Medically Defining, Screening, and Treating Conduct Disorder: A French Controversy

For several decades, the use of psychotropic medication has either been regarded as a medical issue or an example of the medicalization of social problems. As the publication in 2005 of a knowledge synthesis on conduct disorder in children and adolescents and the reply of the «Pas de zéro de conduite» collaboration (literally: No F for Conduct) was a highly important event in the French mental health scene, it deserves a thorough discussion. In the hope of improving the practices and policies targeting children and their families, it is essential to gain a better understanding of the bones of contention between the proponents and opponents of a medical or rather biosocial model. To achieve this, we first analyze how this model assigns a central role to certain disorders defined and diagnosed based on constellations of symptoms. We then identify five dimensions which seem to hold center stage in the controversy: genetic susceptibility, neurocognitive deficits and temperament, the familial and social environment seen as a reservoir of stressors, large-scale screening for disorders using simple instruments and multi-modal treatments, including psychotropic medication. We take an interest in the French debate as this allows us to stand back from the models prevailing in North America. It also underscores the importance of multidisciplinary thinking and social sciences when elaborating clinical or political mental health guidelines.