Sami Timimi on ADHD, Autism and Children's Mental Health
On the future of mental health
Posted Apr 01, 2016
The following interview is part of a “future of mental health” interview series that will be running for 100+ days. This series presents different points of view about what helps a person in distress. I’ve aimed to be ecumenical and included many points of view different from my own. I hope you enjoy it. As with every service and resource in the mental health field, please do your due diligence. If you’d like to learn more about these philosophies, services, and organizations mentioned, follow the links provided.
Interview with Sami Timimi
EM: You are the author of Naughty Boys: Anti-Social Behaviour, ADHD and the Role of Culture. Can your share some of the headlines of that book?
ST: This book is all about how our cultural context shapes our beliefs and practices, not only with regard to how we rear children, but more broadly, such as how we make sense of what childhood, child development, and family life are.
Our professional constructs (such as the diagnoses used by psychiatrists, psychologists and others), do not reflect any advance in 'scientific' discovery, but just another set (albeit a highly influential one) of cultural beliefs and practices - ones that I suggest have many negative, unintended consequences.
Using diverse sources such as literature from sociology, psychology, medicine, anthropology, history, and philosophy, I discuss how Western society's political, social and economic value system puts high levels of stress on children and families. Focusing on the behavior of boys, I argue that diagnoses like ADHD reflects an ambivalence that neoliberal Western culture has toward children that is often manifest in the tendency to problematise 'childish' behaviors and then 'medicalise' them, sparing all concerned from the more difficult task of accepting, understanding and supporting the imperfect and often contradictory ways children develop and find emotional security.
EM: You are also the author of A Straight Talking Introduction to Children’s Mental Health. What are some its highlights and main points?
ST: This is one in an edited series of books by PCCS book that is aimed at members of the public. This particular book is written with a readership such as parents and teachers in mind. It provides information that will help people who are involved with children who are experiencing emotional or behavioral problems, make informed decisions.
The book outlines a 'social construction' perspective and the evidence (or rather lack of it) supporting the idea that child psychiatric diagnoses are valid and reliable. It also discusses the evidence behind the various treatment options (psychological and pharmacological) available, illustrating some of the pitfalls of choosing to go down a medication route (such as the evidence of poor long term outcomes) and the lack of evidence that any particular 'brand' of psychotherapy has better effectiveness than any of the hundred or so others. There is a chapter that outlines ideas on 'how to get help' and some issues that parents/teachers might find it helpful to think about and try before seeking professional help.
EM: You are likewise the author of The Myth of Autism: Medicalising Men’s and Boys’ Social and Emotional Competence. Can you tell us a bit about it?
ST: Rates of diagnosis of autism has reached what some consider 'epidemic' proportions, rising from 0.04% of the population to about 1.5% in just five decades. Debates rage about possible causes and treatments, but, prior to this book, few had raised the more fundamental question of whether the concept of 'autism' itself was the main problem for the repeated failure to figure out what autism 'is' (at the biological and/or psychological level) and how best to treat it.
Co-written with two people who have themselves received a diagnosis of an autistic disorder, we discuss the science (or rather lack of it) and politics that have contributed to building the concept of autism and conclude that the popularity of the label is because of social and political issues rather than the result of any scientific breakthroughs.
From a biological point of view the evidence suggests there is no such thing as a discrete condition of 'autism.' From a clinical point of view, we conclude that 'autism' is a diagnosis that has the potential to cause harm, whilst assisting little in helping us understand what sort of therapeutic endeavor may prove most helpful to any particular individual. We therefore come to the radical conclusion that autism, as a diagnosis, should no longer be used.
EM: What are your thoughts on the current, dominant paradigm of diagnosing and treating mental disorders and the use of so-called psychiatric medication to treat mental disorders in children, teens and adults?
ST: The dominant paradigm is broken and unfixable. It is unscientific and, based on available figures for outcomes achieved by mainstream mental health services, profoundly harmful. The only way I can see to move forward from this disaster is for commissioning and payment of services to stop being based on diagnoses and for the accompanying narrow biomedical model of mental health to be scrapped.
For the many available alternatives to flourish (such as payment/commissioning by outcome/recovery), it is my conclusion that we must first do away with diagnostic/technical based models. The evidence points to successful mental health work being profoundly relational and contextual, and this is where a 'rational' approach to training and service delivery, should therefore focus its efforts.
However, I have also discovered that in our current economic/political system, science has little to do with what becomes successful at a societal level. In neoliberal cultures its all about money and marketing. The marketing power of the promise of a technical/scientific solution to the complexities of being human wins most times (what I call marketing 'scientism' - science as a faith system, rather than an evidence based appraisal system).
Our hope for change, I believe, lies in challenging the power of psychiatry and psychology, patents running out for drug companies, public skepticism, service user movements, and campaigns such as the ones against DSM 5 reaching ever-larger audiences. I believe that eventually change is inevitably as 'you can't fool all the people all the time' as the saying goes. We shall have to wait and see when that tipping point that leads to system wide change will come.
EM: If you had a loved one in emotional or mental distress, what would you suggest that he or she do or try?
ST: It pains me as a psychiatrist to say this, but as things stand I would recommend that you avoid seeing a psychiatrist. I know may great psychiatrists, but without personal recommendation, given the nature of current dominant models, you are putting your loved one in danger of being prescribed medications that may lead to some short term gain at the expense of long term enslavement to a 'chronic' disease model, addiction to difficult to come off meds and lack of empowerment to take control of finding a path for their own recovery.
Beyond that, given that each situation is unique, I only have rather banal advice such as accept, understand, talk to that person, and try and remain inclusive of them in your family/community life. You may wish to help them find a counselor, but only if they want to. Personally I would prefer to see a counselor/therapist who does some form of outcome monitoring (to help us understand if I am perceiving any change in my distress levels) and able, if needed, to meet with other members of my social network (able to keep a 'context rich' perspective).
Sami Timimi is a Consultant Child and Adolescent Psychiatrist and Director of Medical Education in the National Health Service in Lincolnshire and a Visiting Professor of Child Psychiatry and Mental Health Improvement at the University of Lincoln, UK. He writes from a critical psychiatry perspective on topics relating to mental health and childhood and has published over a hundred articles and tens of chapters on many subjects including childhood, psychotherapy, behavioral disorders and cross-cultural psychiatry.
He has authored 4 books including Naughty Boys: Anti-Social Behaviour, ADHD and the Role of Culture, co-edited 4 books including, with Carl Cohen, Libratory Psychiatry: Philosophy, Politics and Mental Health, and co-authored 2 others including, with Neil Gardiner and Brian McCabe, The Myth of Autism: Medicalising Men’s and Boys’ Social and Emotional Competence.
Eric Maisel, Ph.D., is the author of 40+ books, among them The Future of Mental Health, Rethinking Depression, Mastering Creative Anxiety, Life Purpose Boot Camp and The Van Gogh Blues. Write Dr. Maisel at firstname.lastname@example.org, visit him at http://www.ericmaisel.com, and learn more about the future of mental health movement at http://www.thefutureofmentalhealth.com
To learn more about and/or to purchase The Future of Mental Health visit here
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