Psychiatry beyond the current paradigm

Bracken, Pat; Thomas, Philip; Timimi, Sami; Asen, Eia; Behr, Graham; Beuster, Carl; Bhunnoo, Seth; Browne, Ivor; Chhina, Navjyoat; Double, Duncan; Downer, Simon; Evans, Chris; Fernando, Suman; Garland, Malcolm; Hopkins, William A.; Huws, Rhodri; Johnson, Bob; Martindale, Brian; Middleton, Hugh; Moldavsky, Daniel; Moncrieff, Joanna; Mullins, Simon; Nelki, Julia; Pizzo, Matteo; Rodger, James; Smyth, Marcellino; Summerfield, Derek; Wallace, Jeremy; Yeomans, David

doi:10.1192/bjp.bp.112.109447

Cited by 385 publications

(269 citation statements)

References 49 publications

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“…The “common factors” evidence-based literature demonstrates that specific techniques are not as important as contextual factors and the human relationship in therapy. The technical aspect of care (matching treatment to diagnosis) has little impact on outcomes, whereas relational and contextual aspects of care are crucial (Bracken et al, 2012; Dunacn et al, 2010). Below are a few ideas that I and colleagues use and that start from a “social construction” assumption and use a context and relationship rich perspective.…”

Section: Treating Adhd As a Social Constructmentioning

confidence: 99%

Non-diagnostic based approaches to helping children who could be labelled ADHD and their families

Timimi

2017

International Journal of Qualitative Studies on Health and Well

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Mental health services are not always good for you. There are some troubling facts to confront such as the increase in the use of diagnostic based approaches and psychotropic medications for children and young people being associated with poorer rather than better outcomes. In this article I will outline some of the evidence around outcome as a result of treatment for young people diagnosed with attention deficit hyperactivity disorder (ADHD) and for those who are prescribed long-term stimulants. I will then discuss clinical approaches that move beyond a focus on symptom management that diagnostic paradigms encourage. This includes clinical models that take account of the diversity of contextual and relational issues that young patients present with and the possibility afforded of engaging in more positive and hopeful therapeutic approaches such as the Relational Awareness Programme (RAP).

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Section: Treating Adhd As a Social Constructmentioning

confidence: 99%

Non-diagnostic based approaches to helping children who could be labelled ADHD and their families

Timimi

2017

International Journal of Qualitative Studies on Health and Well

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“…Bracken et al, 2012), these social perspectives leave analytical gaps. They can diminish normativity, for example in terms of the potential significance of the mental health system in preserving life.…”

Section: Social Perspectives Of Mental Distress and Explanation Of Pomentioning

confidence: 99%

Why do people with mental distress have poor social outcomes? Four lessons from the capabilities approach

Brunner

2017

Social Science & Medicine

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a b s t r a c tMacro level data indicate that people experiencing mental distress experience poor health, social and economic outcomes. The sociology of mental health has a series of dominant competing explanations of the mechanisms at personal, social and structural levels that generate these poor outcomes. This article explains the limitations of these approaches and takes up the challenge of Hopper (2007) who in this journal proposed the capabilities approach as a means of normatively reconceptualising the experiences of people with mental distress, with a renewed focus on agency, equality and genuine opportunity. Using an innovative methodology to operationalise the capabilities approach, findings from an in-depth qualitative study exploring the lived experiences of twenty-two people with recent inpatient experience of psychiatric units in Scotland are presented. The paper demonstrates that the capabilities approach can be applied to reconceptualise how unjust social outcomes happen for this social group. It distinguishes how the results of using a capabilities approach to analysis are distinct from established dominant analytical frameworks through four added features: a focus on actual lived outcomes; the role of capabilities as well as functionings; being normative; and incorporating agency. The capabilities approach is found to be an operationalisable framework; the findings have implications for professionals and systems in the specific context of mental health; and the capabilities approach offers a fertile basis for normative studies in wider aspects of health and wellbeing.

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“…Desde esta perspectiva se asume que detrás de cada categoría diagnóstica existe un proceso fisiopatológico en el sistema nervioso, el cual es atribuido hipotéticamente a una conjunción de factores genéticos y ambientales, que generarían una alteración en la fisiología normal de alguna estructura del sistema nervioso. Según este modelo, cuando un proceso tal se instaura, da lugar a una serie de alteraciones cognitivas y comportamentales que son consideradas la expresión sintomá-tica de la fisiopatología subyacente (Bracken, Thomas, Timimi & Yeomans, 2012;Read, Mosher & Bentall, 2015). De este enfoque ha surgido la promesa de que la investigación neurobiológica, a medida que incorpore nuevas tecnologías, será capaz de descifrar los mecanismos fisiopatológicos específicos de los distintos trastornos psiquiátricos y generar pruebas de laboratorio para identificar sus marcadores biológicos (Bracken et al, 2012).…”

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“…Según este modelo, cuando un proceso tal se instaura, da lugar a una serie de alteraciones cognitivas y comportamentales que son consideradas la expresión sintomá-tica de la fisiopatología subyacente (Bracken, Thomas, Timimi & Yeomans, 2012;Read, Mosher & Bentall, 2015). De este enfoque ha surgido la promesa de que la investigación neurobiológica, a medida que incorpore nuevas tecnologías, será capaz de descifrar los mecanismos fisiopatológicos específicos de los distintos trastornos psiquiátricos y generar pruebas de laboratorio para identificar sus marcadores biológicos (Bracken et al, 2012). Dado que este enfoque considera que los trastornos psiquiátricos son cerebrales, sus defensores han argumentado que la noción de trastorno mental debe ser redescripta en términos cerebrales (Andreasen, 2001).…”

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“…La principal crítica surge precisamente del análisis cuidadoso de la evidencia científica existente, pues se ha encontrado que en numerosos casos dicha evidencia no apoya los supuestos del modelo (Timimi, 2014;Chaufan & Joseph, 2013). En particular, respecto a la etiología no ha sido posible encontrar marcadores biológicos que tengan utilidad clínica para ningún trastorno psiquiátrico (Bracken et al, 2012;Chaufan & Joseph, 2013;…”

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Filosofía de la mente y Psiquiatría alcances y límites de una perspectiva naturalista para el estudio de los delirios

Vilatta

2017

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En el presente artículo me concentraré en el estudio filosófico de los delirios, como un caso ejemplificador del vínculo que pueden establecer la filosofía de la mente y la psiquiatría. Frente a versiones radicalmente naturalistas, que proponen variantes reduccionistas o eliminativistas para la explicación de ciertos fenómenos mentales y sus variantes “anormales”, defenderé una versión moderada de la perspectiva naturalista. Al respecto, señalaré que retener algún grado de simpatía hacia el naturalismo en las investigaciones filosóficas sobre los delirios es necesario para desarrollar teorías sobre las creencias empíricamente informadas que no resulten contradictorias con los desarrollos actuales en psicología cognitiva y neurociencias. No obstante, afirmaré también que una perspectiva exclusivamente naturalista -tanto por parte de la filosofía como de la psiquiatría misma- es incapaz de dar cuenta del contexto normativo en donde juegan las creencias. Los criterios normativos, especialmente externos (sociales y pragmáticos) que se emplean para clasificar ciertas creencias como delirantes no resultan inteligibles bajo una explicación puramente natural. Por el contrario, para comprender las creencias delirantes qua delirantes, será preciso acercarnos a un abordaje híbrido que pueda contemplar las causas naturales del fenómeno así como su evaluación normativa.

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Psychiatry beyond the current paradigm

Cited by 385 publications

References 49 publications

Non-diagnostic based approaches to helping children who could be labelled ADHD and their families

Non-diagnostic based approaches to helping children who could be labelled ADHD and their families

Why do people with mental distress have poor social outcomes? Four lessons from the capabilities approach

Filosofía de la mente y Psiquiatría alcances y límites de una perspectiva naturalista para el estudio de los delirios

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