What does it mean to experience paediatric depression?: the ethics of mental health diagnosis and treatment in children and adolescents

Abstract

This thesis explores the ethics of mental health diagnosis and treatment in children and adolescents through a collection of different perspectives based on literature analysis and interviews with practising clinicians. Compared to other medical fields, paediatric psychiatry is considerably novel; it has only recently become a medical specialty and differs from other medicine by involving both biological and psychological aspects of care. Recently, human brain development has become better understood, but the effect of mental illness on the trajectory of development is only just beginning to be studied. Despite this limited understanding, children who may not have been diagnosed for psychiatric disorders in the past are increasingly receiving off-label prescription treatments. This trend may be due to improved sensitivity of diagnostic practices as well as the medicalisation of normal, classifying previously healthy borderline behaviours as pathological. What are the implications of increasing medicalisation? How are child-specific diagnoses and treatment plans determined? I focus on identity development in young people with mental disorders, specifically depression, and try to explain the effects of labelling and medication on that development. Also the physiological impact of psychopathology and psychotropic treatment on neurodevelopment is examined, as well as the lack of long-term clinical data for drug treatment in children. Though the key source material has been from literature in the US and UK, the thesis broadens to an international perspective with a global look at the relationship between culture and paediatric psychiatry practices. Finally, mental health care professionals were interviewed to provide a clinical perspective to supplement the literature analysis. By drawing historical, philosophical, psychological, biological, cultural, and professional perspectives together in this novel way, ethical considerations necessary in the psychiatric care of paediatric patients are given a more thorough understanding, and a framework for assessing these considerations is presented through a focused interdisciplinary lens.