Child psychiatry should be challenged and this worthwhile, though occasionally uneven, book edited by Sami Timimi and Begum Maitra aims to start a critical debate. In medicine we are too often taught that there is only one right answer, but in psychiatry looking at the development of the formal classification systems should at least cause some doubt.
The authors criticise the increasing dominance in child psychiatry of a biomedical model which implies linear causation of ‘disorder’ on an individual basis and ignores the historical and cultural context. They are especially well able to take a sideways glance at this phenomenon because of non-European backgrounds and, therefore, observe that although immaturity is a necessary stage, its construction in terms of childhood is culturally determined.
The 19th century was the great age of institutions in Britain. Children were no longer allowed to work and then were required to attend school, thus becoming available for observation, measurement and classification. Many were removed from home and placed in residential schools and children's homes, a practice which continued until the 1980s. As with adult psychiatry, deinstitutionalisation occurred for a variety of reasons, some well-intended, some scientific and others purely economic. Although the development of psychotropic drugs contributed to the emptying of asylums, this could hardly be said for children's homes and special educational boarding schools. A value shift had occurred.
Nevertheless, the identification of child psychiatric disorders went hand-in-hand with the development of drugs to treat them – especially attention-deficit hyperactivity disorder and childhood depression. This book addresses these topics in some detail. Although a critique of the marketing of stimulants and antidepressants for children is not new, Timimi & Maitra, rather than blame the drug companies, set the issue within a Western cultural system of individualisation for consumption.
Overall, despite the presence of ‘straw men’ I would recommend this book for provoking thought about the role of our profession.
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