Critique of ADHD as a cultural construct is not "anti-psychatry"

16 January 2004

Next eLetterTop

D B Double,
Consultant Psychiatrist
Norfolk Mental Health Care NHS Trust

Send letter to journal:
Re: Critique of ADHD as a cultural construct is not "anti-psychatry"

Email D B Double

Eric Taylor dismisses Sami Timimi's critique of ADHD as an oversimplified polemic (Timimi & Taylor, 2004). He admits he may have been biased because he viewed it as an anti-psychiatry tract. I find it unfortunate that the threat of "anti-psychiatry" means that a serious attempt does not appear to have been made to resolve the controversy round ADHD (Double, 2002a).

Is there a dispute about the facts as well as their interpretation? For example, it is not clear whether brain differences have been shown in unmedicated children, with the protagonists stating opposing views. From the article, it is difficult to see who is correct because Taylor merely quotes the chapter on ADHD from his co-edited textbook (viz. Schachar & Tannock, 2002).

Furthermore, Taylor makes various statements, again with the authority of this textbook chapter, which seem to need further clarification. For example, he says there are known physical counterparts of hyperactivity in brain structure and function, and then does not say what these abnormalities are. If we know what they are, they should be stated and we can then debate their role in aetiology. Similarly, he says that some molecular genetic variations have been robustly replicated, but then does not name the genes, except to say they especially affect dopamine systems. If he committed himself, we could then judge whether his claim proves to be fact or speculation.

There is surely an onus on Taylor to justify his response to Timimi's challenge that the medical model of ADHD "offers a decontextualised and simplistic idea that leads to all of us - parents, teachers and doctors - disengaging from our social responsibility to raise well-behaved children". Instead, Taylor proposes increased recognition of the disorder, at least in the UK, "because there are several good ways of supporting children with severe hyperactivity". If the central issue is the role of medication in treatment, this is clearly a matter of values (Double, 2002b). The recently published edited collection by Fulford at al (2003) argues that meanings as well as causes are essential to good psychiatric care. One way of viewing the ADHD controversy is that Timimi is more concerned about the meaning rather than the physical cause of the disorder. Such a position should not be dismissed as anti-psychiatry, but acknowledged as a valuable contribution to the debate about the extent to which the use of medication exploits people's emotional problems.

 

Double, D.B. (2002a) The history of anti-psychiatry (An essay review). History of Psychiatry, 13, 231-236

Double, D.B. (2002b) The limits of psychiatry. BMJ, 324, 900-904 [Full text]

Fulford, B., Morris, K., Sadler, J. & Stanhellini, G. (2003) Nature and narrative. An introduction to the new philosophy of psychiatry. Oxford: OUP

Schachar, R. & Tannock, R. (2002) Syndromes of hyperactivity and attention deficit. In Child and Adolescent Psychiatry (4th edn) (eds M. Rutter & E. Taylor), pp. 399418. Oxford: Blackwell.

Timimi, S. & Taylor, E. (2004) ADHD is best understood as a cultural construct. British Journal of Psychiatry, 184, 8-9