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The social and cultural construction of psychiatric knowledge: an analysis of NICE guidelines on depression and ADHD.

Moncrieff, J; Timimi, S; (2013) The social and cultural construction of psychiatric knowledge: an analysis of NICE guidelines on depression and ADHD. Anthropol Med , 20 (1) 59 - 71. 10.1080/13648470.2012.747591. Green open access

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Abstract

The current paper presents an analysis of the NICE guidelines on depression and attention deficit hyperactivity disorder (ADHD) from the perspective of the philosophy of science, guided particularly by Foucault's notion of the symbiosis of knowledge and power. It examines how data that challenged the orthodox position on the validity and drug treatment of these conditions was managed in the process of guideline development. The depression guideline briefly considered the complexity and heterogeneity of depression, and numerous methodological problems with evaluating treatments, including antidepressants. However, the guideline recommendations made no reference to these issues and ignored evidence that questioned the analysis of antidepressant trials. The guideline on ADHD reviewed validity, but did not consider evidence from the critical literature, and overlooked inconsistencies in the data. The guideline identified that drug trials have shown no long-term benefit in ADHD, but still recommended treatment with stimulant drugs for children with severe symptoms and for all adults claiming consensus for this position. Both guidelines demonstrate how contradictory data are managed so as not to jeopardise the currently predominant view that ADHD and depression are valid and un-contentious medical conditions that should be treated with drugs. The subjective nature of guideline formation that is revealed illustrates Foucault's suggestion that the authority of medicine operates to promote a technological view of the nature of certain human problems, which in turn strengthens medical hegemony over these areas.

Type: Article
Title: The social and cultural construction of psychiatric knowledge: an analysis of NICE guidelines on depression and ADHD.
Location: England
Open access status: An open access version is available from UCL Discovery
DOI: 10.1080/13648470.2012.747591
Publisher version: http://dx.doi.org/10.1080/13648470.2012.747591
Language: English
Additional information: © 2013 The Author(s). Published by Taylor & Francis This is an Open Access article distributed under the terms of the Creative Commons Attribution License http://creativecommons.org/licenses/by/3.0/, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. The moral rights of the named author(s) have been asserted.
Keywords: Anthropology, Medical, Attention Deficit Disorder with Hyperactivity, Central Nervous System Stimulants, Child, Culture, Depression, Evidence-Based Medicine, Humans, Mental Health Services, Practice Guidelines as Topic, Social Values
UCL classification: UCL
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Brain Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Brain Sciences > Division of Psychiatry
URI: https://discovery.ucl.ac.uk/id/eprint/1427418
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