El Ouardani Christine N
Department of Human Development, California State University Long Beach, 1250 Bellflower Blvd, Long Beach, CA, 90840, USA.
Cult Med Psychiatry. 2017 Mar;41(1):94-110. doi: 10.1007/s11013-016-9506-7.
Based on 9 months of ethnographic fieldwork in a U.S. mental health clinic focused on the treatment of preschool-aged children who exhibited extremely disruptive behavior, this article examines the contradictions clinicians faced when trying to identify and attribute "intentionality" to very young children. Disruptive, aggressive behavior is one of the central symptoms involved in a wide-range of childhood psychopathology and the number one reason young children are referred to mental health clinics in the United States. In the clinic where I conducted my research, clinicians were especially interested in diagnosing these children with oppositional defiant disorder (ODD), in order to identify those at risk for more serious mental illness later in the lifecourse. In this article, I look at the different strategies clinicians used in interpreting whether aggressive, defiant behavior was a part of the child's "self," a biologically driven symptom of a disease, or a legitimate reaction to problematic social environments. I argue that conceptualizing intentionality as a developmental, interpersonal process may help to make sense of the multiple discourses and practices clinicians used to try to reconcile the contradictions inherent in diagnosing ODD.
基于在美国一家心理健康诊所进行的为期9个月的人种志田野调查，该诊所专注于治疗表现出极度破坏性行为的学龄前儿童，本文探讨了临床医生在试图识别非常年幼的儿童的“意图性”并将其归因时所面临的矛盾。破坏性行为和攻击性行为是广泛的儿童精神病理学所涉及的核心症状之一，也是美国幼儿被转介到心理健康诊所的首要原因。在我进行研究的诊所里，临床医生对诊断这些儿童患有对立违抗障碍（ODD）特别感兴趣，以便识别那些在生命后期有患更严重精神疾病风险的儿童。在本文中，我研究了临床医生用于解释攻击性行为和违抗行为是儿童“自我”的一部分、疾病的生物学驱动症状还是对有问题的社会环境的合理反应的不同策略。我认为，将意图性概念化为一个发展性的、人际间的过程，可能有助于理解临床医生用来调和诊断ODD所固有的矛盾的多种话语和实践。
