Frigerio Alessandra, Montali Lorenzo, Fine Michelle
University of Milano-Bicocca, Italy.
Health (London). 2013 Nov;17(6):584-604. doi: 10.1177/1363459312472083. Epub 2013 Feb 14.
Attention deficit/hyperactivity disorder is currently the most debated childhood psychiatric diagnosis. Given the circulation of competing perspectives about the 'real' causes of children's behaviour and the 'best' way to treat them, we aim to analyse the interactions of the central social actors' discourses about attention deficit/hyperactivity disorder children within the Italian context. Adopting a multi-method approach, we focus on the polyphonic chorus of voices surrounding the child, studying the discourses of mental health professionals, teachers and parents. These actors are representative of three contexts that are deeply engaged with attention deficit/hyperactivity disorder: medical institutions, schools and families. Our theoretical and methodological approach integrates positioning theory, the Bakhtinian notion of dialogical thinking and discourse analysis to study stakeholders' reflexive and interactive positioning in terms of the attribution of rights, duties, responsibilities and power issues. The results show that mutual blame is a constitutive element of relational dynamics among the key adults surrounding attention deficit/hyperactivity disorder children. We argue that these conflicting relationships are not merely related to the debate regarding the validity of the attention deficit/hyperactivity disorder diagnosis. Rather, the mutual blame centres on questions of compliance, recognition of authority and morality. Through the blame game, adults negotiate their own and others' subjectivity in ways that simultaneously (re)produce power relationships and resistance efforts.
注意缺陷多动障碍是目前最具争议的儿童期精神疾病诊断。鉴于围绕儿童行为“真正”原因及“最佳”治疗方式存在相互竞争的观点，我们旨在分析意大利背景下核心社会行为者关于注意缺陷多动障碍儿童的话语互动。我们采用多方法途径，聚焦围绕儿童的多种声音，研究心理健康专业人员、教师和家长的话语。这些行为者代表了与注意缺陷多动障碍密切相关的三个背景：医疗机构、学校和家庭。我们的理论和方法途径整合了定位理论、巴赫金的对话思维概念和话语分析，以研究利益相关者在权利、义务、责任和权力问题归属方面的反思性和互动性定位。结果表明，相互指责是围绕注意缺陷多动障碍儿童的关键成年人之间关系动态的构成要素。我们认为，这些冲突关系不仅与关于注意缺陷多动障碍诊断有效性的辩论有关。相反，相互指责集中在顺从、对权威的认可和道德问题上。通过指责游戏，成年人以同时（再）产生权力关系和抵抗努力的方式协商自己和他人的主体性。
