Conceptualizing the mental disorders in children and adolescents

I critically explore the assumption of the DSM and theorists such as Wakefield and Gert that mental disorder must be attributed to an individual rather than a group of people. This assumption is especially problematic in child and adolescent psychiatry where very often the focus of clinical attention is the family system. There is of course substantial evidence that some mental disorders of individuals are caused by their relationships with other people and that their recovery is greatly facilitated by treating the group, such as a family, as a whole. However, there has been much less conceptual work on defining what it might be for a couple, family or other group to itself be attributed a mental disorder. To address this issue, I employ a debate between Wakefield (2000), Murphy and Woolfolk (2000) on whether it is part of the concept of a mental disorder that it is caused by an internal malfunction of a person. I also discuss the proposal of Bolton (2000) that we do away with the concept of mental disorder altogether and instead use a broader concept of mental health problem. I argue that ultimately it is not an a priori conceptual truth that mental disorders are individual, and we need to bring in pragmatic considerations to decide whether it is helpful to restrict ourselves to such a definition or whether we could be better served by a more expansive definition. I link this to the philosophical view of pragmatism and argue that a pluralistic nonreductive approach is especially appropriate in child and adolescent psychiatry.