFORMANCE IN A PILL": Well, I think that's a problem right there. When people say "test for ADD," it's implied that somehow there is a test you can run, whether or not it's a blood test, a brain scan, or even a psychological test. And there is no test for ADD, as there is no test for most psychiatric disorders.

So the idea is perhaps one "evaluates" for ADD, and that is, actually, if it's done well, is a fairly complicated process, because ADD per se is simply a list of behaviors. And the causes of these problems -- of problem behaviors -- are quite varied.

BOGAVE: I'd like you to tell us about a case of a child that you had trouble diagnosing.

DILLER: OK. I'm thinking of Jenny, and she was a nine-year-old girl who really was a real sweetheart of a child. And her parents called me up and said basically she's struggling at school. And I asked them: how is she doing at home? And they said: fine, except when we have to do homework, and homework becomes a real bear. And the teacher said, because she does appear to daydream at school, the teacher said: maybe she has ADD; get her evaluated for ADD.

And what struck me is, in this one area of being able to read and read quickly enough for her school, that she was struggling. And, indeed, her coping behaviors could look very much like ADD. And now one would say: well, maybe her primary problem was really a learning disorder and not an attentional problem. But, in fact, these two conditions happen very, frequently, and the bottom line is that medication in the form of Ritalin might allow her to stick with tasks that are difficult or boring for her.

And so at issue here is, you know: do I prescribe her a medication -- because the family had gone to some attempts to address this, even though I really didn't see her attentional problems -- certainly she had no hyperactivity and she was barely impulsive -- as justifying the ADD diagnosis.

I think this kind of child is very common these days.

BOGAVE: So what happened? Did you prescribe Ritalin? Or what did you recommend?

DILLER: I think she did try Ritalin and got some improvement from Ritalin, but eventually the parents found a tutor for her, and that worked out better.

BOGAVE: So as you're saying here and as you write in your book, you sometimes do prescribe this drug, even though -- even for kids who don't really fit the model for ADD or who you don't believe have ADD; which I guess is using it somewhat as a performance enhancement drug.

DILLER: Well, I think that I and the family and the child and to some degree the school are all caught in a difficult bind here in terms of our expectations of children these days and what we can offer them. And I know I'm not alone in facing this dilemma as a physician, in terms of offering children and adults medications, even though they don't meet the exact criteria.

There are much larger social issues going on here, that in my prescribing Ritalin for this child are hardly being addressed. And unless those larger pictures -- larger issues are addressed, then I'm acting in ways that may not -- we may help the child on the short-term, but may not be entirely ethical, you know, for me in the long-term also.

BOGAVE: Let's talk about some of those social pressures -- social issues involved in prescribing Ritalin. Do parents pressure you to prescribe the drug because they feel that their child isn't doing as well as the Jones' little boy down the street, who takes Ritalin, so maybe they should try it on their child?

DILLER: Well, I think that happens, but I want to be clear that I don't think any parent who comes to me even with the anticipation that they're going to get medication does that eagerly, without -- or without some great ambivalence or reluctance.

On the other hand, watching their child continue to struggle will often lead them eventually to consider using a medication that in some variety has been used for over 50 years, and at least for children, seems relatively safe.

BOGAVE: When you're presented with a case of a child who doesn't quite fit the definition of ADD, but you obviously know something's going wrong with this child's life, and perhaps it's in the home or at school, what do you look for? And how do you advise a non-drug treatment for this child?

DILLER: Well, if the -- if the problem is in learning, then I will ask the school to do a closer evaluation or refer them to some outside educational specialist. And that remediation support can take the form of a child getting some extra help in the classroom or be just given more time to complete a test; maybe tutoring after school.

If the problem is one within the family, and it wouldn't have to be a great problem. It could be simply, again, the parents are not addressing the child's personality in the most appropriate way, it could mean asking the parents to come back for a couple more visits with me or someone equivalent, where we'd go over that.

Now, this kind of behavior -- ADD, ADHD behavior -- can also be reflected in more serious problems in the family -- marital problems, an adult is depressed, perhaps there is some form of drug abuse or physical abuse. Of course, those problems require much greater attention, and hopefully would be picked up in evaluation.

I think the trouble here is, very often Ritalin is the only indication -- the only intervention, that is, followed through with, and that can be a problem because what I wanted to get at was: even if Ritalin does work -- you asked me if Ritalin works -- it does work on the short-term. However, I don't believe that Ritalin is the moral equivalent of better schools, better parenting and a greater acceptance of temperamental diversity.

BOGAVE: How dramatic is the effect of Ritalin on the children taking it?

DILLER: Well, it depends. It can be quite dramatic. And I think this is why it is a very, very popular medication at this time. And children who heretofore have been unable to really focus on things that they don't like, for the first time can sit still and participate. And that four or five- or six-year-old can be a very dramatic experience for the parent -- more the parent. I think the child probably just experiences the fact that people aren't yelling at him as much.

BOGAVE: Well, that can be a great thing, right?

DILLER: Definitely. But if you asked that child, are they noticing anything? They'll say "no." Most children will say: I don't feel anything one way or the other.

BOGAVE: As you're talking about Ritalin, it just doesn't sound like such a bad thing. It sounds like it can do some real good.

DILLER: Well, well, you know, people say -- people wonder whether or not this book is an anti-Ritalin book, and I try to make it clear that "Running on Ritalin" is not an anti-Ritalin book. I think, though, that the book and what I'm getting at here is that a 700 percent in the use of the pill in this country, and really in this country alone, except for Canada, is telling us something about how we view children's problems.

The fact that Ritalin works per se has been known and known for 50 years. What it tells us is at the moment, we're tending to view our children's problems as a chemical imbalance. And I think that is a limited view. I think rather this should be viewed more as a living imbalance between what our children's brains can deliver and what's being expected from them and what the responses are from the environment.

BOGAVE: It's interesting to me that you point out that 100 years ago, children had more options open to them if they did have trouble in school, couldn't pay attention. You could go back to helping on the farm, for instance, or you could work in the family store. And that's not -- just not so much the case today; that there's an increasing emphasis on academics in the school system, longer hours, more homework, less recess, year-round schooling, perhaps. Do you see all this as contributing to a ballooning use of drugs, or Ritalin and psychotropic drugs in children?

DILLER: One could say there's an increasing intolerance for diversity of temperament and intelligence. And I think we'd have to go back a little more than 100 years, because compulsory education began in the late 1890s. But once children were being asked essentially sit for about six hours, a lot of those who might otherwise been successful in other cultures and other lives are now experiencing problems.

That doesn't explain entirely the Ritalin phenomenon in our country, because there are countries that have compulsory education that don't have this rate of Ritalin use. But I do feel in the last 10 years or so the -- the push toward earlier education, more daycare for children, a sort of educational paranoia that's going around that says: you know, if your child is not successful in third or fourth grade, that means he's not going to be able to attend the post-graduate school of his choice. And what will that mean about his, you know, future and his choices? I think that -- that kind of thinking, while existing prior to the last 10 or 15 years, has really, really taken off in the 1990s.

BOGAVE: it also seems as if, with the rise of two-career families and children entering daycare and structured environments at a younger and younger age, that we're asking kids to socialize a lot earlier than ever before. Maybe some are just not cut out for it. Or we're comparing kids at younger and younger ages. Do you think that's part of the picture also?

DILLER: Yeah, I do. I would just say yes to that. That's not to say that a child at three might at six be discovered to be struggling in the first grade. But now, with structured daycare, it's three where they're coming into the doctor and having potentially a life-long label assigned to them of being ADD.

And since the recommendations these days are increasingly for Ritalin for one's whole life, it's a little bit daunting as the doctor involved here to assign both the medication and the label to a three-year-old.

BOGAVE: Does that come up in your practice?

DILLER: It comes up. It comes up increasingly. I am a behavioral pediatrician, so even more than a child psychiatrist, I think about a quarter of my population is six and under -- under six.

BOGAVE: So do you have patients who are on Ritalin who are three years old?

DILLER: At the moment, probably not. Has that happened? Yes. And am I comfortable with that? No. I don't know about three. But I would say close to five, yes. And I'm talking -- I'm not sure about a three-year-old, but I would say close to five. But there are -- there are examples now in the literature of children two-years old taking this medication.

BOGAVE: Since writing your book, have you been prescribing Ritalin less than before?

DILLER: I would say probably not. I continue to feel that on an individual level that the medication may allow the child to perform better or help that person through the situation. What writing the book has done for me is allowed me to deal with my own ethical problems here. Ritalin allows a person to address that living imbalance in a more -- an easier fashion. But if I only prescribe Ritalin and I don't bring up to that family, or the large of society, the factors -- economic, social, cultural -- that are involved in this large living imbalance, then I feel in just prescribing the Ritalin, I'm complicitous. I'm complicitous with those forces that I feel actually are bad for children and families.

I -- I think for me the best doubt comes, Barbara -- and this is where I can talk about my own experience -- has been where the primary interventions have been with the family, primarily the parents, and importantly with the school. Then Ritalin, or its equivalent, has been added, and the families will say that the Ritalin was helpful there, but was -- what was more helpful was their getting clear about the kind of parenting that they had to deliver to their child.

They almost might add that the adaptations, or accommodations, in school helped the child in the early grades.

BOGAVE: The people that I've talked to who -- who've been diagnosed with ADD express it in some odd ways. They say: I am ADD. Or they seem to have such relief in the diagnosis.

DILLER: The thing that people forget is that ADD is a metaphor; it's a way of looking at the problem. And I think for some people who have been self-blaming themselves for years and years and years, that their inability to perform is a result of some moral failure, finding out that ADD -- and that's seen, let's say, as a neurobiological disorder that really is just their brain and nothing else -- finding that out can be a tremendous burden that's lifted for them.

At the same time, there's another group of people where that kind of message may not be that good. Now, by the way, I think even hearing it as a neurobiological disorder has a downside, which is it's immediately a disease. I think one can make the same statement about the person's behavior by saying, you know: this is your personality, this is your temperament that has good aspects to it, that work for you; and parts that don't work for you, particularly in the situations you find yourself in.

And I know that we're -- in psychiatry these days, tilted toward describing everything a "disorder." But I do think that even if one acknowledges a biological component -- which there certainly is a biological component to behavior -- it doesn't have to be described in such a negative way.

BOGAVE: Lawrence Diller is a behavioral pediatrician. His new book is "Running on Ritalin."

Coming up, a review of "Which Chocolate Space Egg." This is FRESH AIR.

This is a rush transcript. This copy may not
be in its final form and may be updated.

TO PURCHASE AN AUDIOTAPE OF THIS PIECE, PLEASE CALL 888-NPR-NEWS

Dateline: Barbara Bogave
Guest: Lawrence Diller
High: Pediatrician Lawrence Diller specializes in child development and behavior. He's evaluated hundreds of patients for attention deficit disorder, for which the drug Ritalin has often been prescribed. His new book "Running on Ritalin: A Physician Reflects on Children, Society and Performance in a Pill" (Bantam Books). After seeing more and more parents come into his practice asking for Ritalin for their children, Diller became concerned and wrote an article in 1996 that started a national debate about the use of the drug.
Spec: Ritalin; Children; Health and Medicine
Please note, this is not the final feed of record
Copy: Content and programming copyright 1998 WHYY, Inc. All rights reserved. Transcribed by FDCH, Inc. under license from WHYY, Inc. Formatting copyright 1998 FDCH, Inc. All rights reserved. No quotes from the materials contained herein may be used in any media without attribution to WHYY, Inc. This transcript may not be reproduced in whole or in part without prior written permission.
End-Story: ADD & Ritalin

Show: FRESH AIR
Date: SEPTEMBER 10, 1998
Time: 12:00
Tran: 091004NP.217
Type: FEATURE
Head: "Whitechocolatespacegg"
Sect: Entertainment
Time: 12:46

BARBARA BOGAVE, HOST: Liz Phair has just released her third album, called "Whitecocolatespacegg" -- her first in four years. During that time, she got married, had a baby, and some presumed, settled down after two albums of portraying herself as a jittery, moody, sexually-avid rock and roller.

Rock critic Ken Tucker says there are changes in Liz Phair, but maybe not the ones you might expect.

(BEGIN AUDIO CLIP -- ROCK MUSICIAN LIZ PHAIR PERFORMING)

I cut the grass
My left eye hurts
And I'm waiting for beating hearts
I can be a complicated communicator
(unintelligible) spinning
I feel energy
From all sides
It feels good
(unintelligible)
(unintelligible) Florida driveway

KEN TUCKER, ROCK CRITIC: Liz Phair says in that new song "I can be a complicated communicator." And in a way, she's right. The great pleasure of her 1993 debut "Exile in Guyville" was its forthright candidness; its rush of songs about sex, love, men and sisterhood that had the tone of an exceptionally well-written diary.

"Whitechocolatespacegg" by comparison, grapples with the problem that all young pop musicians have when they hit their 30s and their third release. Chances are, autobiography has been mostly used up, and you're leery of revealing as much personal stuff as you once were.

Phair deals with this in a number of songs by assuming another character, as in this tune written in the voice of a depressed boy, called "Only Son."

(BEGIN AUDIO CLIP -- ROCK MUSICIAN LIZ PHAIR PERFORMING "ONLY SON")

All these babies are born
To the wrong kind of people
And I wish I had known
I was not good enough

I'm the worst kind of son
Bringing shame to my family
And I know I have worn my mother's heart out
Believe me, I saw it
I saw it coming

TUCKER: Liz Phair is a tease in the best sense. She dares you to wonder whether what she's singing expresses her own feelings or is stuff she just made up -- you know, like a real artist does, creating things.

For instance, I hope she actually didn't fall at some point in her life for the domineering, faux-sensitive creep she describes in "Johnny Feelgood." But even if she did, she sure got a very good song out of the experience.

(BEGIN AUDIO CLIP -- ROCK MUSICIAN LIZ PHAIR PERFORMING "JOHNNY FEELGOOD")

Johnny Feelgood
Johnny right on
Johnny miss you
Johnny light on
Johnny messy
Feels strangely good about myself

(unintelligible)
Is a memory
(unintelligible)
Let 'em send me
I could take this
In doses large enough to kill

And never met a man
(unintelligible)
(unintelligible)
Every (unintelligible)
So dirty and dry
'Til he knocked me down
Started dragging me around
In the back of his convertible car

And I liked it

TUCKER: As that song clearly showcases, Phair has made the maximum asset of a minimal voice. Her flat, conversational tone echoes against itself and reverberates off the multiple guitar rhythm section set up on nearly every song here.

The effect increases a feeling of intimacy, which she plays off of with brilliant ambiguity. For someone who uses the first person singular a lot, one of the best things about this exceptionally charming album is the way Liz Phair seems to open and curious about everyone and everything around her. Maybe it's an artistic strategy. Maybe it's a matter of growing up.

BOGAVE: Ken Tucker is critic-at-large for "Entertainment Weekly."

For Terry Gross, I'm Barbara Bogave.

This is a rush transcript. This copy may not
be in its final form and may be updated.

TO PURCHASE AN AUDIOTAPE OF THIS PIECE, PLEASE CALL 888-NPR-NEWS

Dateline: Barbara Bogave
Guest: Ken Tucker
High: Rock critic Ken Tucker reviews "Whitechocolatespacegg" by Liz Phair.
Spec: Liz Phair; "Whitechocolatespacegg"; Music Industry; Entertainment
Please note, this is not the final feed of record
Copy: Content and programming copyright 1998 WHYY, Inc. All rights reserved. Transcribed by FDCH, Inc. under license from WHYY, Inc. Formatting copyright 1998 FDCH, Inc. All rights reserved. No quotes from the materials contained herein may be used in any media without attribution to WHYY, Inc. This transcript may not be reproduced in whole or in part without prior written permission.
End-Story: "Whitechocolatespacegg"
Transcripts are created on a rush deadline, and accuracy and availability may vary. This text may not be in its final form and may be updated or revised in the future. Please be aware that the authoritative record of Fresh Air interviews and reviews are the audio recordings of each segment.