Visit New E-magazine :http://www.SpecialWorld.Net
For full article + hyperlinks
See Practical Protocol above in Popular Posts.
See Practical Protocol above in Popular Posts.
Reclaiming a ‘normal’ childhood -
The ‘medical model’ at the heart of DSM-5 threatens to
pathologise the normal behaviour of thousands of children
Since the ‘Psychiatrists’ Bible,’ DSM-5 (Diagnostic and
Statistical Manual of Mental Disorders, 5th Edition) was published in May 2013,
not a day has gone by without children throughout the Western World leaving
clinics with stigmatising and often unhelpful labels of mental disorders tied
tightly around their necks. But are these labels helpful to these young people?
Do they maximise their human potentials and help them develop as confident
adolescents or adults? Certainly we know from the field of Attribution Theory
that people become more like the characteristics that significant others
ascribe to them in childhood, and over time this creates a vicious cycle of
progressive pathologisation in which their self-esteem, efficacy and motivation
can plunge to new lows.
Many psychologists would argue that making sensitive
and suggestible young people more aware of their potential stressors could
backfire and contribute to a worsening of their situation. Hence, a shy child
may become more acutely aware of being anxious in a range of social situations
after a psychiatrist has labeled them as having Social Anxiety Disorder. And
the implications don’t stop there. A child who is experiencing the significant
loss of a family member may be given the label of Temporary Grief Syndrome and
be prescribed medication, such as anti-depressants, within days. This, in turn,
could heighten their risk of self-harm and even suicide. This is because DSM-5
has removed the ‘Bereavement Exclusion’ clause, which previously protect- ed children
and young people for a period of two months after such a loss.
Could this new
guidance cause long-term psychological harm and even create
psycho-pharmaceutical dependency? And what about a child who is acutely anxious
about family dynamics and the domestic violence they may have witnessed? Would
they benefit from having the pattern of presenting behaviours diagnosed as ADHD
when the medication used for that condition is contra-indicated in severe
anxiety cases? Sadly in many cases this caveat is ignored and once again the
child’s normal pattern of behaviour is pathologised.
‘Medical Model’
explanations that locate the problem as ‘within the child’ are questionable
given their limitations. Many mental health workers now believe that what is
important is not a pseudoscientific label but under- standing what has happened
to the young person to make them behave in a particular way. Dr Lucy Johnstone,
a leading clinical psychologist and trainer, who co-authored the British
Psychological Society’s ‘Good practice guidelines on the use of psychological
formulation’ says that mental distress is often the result of early child- hood
trauma in the context of attachment difficulties. This much more socially
constructed explanation of a young person’s needs and difficulties is more
ethically acceptable to many thousands of child mental health practitioners
around the world than blaming undetectable genetic or biochemical imbalances.
Indeed a spokesperson for the American Psychiatric Association, which publishes
DSM-5, admitted for the first time last year that despite 30 years of waiting
for biomarkers to explain mental health disorders none have actually been
forthcoming for childhood conditions (for a discussion on this see ‘Biomarkers
in psychiatry: drawbacks and potential for misuse’ by Shaheen E Lakhan, Karen
Vieira and Elissa Hamlat ).
The majority of psychologists today believe in this
concept of social constructivism and the fact that patterns of serious
behaviour often result from the interaction and influence of a range of
understandable stressors affecting young minds. These stressors include the
imbalance of adult power by those who were trusted to protect children in their
care, which has played such an important part in the high profile cases that
have dominated our media over the last 20 years. One response to this imbalance
has been to model another abuse of adult power called ‘psychiatric diagnosis’
when a softer and more collaborative psychological formulation is what would be
more helpful to client and professionals alike. Some argue that this misuse of
power is ‘neo-colonial’ in nature (see Derek Summerfield’s article ‘How
scientifically valid is the knowledge base of global mental health?’) and can ‘retraumatise the client’, a conclusion that seems entirely
reasonable when you consider the increasing use made of electro convulsive
therapy (ECT) or very toxic ‘drug cocktails’. So what protective measures,
procedures and protocols can be put into place to better safeguard vulnerable
groups like distressed and anxious children?
One constructive contribution that
I have suggested to UK colleagues who are members of the Health Care
Professions Council (HCPC) is a practical protocol that confers the ‘ethical
legitimacy’ to challenge medics when we have concerns about the mental health
and wellbeing of a young person with whom we jointly work. This ‘Ethical
Legitimacy’ is provided by the HCPC Code of Conduct which states, ‘You must not
do anything, or allow someone else to do anything, that you have good reason to
believe will put the health and safety of a service user in danger. This
includes your own actions and those of other people. You should take
appropriate action to protect the rights of children and vulnerable adults if
you believe they are at risk.’ (Page 8 of the HCPC’s ‘Standards of Conduct.
Performance and Ethics - your duties as a registrant’.
The full protocol is available in the ‘Most popular’ posts on : http://www.cope-yp@blogspot.com
See above link.
The full protocol is available in the ‘Most popular’ posts on : http://www.cope-yp@blogspot.com
See above link.
The way that many concerned educational psychologists are
putting this into practice is to ring the medic who is involved in writing the
prescription, which is usually a psychiatrist or community paediatrician, to
let them know of their concerns. This is a basic step in meeting our ‘safe-
guarding’ obligations. These concerns might include:
• That the
prescription of psychotropic drugs to children who are under five is against UK
medical guidelines, despite being commonplace.
• That the behaviour pattern for which the
child is being given drugs is not apparent in school (so there is no
triangulation of data, as the UK’s National Institute for Health and Care
Excellence recommends).
• That no ‘Drug Holiday’ has been given for an
extended period of time, which is a clear breach of NICE guide- lines.
• That severe side
effects, eg tremors or lethargy, are resulting from the drug regimen and are
causing concern to staff in school or other settings.
• That the ‘drug
cocktail’ a child is on, ie that the combination of drugs may be ‘life
threatening’. Pharmacists can intervene in these cases.
• That there are adverse drug effects of sleep
disturbance and weight loss, which are having an adverse psychological and/or
physical impact on the child.
• That the child has collapsed at school and
been hospital- ised (not as rare as might be thought - two such incidents
occurred in one small area in a 12-month period).
• That parents are
reporting behaviours to access Disabled Living Allowance or other benefits.
• That children who regularly display high
levels of anxie- ty, which is the case with many children we all work with,
should not be prescribed psycho-stimulants like Ritalin Medics contacted in
this way will invariably thank you for taking the time to ring them and will
consequently review the medication.
Other constructive suggestions are to establish effective
multi-professional Pathways, similar to those used for a decade with Autistic
Spectrum Conditions, so that no one professional can ‘diagnose’ a supposed
‘disorder’. This will greatly protect children from dubious diagnoses of
disorders and will ensure that information is properly ‘tri- angulated’ from a
variety of sources before consideration is given to entering a Behaviour
Pathway process.
To borrow a phrase from Professor Allen Frances, who was Editor in Chief of DSM-4, our challenge is to ‘Save Normal’. The broadening bands of inclusive conditions and disorders in DSM-5 must not be allowed to gradually and insidiously destroy the concept of a healthy normality, or that wondrous state of mind we remember as childhood. ·