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D
B Double, Send letter to
journal: 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. 399–418. Oxford:
Blackwell. Timimi, S. &
Taylor, E. (2004) ADHD is best understood as
a cultural construct. British Journal of Psychiatry, 184,
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