Pathological Child Psychiatry and the Medicalization of Childhood

Sami Timimi

Brunner-Routledge, £15.99, pp 190

ISBN 1 58391 216 9

Rating:

When asked to review this book I leapt at the opportunity. Children who are in some way “failing” represent a significant proportion of the referrals to my clinic. Despite the rather scathing way that many professionals, including some doctors, refer to diagnosis as “the medical model” (always used pejoratively), many parents and many other professionals welcome a diagnosis. Being too lively is ADHD (attention deficit hyperactivity disorder); clumsiness is dyspraxia; failing any of the three Rs is dyslexia; odd mannerisms or a poor social mechanism suggests an autistic spectrum disorder. The medicalisation of childhood, perhaps? And resources and benefits (such as educational support and Disability Living Allowance, respectively) follow diagnosis. Health professionals, education services, social workers, and Benefits Agency staff sit up and take notice at certain diagnoses, however much they may claim not to.

I was disappointed. This book is very much a personal view and, I suspect, rather cathartic for Timimi. He writes in an autobiographical style, and draws on his experience as a teenage immigrant from Iraq. He clearly wants to get a few things off his chest about his training. Describing his book as “an act of resistance” shows that perhaps Timimi views himself as a maverick.

The first six chapters are a mixture of philosophy and grievances with children's mental health services. I am not sure whether his previous consultants will recognise themselves from his descriptions, but this is obviously a book that Timimi could publish only once he had become a consultant himself. He might feel that this proves his point that child psychiatry is not open to novel ideas, approaches, or criticism. Chapter seven is the one bright spot, with examples focusing on ADHD (although there are other brief anecdotes scattered through the book). However, Timimi starts the next chapter with a sentence that occupies the whole of the first paragraph. The discussions of postmodernism and the philosophical arguments did just what the ball did to the goalkeeper of England's football team—they went over my head.

Child and adolescent mental health services certainly need a good shake up, but this book is not part of the answer. Although the book is aimed at professionals in mental health services, I think it is more likely to become popular as a text on sociology courses. It was of little value to this jobbing neurodevelopmental paediatrician in a district hospital.