Parents, clinicians and the genesis of a contested diagnosis: The development of knowledge surrounding pediatric bipolar disorder in the United States

Abstract

The diagnosis of paediatric bipolar disorder (PBD) has emerged as an object of controversy in the United States over the last two decades as it continues to expand despite a lack of professional consensus surrounding diagnostic criteria. At the same time there is a push among American parents for greater acknowledgement and awareness of their position, as well as clinical alignment with what they see as indicative of the disorder. Interaction between these two groups, and their local systems of professional versus experiential knowledge, provides insight into how a contested disorder is constructed by competing knowledge systems, shedding light on psychosocial processes leading to diagnostic expansion. This paper presents findings from thematic dialogical analyses of interviews with 10 American child psychiatrists and 15 parents of children with PBD. Using a socio-psychological framework emphasizing modalities of social influence and cognitive polyphasia, the circular influence at play among and between these two key actors in the genesis and development of PBD as a diagnostic category will be explored. This paper is very much grounded in scholarship related to the medicalization of childhood, and the construction of related diagnoses such as ADHD and Autism, however much of the literature on PBD remains in the clinical realm. As a disorder still attempting to establish itself, an exploration into the wider social and cultural factors shaping negotiated interactive processes behind how PBD emerges and takes hold is warranted.