LAS TRES ETAPAS SUCESIVAS DE LA MEDITACIÓN

As already outlined in this chapter, one probable reason for the foregrounding of mothers in the literature around ADHD is the gendered nature of care-giving. As the literature suggests, it is mothers who assume medical responsibility for their children (and families) (Seymour-Smith and Wetherell, 2006) and, most typically, it is mothers who have most dealings with experts regarding their children.

Resonating with the wider literature on parenting and moral responsibility (see Ribbens McCarthy et al., 2000), the accounts of mothers of children with ADHD orient to themes of responsibility, self-sacrifice and putting their children first (Austin and Carpenter, 2008; Bull and Whelan, 2006; Singh, 2004). A further reason for mothers’ foregrounding in the literature is the historical implication of mothers in their children’s disorders (Singh, 2002a; Rose, 1999). Both

psychological and popular discourse suggests good mothering produces good children. Consequently, mothers are often judged in relation to their children’s

behaviour and are blamed for it if it is not acceptable. As Caplan (1989, cited in Malacrida, 2001:145) says, the ‘measure of a good mother is a perfect child.’ An ADHD child is far from the normalised version of a perfect child. Indeed, the literature seems to indicate that on presentation of a child with a possible ADHD diagnosis to medical professionals, mothers are often the subject of scrutiny rather than the child (Berman and Wilson, 2009; Litt, 2004; Malacrida, 2001). As Berman and Wilson reveal in their study of intake workers’ constructions of mothers who present their children for assessment at a children’s hospital, mothers’

psychological and emotional profiles are routinely assessed when doing evaluations for ADHD.

The historic, but still prevalent, repertoires of maternal blame, and the subject position of the ‘blameworthy mother’ are drawn upon and made relevant by

mothers of children with ADHD throughout this body of literature. In the majority of these studies, mothers talk of feeling blamed for their children’s condition (Austin and Carpenter, 2008; Blum, 2007; Neophytou and Webber, 2005; Litt, 2004; Singh, 2004; Harborne, Wolpert and Clare, 2004; Klasen and Goodman, 2000). In particular, mothers report feeling that their parenting is subject to judgement and scrutiny by others.

The blameworthy mother

It is within this prevailing social context of mother-blame that diagnosis of ADHD is sought. There is some evidence to suggest that within the UK it is mothers who seek medical diagnosis, often contrary to their GP’s opinion (Malacrida, 2001; Norris and Lloyd, 2000). Bennett (2007) suggests that while the ‘blameworthy’ mother is a prevalent subject position, then the medical explanation will always be a desirable repertoire to draw upon. Biological explanations for ADHD are routinely provided by mothers within the literature, with mothers in several of the studies

suggesting their children’s ‘difference’ was evident from birth, or even within the womb (Bull and Whelan, 2006). Certainly, much existing literature reports mothers’ relief at a biological explanation for their children’s behaviour, as this absolves mothers of any culpability for their child’s condition (Neophytou and Webber, 2005; Singh, 2004; Segal, 2001; Klasen and Goodman, 2000). However, there is a body of work that suggests that the blameworthy mother subject position is so pervasive that a medical diagnosis of ADHD, only partially, or only temporarily, absolves mothers of culpability (Harborne et al., 2004). Both Blum (2007) and Singh (2004) identify a mother-blame, brain-blame binarism. However, both also acknowledge that, rather than brain-blame removing mother-blame, the latter becomes

‘reconstituted’ (Singh, 2004). Blum suggests that once a medical diagnosis is obtained for their children, mothers are positioned (and position themselves) as blameworthy ‘proximate causes’. That is, there is an onus on mothers to resolve any subsequent problems or issues their children might have. As Singh argues, post diagnosis, mothers are expected to be vigilant of their children, and prevent any escalation of ‘troublesome’ behaviour. Any outbreak of such behaviour is because the mother has ‘misread’ the situation or demanded too much of their sons (Singh, 2004:1202). Diagnosis also brings concerns and feelings of guilt around medication. Mothers are caught in a moral dilemma; do good mothers seek absolution and cure for their children through medication, or is that an

irresponsible and possibly abusive course of action to take? As one mother says ‘I feel damned if I do give him the pills and damned if I don’t’ (Taylor, O’ Donoghue and Houghton, 2006:120). This guilt is, no doubt, fuelled by media headlines such as ‘Unscrupulous parents seek ADHD diagnosis for benefits’ (Goldberg, 2011). An ADHD diagnosis is not only represented as benefiting parents financially; equally, mothers’ pursuit of medication is constructed as self-serving in relation to their ability to manage their children and the relief it brings to mother/child

interactions(Singh, 2004). In addition to representing mothers (and fathers) as self- serving, the media can also represent them as neglectful and even abusive in their ‘drugging’ of their children (Horton-Salway, 2011).

The double bind that mothers experience with regards to medication is indicative of how they can be positioned by the different understandings (or repertoires) of ADHD. The biological repertoire makes available the subject position of the abnormal or ‘sick’ child, who is adversely affected by a chemical imbalance within the brain. Medication of such a child, to control this imbalance, is, therefore, reasonable, and to be expected. Clearly, this biological repertoire has implications for the positioning of parents. Within this repertoire, parents seeking medication are ‘doing right by their child’. However, understandings of ADHD which draw on social and psychological explanations of ADHD (the psychosocial repertoire), make relevant very distinct child and parent subject positions. Within this

repertoire, children are constituted as normally naughty, or normally anti-social. Therefore, medicalization is critiqued as being irrelevant and unhelpful. Parents, who pursue the medical route are, consequently, positioned as self-serving or even abusive (Horton-Salway, 2011). Post diagnosis, mothers can be positioned either as irresponsible, abusive mothers who are too quick to medicate their child, or, as ‘non-vigilant’ mothers who cannot cope with (or control) their child.

The scrutinised mother

Judgement and scrutiny in public spaces features significantly in mothers’ accounts. Mothers report feeling judged by other mothers. As Singh states (2004:1201), ‘to this extent it does not matter whether mothers are actually experiencing this judgement or ‘imagining’ it. The point is that even their

imagination reflects the internalisation of this disciplinary power’. This (possibly) perceived judgement by others may account for the high number of accounts

which describe feelings of isolation and alienation (Bull and Whelan, 2006;

Neophytou and Webber, 2005; Segal, 2001; Klasen and Goodman, 2000) and the withdrawal from social situations. It is little wonder that, as a result of the

judgement and scrutiny that mothers report experiencing, they should also report feelings of inadequacy and low self-worth (Bennett, 2007; Singh, 2004).

More positively, the biological/medical repertoire makes available the subject position of ‘expert’ and ‘pro-active’ mother, which work to counter the more negative positioning. Malacrida (2001) suggests that to counter their experiences of feeling judged and scrutinised by professionals, mothers work to present themselves in a positive light. The literature reveals that mothers construct themselves as good mothers by positioning themselves as skilled managers of their children’s behaviour and as pro-active advocates for their children. Both these positions allow mothers to demonstrate their expertise on their children’s condition.

The take-up of these two positions (skilled managers and pro-active mothers) resonates with the two types of carework undertaken by a specific group of mothers of children with an ADHD diagnosis, as identified by Litt (2004); direct carework and advocacy. She asserts that direct carework involves the

management of everyday routines, such as behavioural control and managing medication. Advocacy involves mediation, resource acquisition and resource co- ordination. Although this exact terminology is not necessarily used elsewhere in the body of literature, the discursive repertoires relating to parenting skill and advocacy are regularly drawn upon by mothers and researchers and, as such, deserve highlighting.

Mothers as skilled managers

Litt’s work highlights the intensity of the experience of parenting a child with ADHD, and how so much of a mother’s time is occupied with managing children’s disruptive behaviour (Litt, 2004). Although mothers regularly talk about

experiencing stress (Bull and Whelan, 2006; Neophytou and Webber, 2005; Harborne, Wolpert and Clare, 2004), a much stronger parenting account that emerges from the literature is one of mothers coping with the situation and,

specifically, of mothers learning appropriate strategies and skills to cope with their children (Bull and Whelan, 2006; Litt, 2004; Segal, 2001). Segal (2001) even suggests that mothers undergo a process of ‘learned mothering’ to become

‘professional’ parents. Although a cautious approach to accepting such labels and processes as literal must be taken, it is interesting that so much of the literature refers to the development of appropriate coping strategies; as Wilkinson and Kitzinger (2000) suggest, talk of coping is not to be understood literally but as a discursive accomplishment. To be seen to cope is to fulfil a ‘socially normative moral requirement’ (2000:797). Doing ‘good mothering’ involves coping with and managing disruptive children. Mothers connect appropriate and successful management of their children with the development of an in-depth knowledge of their children and, within the literature, they demonstrate both subject knowledge of their child’s condition (Taylor et al., 2006; Segal, 2001), and also, experiential knowledge of their own child (Hjorne, 2005; Litt, 2004). Mothers’ own subjective experience is, at times, drawn upon to critique ‘professional’ parenting techniques (Bull and Whelan, 2006). Although mothers highlight their willingness to engage with parenting strategies (doing the good mother), they also report the limited success of such strategies.

Another example of how mothers claim expertise and effective management skills is in relation to their children’s medication. As discussed earlier, medication poses

its own moral dilemma, and mothers indicate they experience themselves in a double-bind position. Guilt and concern about the side-effects of medication are articulated in several studies (Bull and Whelan, 2006; Neophytou and Webber, 2005). However, this is managed, or countered by mothers, who describe how they provide medication ‘breaks’ for their children (Neophytou and Webber, 2005; Singh, 2005) or describe how they assume responsibility for the monitoring and ‘fine-tuning’ of their child’s medication (Taylor et al., 2006; Litt, 2004). Not only do mothers demonstrate their developing expertise in relation to their children’s medical condition, but they also demonstrate their maternal concern and care for their children’s health by providing examples of how they, partially, resist regulated medication of their children.

Mothers’ claim to expertise is also employed by mothers when occupying the position of pro-active mother, a position which resonates with Litt’s second type of caregiving; advocacy.

The pro-active mother

Existing literature highlights how expertise is drawn upon by mothers to negotiate with professionals and to provide authority to their demands and concerns.

Malacrida (2001) cautions against assuming a ‘unilateral direction of power’ that emanates from professionals; mothers are prepared to challenge professional perceptions of their children (Todd and Jones, 2003; Norris and Lloyd, 2000). Mothers are presented as active in the pursuit and conveyance of knowledge about their child’s condition (Segal, 2001; Klasen and Goodman, 2000). Mothers draw on their own experience and reading to establish warrant for their knowledge and, indexically, position themselves as experts in relation to ignorant others; several studies report mothers as seeking to educate others about ADHD (Taylor

theme that appears in several of the studies, and the language of ‘battle’ is used (by mothers and by researchers) to position mothers vis-à-vis their metaphorical enemies, that is, other parents, teachers and medical professionals (Blum, 2007; Harborne et al., 2004; Norris and Lloyd, 2000). Blum (2007) suggests that post- diagnosis, mothers are positioned within powerful authoritative discourses

(medical, educational, political) and have little ‘natural’ authority of their own. She suggests that within this context, ‘good’ parenting becomes a project of ‘concerted cultivation’ (Blum, 2007:204), by which mothers in ‘doing’ good mothering take up intensified action by claiming authority to speak and act on behalf of their children. Blum puts forward the idea that mothers become vigilant in their advocacy role, particularly in managing their children across the educational and health care systems and ensuring their access to appropriate resources. This take-up of pro- active, advocacy work by mothers is commonly identified within this body of literature (Austin and Carpenter, 2008; Taylor et al., 2006; Litt, 2004; Norris and Lloyd, 2000) and is, perhaps, indicative, as Austin and Carpenter claim, of new ideas of what constitutes ‘good’ mothering. Is ‘good’ mothering of ‘disadvantaged’ children aligned with notions of activism, action, resistance and advocacy? In Litt’s study (2004), mothers assert that it is through their ‘special efforts’ that their

children ‘are doing as well as they are’ (Litt, 2004:636), suggesting that mothers are positioning themselves as good mothers by drawing on their pro-active

mothering and by furnishing their accounts with examples of their competence and expertise. This resonates with Horton-Salway’s (2012) suggestion that the

‘valourised representation’ of the campaigning mother is discursively produced through accounts of the ‘victim identity’ for the boy with ADHD (2012:9).

Although the active, resistant mother is one possible subject position that is made available through repertoires of good mothering, it is also, as mentioned earlier in the chapter, a risky position to assume. Active and resistant mothers can also be

constructed as troublesome, especially in their encounters with professionals. Mothers work to undermine these constructions by drawing upon their own expertise and knowledge, and/or by assuming the subject position of compliant mother, in their attempts to represent themselves as ‘good’ mothers.

Expertise and compliance

As discussed, the subject position of ‘pro-active’ mother makes relevant notions of resistance, activism and advocacy. However, as Malacrida (2001) suggests, power is exercised by mothers not only by confrontation, but through cooperation and the use of ‘superior knowledge claims’ obtained from articles, specialist sites, journals and books. The accessibility, and subsequent routinisation, of expert knowledge results in the erosion of specialised knowledge and enables lay people to confront experts, not from a position of ignorance but from a position of

knowledge. Certainly, the study by Norris and Lloyd (2000) demonstrates that mothers are not afraid of challenging medical opinion that is reluctant to diagnose ADHD and, indeed, it is through the use of medical knowledge that mothers challenge these doctors’ opinions.

It would appear that mothers exercise power in the diagnostic process of ADHD by drawing on available, often expert or specialist discourses. However, despite this exercise of power by mothers, the power situated in institutions and practices of expertise still has the potential to constrain and dominate. As Malacrida (2001) points out, mothers, despite feeling anger or resentment at the professionals have to find ways of presenting their knowledge and expertise of their children to the professionals without threatening their expertise. Resonating with Berman and Wilson’s study (2009) described earlier, Malacrida points out that mothers have an understanding that confrontation with the experts might result in undesirable

compliant in order to be part of the team and in order to gain referrals to the next rung of the ladder.’ In this sense maternal compliance can be understood as a form of ‘game playing’ (Austin and Carpenter, 2008), in which mothers

‘concertedly’ present themselves as compliant, in order to gain advantage.

The literature on mothers of children with ADHD reveals the competing repertoires of the ‘good mother’. Repertoires of maternal activism and battle compete with repertoires of compliance and vulnerability and make available distinct subject positions for mothers to occupy. However, the overarching repertoires which are drawn upon almost routinely by mothers, whether of children with ADHD or not, are those of ‘doing right by their children’ (Taylor et al., 2006), ‘doing one’s best’ (Harden, 2005) and ‘putting their children first’ (Ribbens, McCarthy et al. 2000). In the final section of this chapter, I turn to the literature around fathers and ADHD.