Pediatric Bipolar Disorder in an Era of “Mindless Psychiatry”
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Date
2012-01-02
Authors
Parry, Peter I.
Levin, Edmund C.
Journal Title
Journal ISSN
Volume Title
Publisher
Taylor & Francis Group
Abstract
Pediatric bipolar disorder (PBD) reflects shifts in
conceptualizing bipolar disorder among children and adolescents
since the mid-1990s. Since then, PBD diagnoses, predominantly
in the United States, have increased dramatically, and the diagnosis
has attracted significant controversy. During the same period,
psychiatric theory and practice has become increasingly biological.
The aim of this paper is to examine the rise of PBD in terms
of wider systemic influences. Method: In the context of literature
referring to paradigm shifts in psychiatry, we reviewed the psychiatric
literature, media cases, and information made available by
investigative committees and journalists. Results: Social historians
and prominent psychiatrists describe a paradigm shift in psychiatry
over recent decades: from an era of “brainless psychiatry,”
when an emphasis on psychodynamic and family factors predominated
to the exclusion of biological factors, to a current era of
“mindless psychiatry” that emphasizes neurobiological explanations
for emotional and behavioral problems with limited regard
for contextual meaning. Associated with this has been a tendency
within psychiatry and society to neglect trauma and attachment
insecurity as etiological factors; the “atheoretical” (but by default
biomedical) premise of the Diagnostic and Statistical Manual of
Mental Disorders (3rd and 4th eds.); the influence of the pharmaceutical
industry in research, continuing medical education, and
direct-to-consumer advertising; and inequality in the U.S. health system that favors “diagnostic upcoding.” Harm from overmedicating
children is now a cause of public concern. Conclusion:
It can be argued that PBD as a widespread diagnosis, particularly
in the United States, reflects multiple factors associated with
a paradigm shift within psychiatry rather than recognition of a
previously overlooked common disorder.
Description
19 pages
Keywords
affective disorders, attachment, behavioral disorders, behavioral medicine, emotion regulation, childhood trauma, professional attitudes, diagnostic validity, pediatric illness, DSM validity
Citation
Peter I. Parry MBBS & Edmund C. Levin MD (2012) Pediatric Bipolar Disorder in an Era of “Mindless Psychiatry”, Journal of Trauma & Dissociation, 13:1, 51-68, DOI: 10.1080/15299732.2011.597826