The rise in the diagnosis of attention deficit hyperactivity disorder (ADHD) and the use of stimulant medication such as Ritalin to treat it raises important questions…
The rise in the diagnosis of attention deficit hyperactivity disorder (ADHD) and the use of stimulant medication such as Ritalin to treat it raises important questions about how childhood is conceptualised in contemporary western society today. By focusing on within‐child explanations for behaviour, the diagnosis of ADHD divorces a child from their context; real life experiences, including traumatic ones, are marginalised or excluded from clinical consideration. This paper1 explores how ADHD manages to occupy and hold on to such a dominant position despite the lack of evidence supporting its supposed medical origins, and explores what the ADHD diagnosis reveals about cultural expectations of childhood and power hierarchies in the UK and North America.
The paper's aim is to review how relevant the World Health Organisation's Mental Health Gap Action Programme (mhGAP) initiative is to mental health care in non‐Western societies.
The paper provides a review of the programme and its relevance to mental health care by drawing on available literature and evidence.
mhGAP promotes the idea that mental health problems exist as problems within individuals, that they represent a substantial, though largely hidden, proportion of the world's overall disease burden, and that mental health services need scaling up across the globe to improve outcomes. However, mental health outcomes do not appear any better in those countries with the most developed services and the initiative does not seem to properly engage an evidence base that is at odds with the direction of travel the initiative recommends.
The paper explores these contradictions and argues that, whether intentional or not, mhGAP reflects and is part of the global neo‐liberal economic system and functions largely to expand the market for a particularly Western approach to understanding mental distress.
Evidence‐based medicine (EBM) is a technical and scientific paradigm in clinical practice that has delivered major improvements in the outcome of care in medicine and…
Evidence‐based medicine (EBM) is a technical and scientific paradigm in clinical practice that has delivered major improvements in the outcome of care in medicine and surgery. However, its value in psychiatry is much less clear. The purpose of the paper is thus to examine its value by subjecting empirical evidence from EBM to a conceptual analysis using the philosophy of Thomas Kuhn.
The authors examine evidence drawn from meta‐analyses of RCTs investigating the efficacy of specific treatments for depression in the form of antidepressant drugs and CBT. This shows that the non‐specific aspects of treatment, the placebo effect and the quality of the therapeutic alliance as seen by the patient, are more important in determining outcome than the specific elements (active drug, specific therapeutic elements of CBT).
Using the philosophy of Thomas Kuhn, it is shown that these non‐specific and non‐technical elements are anomalies that indicate that the technological paradigm in the treatment of depression is fundamentally flawed.
Non‐specific elements of mental health care are essential in fostering hope, trust and meaning. They constitute non‐technical factors that are central to the concept of caring, and vital for recovery, and which resonate strongly with the growth of survivor and user‐led systems of support for people who experience distress and madness. As such they pose a major challenge to scientific psychiatry and mental health services based in this. The analysis has major implications for the primacy of the natural sciences in the education and training of those involved in mental health work, and demonstrates the importance of an open debate about the value of the scientific imagination in mental health work.
This paper is important because it supports user‐led self‐defined notions and understandings of recovery, and does so using a philosophical conceptual analysis.
This conceptual analysis is highly original. To the authors' knowledge no one has subjected EBM to a detailed conceptual analysis using the ideas of Thomas Kuhn.