Thursday, February 9, 2023

"From Nazi Blitzkriegs to ADHD Treatment: What Stimulant Drugs Can and Cannot Do" by Bruce Levine

 

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 Source: Bruce E Levine

From Nazi Blitzkriegs to ADHD Treatment: What Stimulant Drugs Can and Cannot Do

Early in World War II, the highly effective Nazi blitzkriegs were very much dependent on a Wehrmacht juiced up on the methamphetamine Pervitin. Norman Ohler, author of Blitzed: Drugs in the Third Reich (2015), quotes medical historian Peter Steinkamp: “Blitzkrieg was guided by methamphetamine. If not to say that Blitzkrieg was founded on methamphetamine.”

When humans are forced to be cogs in a machine—be it a war machine, a workplace machine, or a school machine—we need to become more machinelike, which can be expedited by some psychostimulant drugs. Commonly used legal psychostimulants are caffeine, nicotine, methylphenidate (including Ritalin) amphetamine (including Adderall), and methamphetamine, all of which may help us better attend to boring and unpleasant tasks. With caffeine and nicotine, we are likely to retain our emotional awareness; however, with methylphenidate, amphetamine, and methamphetamine, our angst or anguish can be eliminated—making these three drugs better suited to create efficient cogs in war, workplace, and school machines.

For the methamphetamine-fueled Panzer troops who overran Poland in 1939, Ohler reports that “the drug seemed to have helped the tank units not to worry too much about what they were doing in this foreign country, and instead let them get on with their job—even if the job meant killing.” I’ve talked with many Adderall-fueled students and workers who tell me that this amphetamine and other ADHD drugs help them to better “stay on task” by disconnecting them from their feelings, most importantly from their boredom and resentment—boredom with an uninteresting task and resentment about being forced to do it.

But are we giving psychostimulants to inattentive children and teens without evidence that these drugs actually help them in the long term? Certainly, we recognize that methamphetamines are even more potent and addictive than amphetamines such as Adderall and Vyvanse that are commonly used to treat attention deficit hyperactivity disorder (ADHD)—so would one be crazy to believe that the Food and Drug Administration (FDA) has approved a methamphetamine for the treatment of ADHD? Before answering these questions, some background as to why machine authorities are so enamored by anything they believe will make humans more efficient cogs in institutional machines.

Fascism, Eugenics Races, and Performance-Enhancing Drug Races

Fascism is in part characterized by the exaltation of the state over the individual in a highly efficient machinelike society. For competing fascist states—be they overtly or insidiously fascist—there will not only be arms races, but eugenics races and performance-enhancing drug races so as to achieve greater efficiency and national superiority. Hitler admired American eugenics policies as well as American psychostimulant use, and Nazi Germany ultimately would surpass the United States in both areas.

With regard to eugenics, the United States and Great Britain were most responsible for igniting this movement, but it was Nazi Germany that acted most decisively to accomplish the goal of eugenics: ridding society of individuals considered inefficient and burdensome. When Hitler came to power in 1933, he sought to first catch up and then to surpass the United States in eliminating those individuals whom the Nazis infamously labeled as having a “life unworthy of living.” Responding to Germany’s increasing sterilizations, in 1934—ten years after Virginia passed its 1924 sterilization act—Joseph DeJarnette, superintendent of Virginia’s Western State Hospital, a psychiatric institution, lamented: “The Germans are beating us at our own game.” Nazi Germany would come to not only surpass the United States with regard to sterilization of psychiatric patients but would move beyond this eugenics policy to another one, murder—killing approximately 200,000 to 300,000 patients in what was later referred to as its T4 program.

With regard to performance-enhancing psychostimulant drugs, Hitler and Nazi Germany also sought to first catch up and then to surpass Americans. The head pharmacist of the drug company Temmler, which would mass produce the methamphetamine Pervitin, was Fritz Hauschild; and Ohler reports that Hauschild “heard how the Olympic Games in Berlin in 1936 had been influenced by a substance called Benzedrine, a successful amphetamine from the United States—and still a legal doping product at the time.” Hauschild knew that the Japanese had created an even more powerful psychostimulant called N-methylamphetamine, and he and Temmler perfected it and found a new method of synthesizing methamphetamine. On October 31, 1937, Temmler patented Pervitin, the first German methamphetamine, which Ohler, reports, “put American Benzedrine very much in its shadow.”

Pervitin

Pervitin immediately became an extremely popular product in Germany. Using a strikingly similar sales strategy employed by modern pharmaceutical companies, Ohler reports, “Representatives of Temmler visited large-scale practices, hospitals, and university clinics all over the country; delivered lectures; and distributed this new confidence- and alertness-boosting drug.” A senior hospital doctor wrote that Perivitin could “integrate shirkers, malingerers, defeatists, and whiners” into the labor process, and Ohler notes that it “soon gained acceptance in a very wide range of circles: students used it as a survival strategy for the exertions of exams; telephone switchboard operators and nurses swallowed it to get through the night shift. . .” While Volkswagen was the people’s car, Pervitin became Volksdroge, the people’s drug.

The German military soon embraced Pervitin. The director of the German Research Institute of Defense Physiology was Otto Ranke; his job, Ohler reports, “was to oil the cogs of the machine.” Ranke tested Pervitin on medical officers by having them solve math and logic problems throughout the night; and Ohler reports that by dawn, the placebo group had their heads on their desks while the Pervitin group were manically working away. However, when the Pervitin group’s work was checked, Ohler reports, “Calculation might have been carried out more quickly, but they contained more mistakes. . . . Pervitin kept people from sleeping, but it didn’t make than any cleverer”; yet, Ohler continues, “Ranke concluded without a trace of cynicism that this made it ideal for soldiers.”

Pervitin was the perfect drug for blitzkrieg or “lightening war,” which was all about catching the enemy off guard by moving troops and tanks forward day and night without sleep. After the 1939 German invasion of Poland, in 1940, next came Denmark, Norway, Holland, Belgium—and then France, which had one of the largest armies in the world. However, the Wehrmacht’s invasion of France bypassed French defense forces by speeding through the Ardennes Forest, which the French thought to have been impassable. Nazi General Heinz Guderian gave the following order: “I demand that you do not sleep for at least three days and nights, if that is required,” and Pervitin made that possible. Arriving in France before French reinforcements could arrive, French defenses were overwhelmed by the German attack.

The Wehrmacht was not alone in its recognition of the advantage of psychostimulant drugs. The Speed Culture: Amphetamine Use and Abuse in America (1975) reports that in World War II, the British and Americans used amphetamines, and Benzedrine was used extensively by the U.S. Army Air Corps stationed in England during the 1940s. There is no doubt that psychostimulants can be quite effective in keeping one awake when would naturally fall asleep, however, eventually there is burnout.

The Wehrmacht would ultimately be crushed and defeated in its invasion of the Soviet Union, where the negative effects of Pervitin far outweighed its tactical value. “In Russia,” a former Wehrmacht medical officer deployed there told Ohler, “it was a war of attrition, positional warfare. In such circumstances Pervitin was no use: It just exhausted you. You eventually had to catch up on the rest you’d missed. Sleep deprivation simply didn’t bring any tactical advantages anymore.” Furthermore, Pervitin was known to be highly addictive with frightening adverse effects including psychosis.

ADHD Treatment: From Benzedrine to Ritalin and Adderall

In the United States in 1937, the physician Charles Bradley observed that the amphetamine Benzedrine “calmed” down a group of children with behavior problems. In the 1950s, the amphetamine Dexedrine became popular, as “speed” was used to reduce fatigue and appetite—and lose weight. However, in the 1960s, amphetamine addiction and its tragic toll began to be seen as a plague analogous to the current opioid epidemic; and this led to Congressional Hearings and the passage of the Controlled Substance Act (CSA) in 1970. Amphetamine was classified as a Schedule II drug, denoting a high potential for abuse and dependency.

However, the psychostimulant revolving door kept turning. By the 1980s, Ritalin cornered most of the ADHD-treatment market in the United States because, as pediatrician Lawrence Diller explained in Running on Ritalin (1998), though Ritalin is also classified as a Schedule II drug, it was not considered to be an amphetamine, making it more palatable for parents. Whether Ritalin should be considered amphetamine-like, an amphetamine derivative, or simply an amphetamine is today controversial; the current U.S. Drug Enforcement Agency (DEA) Fact Sheet for Amphetamines includes Ritalin on its list. Two of the most currently popular ADHD drugs, Adderall and Vyvanse, are unequivocally termed as amphetamines. So, American attitudes toward amphetamines have turned 360 degrees; and while amphetamine use is not as “cool” as it once was, it is even more acceptable.

In 2022, the Centers for Disease Control and Prevention (CDC) estimated that among U.S. children aged 3–17 years that 6 million (9.8%) have at some point been diagnosed with ADHD. Breaking this down by age: among 3–5 year olds, 2% had received an ADHD diagnosis; among those aged 6–11 years, 10% had been so diagnosed; and among those aged 12–17 years, 13% had been diagnosed with ADHD.

The CDC estimated that among young people diagnosed with ADHD, 62% are taking ADHD medication. Breaking this down by age: among 2–5 year olds diagnosed with ADHD, 18% were taking some type of ADHD drug; among diagnosed 6–11 year olds, 69% were being medicated; and among diagnosed 12–17 year olds, 62% were being medicated.

The market value of ADHD drug industry in the United States in 2023, according to IBISWorld, is $10.7 billion, growing on average 0.7% per year between 2018 and 2023.

Cui Bono?

Who benefits from ADHD drug treatment? Not just drug companies.

Given the U.S. school system’s one-size-fits-all nature, ADHD drugs are vital to maintaining it. Without Ritalin, Adderall, Vyvanse and other ADHD drugs, many teachers believe it would be impossible to manage large classes that routinely include inattentive youngsters, some of whom are disruptive. Forced to maintain order, teachers tell me that without these disruptive children being medicated, there would be chaos and little useful instruction—and burnout for teachers.

Teachers can suggest that parents consider taking their disruptive child for a medical evaluation, however, today it is taboo for educators to pressure parents to put their kids on ADHD drugs. No such taboo existed in the 1970s, as The Speed Culture authors Lester Grinspoon and Peter Hedblom offer several examples, including the following one: “In New York the mother of a child labeled ‘hyperactive’ by his elementary school teacher received an ultimatum from the teacher: ‘put the child on drugs or we will not be able to keep him in school.’” While this type of intimidation is now taboo, it is also unnecessary, as most parents have been socialized to believe that they are irresponsible if they don’t follow a teacher’s suggestion to get a medical evaluation and fill a pediatrician’s prescription for an ADHD drug.

Psychostimulants enable one-size-fits-all school systems, which are less expensive than systems that provide varying learning environments that can suit a variety of children. With diverse leaning environments, there would be far less inattention and disruptiveness. In the 1995 book The Myth of the A.D.D. Child (revised in 2017 and renamed The Myth of the ADHD Child), psychologist Thomas Armstrong documents research showing that these so-called “disordered” children are indistinguishable from “normal” children in the following situations: (1) one-to-one interactions with an adult; (2) when they choose the learning activity; (3) when they are paid; (4) when they are interested in the activity, (5) when the activity is novel or in some other way stimulating for them.

While in contemporary neoliberal society, it is acceptable to medicate disruptive preschoolers with psychostimulants, it is seen as unrealistic to spend the money necessary to create diverse learning environments suited for all youngsters. Given this reality, and given how important academic success is for financial survival, do ADHD medications have a cynical value?

One of the few journalists combing the research to discover the effects of ADHD-drug treatment is Peter Simons, managing editor of the webzine Mad in America, who has authored several articles on the this issue. In June 2022, Simons published “Stimulants Don’t Improve Academic Performance in Kids with ADHD,” which provides the details of an especially illuminating study published in the Journal of Consulting and Clinical Psychology in May 2022. This study is titled “The Effect of Stimulant Medication on the Learning of Academic Curricula in Children with ADHD,” and its authors reported the following findings: “There was no detectable effect of medication on learning the material taught during instruction.” ADHD drug treatment studies routinely don’t assess academic performance—focusing only on inattention and disruptiveness as rated by teachers or parents—however, in this study, academic performance was evaluated. The researchers concluded: “Although it has been believed for decades that medication effects on academic seatwork productivity and classroom behavior would translate into improved learning of new academic material, we found no such translation.”

As in most research, there are caveats to this Journal of Consulting and Clinical Psychology study (Simons points out that it used short lessons each day, delivered in a small-group setting, so it cannot be stated with certainty how these results would generalize to a standard, full-length school day in a larger classroom). However, Simons also includes other evidence of ADHD medication treatment failure—most significantly, the National Institute of Mental Health (NIMH) funded long-term study, Multimodal Treatment of Attention Deficit Hyperactivity (routinely referred to as MTA).

MTA’s initial results at the end of 14 months, reported in 1999, were widely publicized by the psychiatric establishment and ADHD drug makers, as they showed that ADHD-diagnosed children who were treated with ADHD medication had significantly reduced ADHD symptoms compared to those children not medicated. However, few Americans who are not Mad in America readers are aware of the disappointing 3-year and 8-year MTA follow ups. After three years, it was found that those children who received ADHD drug treatment were doing no better with respect to ADHD symptoms than those not medicated. And again after eight years, no benefits were found for drug treatment, including no benefits with respect to newly analyzed variables of criminal arrests, psychiatric hospitalizations, and school grades.

Eventually, word may get out about the reality of Ritalin, Adderall, and other amphetamines for ADHD-diagnosed children. So the question is this: Just how crazy is it to believe that methamphetamine treatment might replace amphetamines? In the 1970s, it would have been seen as crazy to give troublesome preschoolers psychostimulants; but today, when disruptive three-year olds don’t respond to behavioral techniques (such as “time outs”), Ritalin is the next treatment option. Furthermore, the FDA has already approved a methamphetamine called Desoxyn for ADHD treatment. Currently, Desoxyn is seldom used, as most American parents are not inclined to put their kids on a methamphetamine; however, in the 1970s, parents weren’t crazy about putting their children on amphetamines, but that has certainly changed.

Summing It Up: Psychostimulant Benefits and Costs

With respect to military invasions, methamphetamine proved quite effective for those Nazi blitzkriegs in which victory could be achieved quickly. However, in lengthy invasions, such as the attempt to conquer the Soviet Union, methamphetamine had “no use.”

Psychostimulant treatment for ADHD can make a child less disruptive in a classroom. However, research shows that: (1) ADHD drugs did not improve “learning the material taught during instruction”; (2) after eight-years, ADHD drugs did not reduce arrests and psychiatric hospitalizations or improve school grades; and (3) the Nazis found that methamphetamine caused more errors when used to solve math and logic problems.

Psychological and physical adverse effects? Methylphenidate (Ritalin and Concerta) amphetamine (Adderall and Vyvanse), and methamphetamine (Pervitin and Desoxyn) are known to result in significant ones.

“We knew [Pervitin] was addictive,” the Wehrmacht medical officer deployed in Russia also told Ohler, “and that it had side-effects: psychoses, nervous excitement, a loss of strength.” Other adverse effects included depression, high blood pressure, and heart difficulties, for which Ohler offers several examples, including this one: “One colonel with the 12th Panzer Division who was known to ‘take a lot of Pervitin’ died of a heart attack while swimming in the Atlantic.”

Ritalin and Concerta adverse effects? From among the fourteen side effects noted by Consumer Reports, here is a sample: “decreased appetite” (54%), “sleep problems” (35%), “irritability/anger” (22%), “heart palpitations” (5%), and “hallucinations” (1%); and  for most of these adverse effects, an even higher percentage was reported with Adderall and Vyvanse; in one comparison, 7% of those taking Ritalin and Concerta reported “talking about harming himself/herself” compared to 9% of those taking Adderall and Vyvanse.

Finally, to those of you who depend on psychostimulants to hold on to your job, my apologies for being such a buzz killer.

 

Bruce E. Levine, a practicing clinical psychologist, writes and speaks about how society, culture, politics, and psychology intersect. His most recent book is A Profession Without Reason: The Crisis of Contemporary Psychiatry—Untangled and Solved by Spinoza, Freethinking, and Radical Enlightenment (2022). His Web site is brucelevine.net

 



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