The Complexity of Psychiatric Care, from Pregnancy to Adolescence: Beyond the Endogenous-Exogenous Dichotomy

Book excerpt: Child and adolescent psychiatry hosts a range of diverse epistemological positions regarding the origin of psychical suffering, from fully endogenous (e.g. genetic) to mostly exogenous (e.g. family trauma, etc.). The complexity of clinical situations generally precludes such epistemologies to require exclusive therapeutic strategies: psychodynamic psychotherapy can be fruitful in the context of monogenic genetic illnesses (at the family or individual level), while pharmacology can be a necessary tool in a variety of difficult relational contexts or personality issues (e.g. in adolescence). Thus nowadays, the most promising therapeutic perspectives in child and adolescent psychiatry attempt to do justice to the polyfactorial complexity of mental suffering (notably by refining their psychopathologies), by drawing on e.g. biopsychosocial or epigenetic models – even more so as prevention policies ask for longitudinal studies to help with the early detection of potential future troubles.