When Doctors Rule the World
In 2005, Sami Timimi, a pediatric psychiatrist, suggested in the British Medical Journal that British and American psychiatrists are inappropriately imposing the West's views of mental illness and child rearing on the rest of the world.
Mounting evidence of the role played by powerful drug companies in shaping modern medicine makes Timimi's views then, and in subsequent publications, compelling reading.
Timimi is eerily well situated to comment on the imperialistic aspects of American psychiatry.
Born to an Iraqi father and an English mother, he lived in Iraq until the age of fourteen, when his family relocated to England.
There, as a child from another world, he experienced extreme cultural confusion.
He recalls the efforts of well-intentioned social service professionals to impose upon him a view of child development that seemed utterly foreign.
Years later, in his training to become a psychiatrist, he found the profession's lack of ability to engage with difference in stark contrast to the cultural tolerance and openness of his upbringing.
He describes psychiatry, which prescribes a rigid code of conduct for new recruits, as nothing less than a dictatorship.
"My wish," Timimi writes, "is to question the assumptions, the universals, the constructs, the clinical applications and all those things that make up my job as a child and adolescent psychiatrist...
as a profession we must be able to appreciate the relative nature of the belief systems we use in our work (and therefore hopefully be able to make positive use of other belief systems)" (Pathological, p.
14).
Deconstructing accepted mental health wisdom, he explores its meanings as well as the global consequences of imposing it on humans regardless of culture.
Timimi is also critical of the top-down attitude many practitioners assume toward their clients.
Which do patients find more effective, he asks, the hierarchical, authoritarian approach or the horizontal, egalitarian, side-by-side therapeutic relationship? And what about the costs and benefits that Western cultural values have brought youth and communities?When we British (and Americans) promote independence, autonomy, self-determination, separation, individuation, and self-expression from infancy onward, he argues, we drive a wedge between children and their families.
We also sever each nuclear family from kin, as if it were expected to survive without assistance.
Such Western values intensify isolation and alienation while robbing children of clear-cut adult role models.
But in our time, interdependence has become a watchword.
Dependability and community increasingly count for more than autonomy and independence.
When society treats kinship as being of paramount importance, a broad cultural framework organizes individual, family, and community experience.
Traditional Western psychiatry serves many power hierarchies and functions as a cultural defense mechanism, an imperialistic tool that both denies difference and inflicts on other countries the social miseries associated with our own: juvenile delinquency, alcohol and drug abuse, sexually risky behaviors, and ever proliferating diagnoses of mental health problems in our youngsters.
One-size-fits-all assumptions about child rearing and pathology, Timimi notes, invite us to impose invalid interpretive frameworks on other people.
When we do so we worsen common problems and simultaneously keep ourselves from learning from alternative viewpoints.
Practitioners need to become more sensitive to the different cultural meanings of mental illnesses and the different culturally specific ways of treating them.
Western culture, Timimi argues in a second book, Naughty Boys, actually breeds antisocial behavior by refusing to tolerate it in the very young.
Adults demand that children function independently very early on.
In contrast, Muslim parents traditionally approach children with acceptance, soothing them, avoiding shocks to their systems, and voicing limited expectations until the child is about seven years old.
Aboriginal parents accommodate childish behaviors for even longer, impart cultural values (the importance of sharing food, for example) by role modeling, and greet aggression in a low-key manner.
In many non-Western cultures, undesirable behaviors are viewed as a social, communal problem rather than as evidence of pathology.
The label of attention deficit /hyperactivity disorder (ADHD) has stakeholders in the West, Timimi suggests.
It lets mental health professionals cast themselves as experts and disempowers clients.
It also-surprise, surprise-enriches pharmaceutical companies.
And finally, it conveys social discomfort with the natural behaviors of childhood and especially those of boys.
The answer?Psychiatrists "should support parents in finding effective ways to enforce discipline in their children using their own parental value system providing we are happy with the level of security and love for that child in their family," Timimi writes.
"How much of what we do as child mental health practitioners has become a colonial exercise, that of prescribing for children, families and allied institutions ways of acting that are based on the best interests of capitalist society and not necessarily the best interests of our clients?The West's values may be good for adventure loving middle-class, white males who like having individual gratification, freedom and minimal responsibility, but [are they] good for children?" (pp.
213, 219).
Timimi insists that, in working to help people with their problems, doctors must remain mindful of context at all times.
His deeply humane, provocative books-must reading for mental health providers and their patients-should help us create a richer dialogue between the members of our societies and between the constituent nations of the world.
Discussed in this article: Sami Timimi's article in volume 331 of the British Medical Journal (July 2, 2005), entitled "Effect of Globalisation on Children's Mental Health"; Timimi, Pathological Child Psychiatry and the Medicalization of Childhood (New York: Brunner-Routledge, 2002); Timimi, Naughty Boys: Anti-Social Behavior, ADHD, and the Role of Culture (New York: Palgrave Macmillan, 2005); and Timimi and Begum Maitra, Critical Voices in Child and Adolescent Mental Health (London: Free Association Books, 2006).
Mounting evidence of the role played by powerful drug companies in shaping modern medicine makes Timimi's views then, and in subsequent publications, compelling reading.
Timimi is eerily well situated to comment on the imperialistic aspects of American psychiatry.
Born to an Iraqi father and an English mother, he lived in Iraq until the age of fourteen, when his family relocated to England.
There, as a child from another world, he experienced extreme cultural confusion.
He recalls the efforts of well-intentioned social service professionals to impose upon him a view of child development that seemed utterly foreign.
Years later, in his training to become a psychiatrist, he found the profession's lack of ability to engage with difference in stark contrast to the cultural tolerance and openness of his upbringing.
He describes psychiatry, which prescribes a rigid code of conduct for new recruits, as nothing less than a dictatorship.
"My wish," Timimi writes, "is to question the assumptions, the universals, the constructs, the clinical applications and all those things that make up my job as a child and adolescent psychiatrist...
as a profession we must be able to appreciate the relative nature of the belief systems we use in our work (and therefore hopefully be able to make positive use of other belief systems)" (Pathological, p.
14).
Deconstructing accepted mental health wisdom, he explores its meanings as well as the global consequences of imposing it on humans regardless of culture.
Timimi is also critical of the top-down attitude many practitioners assume toward their clients.
Which do patients find more effective, he asks, the hierarchical, authoritarian approach or the horizontal, egalitarian, side-by-side therapeutic relationship? And what about the costs and benefits that Western cultural values have brought youth and communities?When we British (and Americans) promote independence, autonomy, self-determination, separation, individuation, and self-expression from infancy onward, he argues, we drive a wedge between children and their families.
We also sever each nuclear family from kin, as if it were expected to survive without assistance.
Such Western values intensify isolation and alienation while robbing children of clear-cut adult role models.
But in our time, interdependence has become a watchword.
Dependability and community increasingly count for more than autonomy and independence.
When society treats kinship as being of paramount importance, a broad cultural framework organizes individual, family, and community experience.
Traditional Western psychiatry serves many power hierarchies and functions as a cultural defense mechanism, an imperialistic tool that both denies difference and inflicts on other countries the social miseries associated with our own: juvenile delinquency, alcohol and drug abuse, sexually risky behaviors, and ever proliferating diagnoses of mental health problems in our youngsters.
One-size-fits-all assumptions about child rearing and pathology, Timimi notes, invite us to impose invalid interpretive frameworks on other people.
When we do so we worsen common problems and simultaneously keep ourselves from learning from alternative viewpoints.
Practitioners need to become more sensitive to the different cultural meanings of mental illnesses and the different culturally specific ways of treating them.
Western culture, Timimi argues in a second book, Naughty Boys, actually breeds antisocial behavior by refusing to tolerate it in the very young.
Adults demand that children function independently very early on.
In contrast, Muslim parents traditionally approach children with acceptance, soothing them, avoiding shocks to their systems, and voicing limited expectations until the child is about seven years old.
Aboriginal parents accommodate childish behaviors for even longer, impart cultural values (the importance of sharing food, for example) by role modeling, and greet aggression in a low-key manner.
In many non-Western cultures, undesirable behaviors are viewed as a social, communal problem rather than as evidence of pathology.
The label of attention deficit /hyperactivity disorder (ADHD) has stakeholders in the West, Timimi suggests.
It lets mental health professionals cast themselves as experts and disempowers clients.
It also-surprise, surprise-enriches pharmaceutical companies.
And finally, it conveys social discomfort with the natural behaviors of childhood and especially those of boys.
The answer?Psychiatrists "should support parents in finding effective ways to enforce discipline in their children using their own parental value system providing we are happy with the level of security and love for that child in their family," Timimi writes.
"How much of what we do as child mental health practitioners has become a colonial exercise, that of prescribing for children, families and allied institutions ways of acting that are based on the best interests of capitalist society and not necessarily the best interests of our clients?The West's values may be good for adventure loving middle-class, white males who like having individual gratification, freedom and minimal responsibility, but [are they] good for children?" (pp.
213, 219).
Timimi insists that, in working to help people with their problems, doctors must remain mindful of context at all times.
His deeply humane, provocative books-must reading for mental health providers and their patients-should help us create a richer dialogue between the members of our societies and between the constituent nations of the world.
Discussed in this article: Sami Timimi's article in volume 331 of the British Medical Journal (July 2, 2005), entitled "Effect of Globalisation on Children's Mental Health"; Timimi, Pathological Child Psychiatry and the Medicalization of Childhood (New York: Brunner-Routledge, 2002); Timimi, Naughty Boys: Anti-Social Behavior, ADHD, and the Role of Culture (New York: Palgrave Macmillan, 2005); and Timimi and Begum Maitra, Critical Voices in Child and Adolescent Mental Health (London: Free Association Books, 2006).
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