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Even though attention deficit–­ hyperactivity disorder (ADHD) is relatively successfully medicalized in Germany, it remains contested. One could even go so far as to say that it is the controversial nature of ADHD itself that helped to promote the success story of the syndrome. The history of ADHD in Germany is often traced back to the ­ children’s story “Zappelphilipp” (“Fidgety Philip”) by the German author and psychiatrist Heinrich Hoffmann, dating back to 1845. Fidgety Philip is described as a ­ little boy who ­ will not sit still at the dinner­table. To some, this story includes an early description of a boy with ADHD symptoms . Yet the story of Fidgety Philip is largely understood as a pedagogical parable that points out a moral misbehavior rather than a disease-­ related inability. Thus, the question is raised regarding when (and how) the moral framework of interpretation was replaced by a medical interpretation. If Philip ­ really was a “sick” child, then the evaluation of his be­ hav­ ior would not be a ­ matter of why he would not sit still—he simply ­wasn’t able to control himself. Interestingly enough, Hoffmann published another story in the same book, entitled “Hans Guck-­ in-­ die-­ Luft” (“Johnny Head-­ in-­ Air”), about a daydreamer whose be­ hav­ ior could nowadays be understood as that of a child with ADD symptoms, the predominantly inattentive type without hyperactivity. 5 The Medicalization of Fidgety Philip ADHD in Germany Fabian Karsch 78   Global Perspectives on ADHD What we can learn from the stories of Fidgety Philip and Johnny is that the violation of certain social norms can ­ today be understood as being a result of an impaired cognitive per­ for­ mance rather than just morally inadequate be­ hav­ ior. The stories can also be interpreted as an indicator that ADHD is not merely a recent conception of teachers, doctors, patients, or the media, but that it might have been ­there all along as a certain variation of the norm that is now framed in medical terms. Yet the medical frame of interpretation, the “medicalization” of this phenomenon, has significantly changed the way in which socie­ ties, predominantly Western, deal with that type of deviant be­ hav­ ior. Not only has medicalization opened up new ways of social control, but accepting socially deviant be­ hav­ ior as a consequence of a biological status shifts responsibilities and may ease the burden of both the parents and the deviator. With further medicalization and decreasing stigmatization, the ac­ cep­ tance of the disease category grows and benefits emerge; access to medi­ cation and the legitimization of deviant be­ hav­ ior seem to be the main ­ factors in this development. The pointed striving­ toward the sick role can thus be observed especially in adult ADHD patients, who are often very aware of ­ those benefits.1 Consequently, psychiatrists as well as nonprofessional stakeholders (e.g., individuals affected by ADHD, including patient organ­ izations) have been seen to promote the disease category. ­ These groups are a strong driving force in establishing and continuously stabilizing the medicalization of ADHD. This chapter traces the emergence of ADHD in Germany, its dissemination, and how ADHD is now pro­ cessed, medically, po­ liti­ cally, and socially. Included are the description of ADHD’s current epidemiology, developments in the governance of ADHD, and dif­fer­ ent forms of stakeholder activism. Fi­ nally, I discuss living and performing with ADHD in daily life. In that context, the question is raised as to ­ whether the practice of using phar­ ma­ ceu­ ti­ cal neuro-­ stimulants is best understood as a form of treatment or if the medicalization of certain be­ hav­ iors is leading ­ toward the establishment of cognitive-­ enhancing drugs in everyday life. Emergence and Expansion of a Disease Category In the late nineteenth ­ century, ­ children in Germany who would not comply with the moral system characterized by Protestant-­ Calvinist ethics and the then valid set of rules—­ emphasizing self-­ control and obedience—­ entered the realm of modern medicine. In 1845, the German psychiatrist Wilhelm Griesinger described ­ children suffering from a “ner­ vous constitution” and “showing no attention” (Rothenberger and Neumärker 2005a: 14). In 1890, the German ADHD in Germany   79 psychologist Ludwig Strümpell described in his treatise “Pädagogische Pathologie oder die Lehre von den Fehlern der Kinder” (“Pedagogical Pathology or the Theory of ­ Children’s Defects”) “restlessness” and “inattention” as moral deficits and flaws of character (Seidler 2004: 241). The assessment of deviant be­hav­ior in moral categories...


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