There is a widening gap between the medical model of dementia and critical sociological perspectives of the condition. Given the relative failure of reductionism in dementia and its rising prevalence, consideration of the utility of these critical viewpoints is warranted. This article considers how these ideas, which challenge some prevailing assumptions about dementia, can be meaningfully applied in conjunction, rather than in competition, with conventional clinical ideas. To illustrate this, current perspectives on selfhood, biopolitics, citizenship and post-humanism are discussed. This article may also help to articulate sociologically oriented approaches already used by some clinicians and legitimise the time and attention needed to explore and deliver these. We support the view that dementia is an episteme in the making and that different traditions and dispositions can fruitfully collide to enliven interdisciplinary conversations about dementia and dementia care.

Criticism of the biomedical model of psychiatry that regards mental illness as brain disease has been labelled ‘anti-psychiatry’. Critical psychiatry arises out of so-called anti-psychiatry, but has additional roots in transcultural psychiatry, its alliance with psychiatric user/survivor groups, and the methodological critique of the neuroscientific basis of mental health problems and psychiatric treatment effectiveness. It is not opposed to psychiatry as such and argues for a person-centred shift for practice and research. This article discusses how a more truly biopsychosocial model, which critiques the biomedical model to produce a more relational practice, is needed not only for psychiatry but also for medicine in general.

Critical trends in psychiatry are abundant today. Their impact on how psychiatry is currently practised is considerable. Yet what deserves close examination is the extent to which these modes of critique (anti-psychiatry, liberation movements, activism, existential, narrative or hermeneutic approaches, theories of values, psychoanalysis) inherently belong to or have become part of the very system that they criticise. Despite their political, social or scientific influence, which is undeniable, their critical power is often limited by their inability to radically challenge the deeper anthropological and philosophical presuppositions on which mainstream psychiatry rests. It can be argued that Foucault offers such a challenge. Implementing his historico-philosophical method, Foucault is sceptical of the anti-psychiatric quest for non-oppressive modes of psychiatric power and the humanist and postmodern efforts to moralise or relativise psychiatric truth. All these modes of critique rest on preconceived notions of nature, power and truth and have been integrated by the pluralism of the psychiatric universe. Yet Foucault's critique seeks precisely the opposite: to explore a new anthropological conception of insanity that has the power to challenge the legal, moral or reductionist constraints under which medical truth currently operates.

Critical psychiatry is associated with anti-psychiatry and may therefore seem to be an embarrassing hangover from the 1970s. However, its essential position that functional mental illness should not be reduced to brain disease overlaps with historical debates in psychiatry more than is commonly appreciated. Three examples of non-reductive approaches, like critical psychiatry, in the history of psychiatry are considered.

Critical psychiatry has often been confused with what is widely known as ‘anti-psychiatry’. In this article the distinction is clarified and the particular contribution critical psychiatry makes is outlined. That contribution is constructive criticism: of the relationship between medicine and mental health practice, of the way drug and psychotherapeutic treatments for mental health difficulties might be better understood. These have implications for everyday clinical practice and there is much to be gained by openly embracing the controversies critical psychiatry highlights.

Attention-deficit hyperactivity disorder (ADHD) is a fact of culture rather than a fact of nature. For a diagnosis like ADHD to be scientifically useful you need to show that the concept leads to advancement of knowledge around causes. For it to be clinically useful, you need to show that use of the concept leads to improved clinical outcomes. As neither can be convincingly demonstrated, ADHD is unlikely to be either scientifically or clinically useful and the concept is well past its use-by date.

Knowledge about attention-deficit hyperactivity disorder (ADHD) is rapidly accumulating. Recent advances in diagnosis, genetics, neuroimaging, drug and non-drug treatments are considered, and the results are related to the critical attack on the ADHD diagnosis, which argues it a medicalising social construct, unhelpfully sustaining power relationships. The advances reviewed suggest that, while this attack can be conclusively dismissed as wrong and misleading, the phenomenological definition of ADHD is no longer sufficient for construct validity, though continues to be valuable as a guide for clinicians. The humanising and individualising concerns underlying the attack on the diagnosis could usefully be redirected to improving effective measurement of patient outcomes.