The Medicalization of Misbehavior


What social workers and psychologists need to know

This presentation begins with a broad survey of the change in the incidence and prevalence of mental health diagnoses over the past 20 years (this presentation can be customized for either the United States or Canada). In this presentation we especially consider the surge in the diagnoses of ADHD and Oppositional Defiant Disorder. I describe a phenomenon which I call “the medicalization of misbehavior.” This phenomenon is almost uniquely North American. When I have visited schools in England and Scotland and New Zealand and Australia (at more than 50 different venues in the past 10 years), I have observed that the boy or girl who is disrespectful, who talks back to the teacher, will be rebuked for being disrespectful. The parents will be told that this behavior is not acceptable and that their child must behave better or risk expulsion – very similar to the conversation which might have taken place in the United States or Canada 30 years ago. But today, a boy exhibiting the same behavior may very well prompt the school counselor or social worker to say something like, “Your son is displaying behaviors which suggests that he may meet criteria for Oppositional Defiant Disorder, diagnosis code F91.3.

What’s the difference between saying “Your son is rude, defiant, and ill-tempered. That must change” and saying “Your son may meet criteria for a psychiatric disorder” ? In one sense, there isn’t much difference: those two sentences may both accurately describe the same boy. But in the first sentence, Your son is rude, the burden of responsibility is clearly on the parent and child. In the second sentence, Your son may meet criteria for a psychiatric disorder, the burden of responsibility has shifted away from the family and client, to the system. This shift is one factor which has fuelled the rise in the prescribing of psychotropic medications for children and teenagers. Professionals must understand this process, and the ways in which American and Canadian medical professionals have been co-opted by American pharmaceutical companies, if they are to be effective advocates for their clients, and work effectively with them.

For more on this point, please see my article “Child psychiatry is sick with hidden conflicts of interest”,; my invited commentary for the New York Times on the overuse of stimulant medications,; and my op-ed for the Wall Street Journal on the North American tendency to over-diagnose psychiatric disorders.

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