Roberts, Jane
(2016)
Paediatric bipolar disorder in the United States and England: psychosocial processes shaping the emergence of a contested diagnosis.
PhD thesis, London School of Economics and Political Science.
Abstract
This thesis investigates the genesis, knowledge and practice of paediatric bipolar disorder (PBD) in the US and England. Using a social representations framework, the thesis expands the socio-cultural psychology of medicalisation to elucidate how an emergent condition moves across cultures through the interaction, transmission and application of multiple forms of knowledge. The research design was comparative and multi-method, comprising three empirical studies, each studying key actors in the diagnostic process. Study 1 examined the ‘voice’ of the pharmaceutical industry incorporating analysis of de-classified internal industry court documents, marketing plans, and pharmaceutical advertisements. Study 2 drew on eighteen in-depth interviews with clinicians and study 3 was drawn from twenty in-depth interviews with parents, both in the US and England. Results show that the pharmaceutical industry uses unstable representations of PBD, and childhood itself, to expand market possibilities of what mental illness in a child could look like. Clinicians in both contexts struggle with pressures to be certain in the face of something unstable, anchoring representations of PBD in what they already know. For American clinicians, parents are allies shaping PBD as distinct from adult bipolar while the child is in need of early diagnosis and management; English clinicians approach PBD as adult bipolar and place the child in context, keeping the diagnosis rare. Parents in both the US and England feel frustrated and cast aside; American parents channel this into a sense of agency, developing ‘experiential expertise’, while in England, parents position themselves as amateurs ,confronting wider hierarchies within which they feel helpless. Overall, the thesis concludes that diagnostic practices are driven by processes of social representation and social influence: definitions of PBD, and its emergence as a diagnosis, are extrinsic to the condition itself, forged instead at the meeting point in which actors, cultures and multiple systems of knowledge and experience interact.
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