It’s hard not to notice that the idea of “attention” is on a lot of people’s minds. In just one week my desk received a copy of The Hedgehog Review,, the monthly Turning Points Magazine & Devotional, and an e-mail message from a parent all dealing with this subject.
Since the advent of a DSM diagnoses involving deficits of attention (initially linked to hyperactivity), the number of children diagnosed has risen sharply, along with the number of prescriptions written to treat them. Many have carried this diagnosis, and treatment, well into adulthood. There are claims from opposing sides—that the claim that medical advancements have made produced an appropriate clarification and treatment of a previously undertreated problem, versus the claim that this a classic example of medicalization and promotion of a disease for the purpose of creating a market for a product.
Those interested in bioethics would appreciate the breadth and depth of analyses by the editors in the Summer 2014 edition of The Hedgehog Review, who call for a “metaphysics, aesthetics, and ethics of attention, as well as a political economy, and an ecology of attention.” In other words, something other than biochemical treatment. We can start with asking what we mean by “attention,” and therefore what would be a “disorder” of it? For example, attention can be viewed as active engagement with the surrounding world, as well as the dedicated focus on a particular subject, as in the inward contemplation required by academic studies. Invariably such discussion leads to our modern culture and its burgeoning distractions and alterations of values; from there it is no surprise that some would walk us back through the evolution of philosophical beliefs over the centuries, in combination with the advancements and effects of technology.
Emerging from all articles is a clear concern for the ethics of attention, with the recognition that a commercial and technologically saturated culture is not just providing options for our attention but demanding it. Thomas Pfau states that “to pay attention is not simply a matter of increasing, seemingly at will, one’s computational processes, but, first and foremost, to recognize and assent to what deserves our attention and why.” Pfau cites Aquinas as regarding attention as “indispensable to an education in the virtues.” With this argument we can see that the coarsening of our culture and the loss of attention are not simply coincident, but linked.
David Jeremiah in his August edition of Turning Points Magazine & Devotional also speaks to the ethics of attention, but is more specific in highlighting what we should and should not attend to. Indeed, if we are to declare there is an ethics of attention, it would be a hollow gesture to simply aver that attention or focus is good without then answering on what should we focus.
Such discussions are difficult to imagine in the environment of the clinical encounter, constrained as it is by time, abbreviated relationships, and various expectations. And as much as I would like to steer all patients away from medication, and have them and their families address the more profound and fundamental personal and social concerns, I also recognize how many patients and families I have seen who have managed to hold it together and succeed with the benefit of medications. But as a profession we ought to appreciate the depth of concern in our society as represented in these publications, and find ways to work along the lines of discussion to address the deeper problems in society, families, and patients.