Academic journal article The Hastings Center Report

Psychiatry and Values

Academic journal article The Hastings Center Report

Psychiatry and Values

Article excerpt

This issue of the Hastings Center Report includes a special report that comes out of a three-year Hastings Center research project on controversies surrounding the diagnosis and treatment of mental disorders in children. Over the last couple of decades, the number of children diagnosed with mental disorders has risen significantly, and so, too, has the number of children prescribed medications. Some critics have accused psychiatry of overdiagnosis--of sometimes diagnosing children with psychiatric disorders when their behavior is actually within the range of normal. This controversy led Erik Parens and Josie Johnston, authors of the report and the Hastings Center investigators in this project, to ask what a psychiatric diagnosis is: what kind of statement is it? Is it just a statement of fact? Or does it necessarily reflect individual and cultural values? Similarly, how does a treatment decision work?

These matters are exceedingly complex, Parens and Johnston argue. Both the diagnosis of a disorder and the decision about how to treat a disorder (when one is diagnosed) incorporate value judgments at several junctures. This dependence on value judgments helps explain disagreements in diagnosis and treatment. Of course, both diagnosis and treatment also incorporate facts that everyone can agree to, and ultimately, some factual claims about diagnosis are possible. One of the most significant of these noted in the report is that a careful examination of diagnostic patterns in pediatric psychiatry reveals not just overdiagnosis but also misdiagnosis and underdiagnosis.

The special report is part of a growing body of work at the Center that looks at how "normal" is defined and deployed. …

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