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Beyond controversies in child mental health: negotiating autism and ADHD diagnosis in France and Brazil

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Abstract

This article explores the local forms that global controversies around autism and ADHD have taken in France and Brazil. Inquiring into the social and historical features of the two contexts makes the abstract, globally circulating ideas meaningful in particular forms, and helps to transcend dichotomies (global/local, biological/relational, mental suffering/disability) through their pragmatic negotiations and integration into the everyday experience of those affected by the conditions. Our research is based on policy reports and regulations, interviews with policy makers, care and school professionals, families, and observations in mental health-care services. We first present inflamed debates in both countries: while autism wars caused the legitimacy of psychoanalysis to be challenged, debates around ADHD focused on the medicalization of social problems. Both controversies impacted policy orientations, the organization of mental health care, and professional knowledge and practices. We discuss the similarities and differences in these transformations in the two countries. We then examine how these controversies unfolded in local configurations of actors and resources. Finally, we call for reflection on how processes of globalization in mental health and local contexts mutually shape each other.

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Notes

  1. While ADHD remains a highly contested illness—it is, in this sense, an “illness you have to fight to get” (Dumit 2006)-, whatever the contestable nature of autism, its very existence is rarely called into question. Instead, how it should be understood or ‘treated’ is what constitutes a field of contestation. We thank one of the anonymous reviewers for calling our attention to this fundamental difference.

  2. In this article, we do not focus specifically on education, although this is the field in which many of the differences in understandings and treatment of these two conditions play out. We are nonetheless aware of the relevance of the field, and we do mention it several times in the article, without examining the issue in depth. As our focus here is on the mental health field and the negotiation of autism and ADHD diagnosis in this area, it is beyond the scope of the article to focus on education as a site of comparison. On the educational implication of autism diagnosis and policies in Brazil, see, for autism, Cascio et al. 2018; Guareschi et al. 2016; Lima et al. 2018; Nascimento et al. 2017; and for ADHD, Beltrame et al. 2019; S. V. Cruz et al. 2016; Leonardo and Suzuki 2016. On the educational implication of autism and ADHD diagnosis and policies in France, see Bailleul et al. 2008; Akrich and Rabeharisoa 2014; Mazereau 2016.

  3. www.pessoacomdeficiencia.gov.br/app/node/888.

  4. www.peticaopublica.com.br/pview.aspx?pi=BR72114.

  5. https://tdah.org.br/tirando-duvidas-direito-das-pessoas-com-tdah.

  6. We opted in this article for leaving out the issue of self-advocacy in both countries since the arc of advocacy in France and Brazil has not leaned heavily toward the self-advocacy model found in countries like the US or the UK. There is an incipient autism self-advocacy community in Brazil, but self-advocates have not been as actively involved in defining policy, education, or inclusion rights as elsewhere. In France, self-advocacy is also relatively weak, although an association of autistic people participated in the preparation of the 2005 law. Moreover, Brazil and France do not present the same fierce opposition between autism self-advocacy and parent-led advocacy as we find in other countries (e.g., the US and the UK). The preferred form of activism in both countries is parent led (Antunes and Dhoest 2018; Chamak 2008; Lima et al. 2018; Nunes and Ortega 2016). As to ADHD, in France, mobilizations are mainly parent led (Rabeharisoa et al. 2014). In Brazil, there is advocacy led by adults living with ADHD, but it is heavily aligned with the biomedical model, disseminating knowledge about the condition and health and education policies, and advancing advocacy and the fight for social and educational inclusion (Ortega and Müller 2020).

  7. Recent anthropological research moves beyond the global/local divide, as evidenced in Escobar’s notion of “glocality” (2001) or in Tsing’s “friction” (2005) to describe zones of global/local engagement (Bemme and D’souza 2014).

  8. In the case of diagnostic consultations, Borelle (2017) showed that professionals take into account not only the clinical ‘truth’ of a diagnosis but also its practical implications, such as the parents' ability to accept a diagnosis, or the implications of the diagnosis in terms of clinical research.

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Acknowledgments

The authors would like to thank the journal’s four anonymous reviewers for detailed and helpful comments on an earlier version of this article.

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Authors and Affiliations

  1. Cermes3 (Centre for Research on Medicine, Science, Health, Mental Health, and Society), Université Paris Descartes, 45 rue des saints pères, 75270, Paris Cedex 06, France

    Aude Béliard & Livia Velpry

  2. ICREA (Catalan Institution for Research and Advanced Studies), Barcelona/Universitat Rovira i Virgili, Medical Anthropology Research Center, Tarragona, Spain

    Francisco Ortega

Authors
  1. Aude Béliard
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  2. Francisco Ortega
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  3. Livia Velpry
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Correspondence to Francisco Ortega.

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Béliard, A., Ortega, F. & Velpry, L. Beyond controversies in child mental health: negotiating autism and ADHD diagnosis in France and Brazil. BioSocieties 17, 619–643 (2022). https://doi.org/10.1057/s41292-021-00234-8

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