The Medicalisation Of Childhood
What drives the mental health crisis of childhood?
Question: What drives the mental health crisis of childhood?
Answer: Cultural forces turn children’s problems into psychological conditions and medicalise their lives.
Western society has become complicit in promoting the diseasing of childhood. Once upon a time childhood was associated with good health. Today, childhood itself, has become a risk factor for mental illness. The mental health of children has been problematised to the point that it has become normalised as a fact of life. And the situation always appears to get worse and worse!
Since I did research for my book Paranoid Parenting over two decades ago, I have noticed a proliferation of alarmist reports about the allegedly distressing state of young people’s mental health. Every year, the number of psychological problems afflicting the young seems to expand. Typically, these reports assert that ‘the problem is greater than we thought’ and is likely to get worse.
Every year they claim that the mental crisis of childhood is getting worse.
There is constant flood of reports promoting the assertion that the mental health crisis afflicting children is getting worse. ‘Evidence of UK’s child mental health crisis is stark and compelling’ warns a reporter in The Guardian, earlier this year. The reporter cited a study by The Children’s Society, which found that levels of happiness amongst children has declined so that 7 per cent of 10–15-year-olds in the UK feel unhappy with their lives. It reported that apparently
‘Rates of probable mental disorders among six- to 16-year-olds increased from 11.6%, or one in nine, in 2017 to 17.4%, or one in six, the health service’s statistical research agency found. Among the same age group, 39.2% experienced a downturn in their mental health while only 21.8% reported an improvement’.
Throughout the Lockdown alarmist reports about children’s mental health predicted that the pandemic would cause a crisis of well-being amongst the young. The media constantly asserted that the pandemic would have a devastating impact on children’s mental health. For example The Sunday Times featured an article about how Covid has spread an ‘epidemic of fear’ among the young, and painted a picture of the hell-like existence of locked-down young people, and their deteriorating mental health.
In July this year, a report by the former children’s commissioner Anne Longfield concluded, that the mental health emergency among children is so profound that it threatens the country’s future prosperity. The report noted that one in six children aged six to 16 was identified as having a probable mental health condition in July last year, up from one in nine in 2017. There was a 47 per cent rise in the number of new emergency referrals to crisis care teams in minors between December 2019 and April 2021.
Apparently in the United States the situation is even worse than in the UK. Last December the U.S. Surgeon General Issued an Advisory on the Youth Mental Health Crisis. It stated that the Covid-19 pandemic had further elevated what was already an alarming situation. Surgeon General Vivek Murthy observed that;
‘mental health challenges in children, adolescents, and young adults are real and widespread. Even before the pandemic, an alarming number of young people struggled with feelings of helplessness, depression, and thoughts of suicide — and rates have increased over the past decade.’
Since the end of the pandemic, the mantra among mental health professionals is ‘No Going Back To Normal’. Some psychiatrist claim that a ‘youth mental health crisis in ‘the next wave of the pandemic’. Others assert that the children’s mental health crisis constitutes a ‘national emergency’. The construction of dystopian view of the future of childhood by the mental health lobby in now widely circulated by the mainstream media.
The medicalisation of childhood and the ceaseless repetition of the claim that children’s mental health is getting worse began decades before the pandemic. Years before the Covid Pandemic, one alarmist report after another warned that the ‘problem is greater than we thought and is likely to get worse’. A year before the pandemic, a survey of teachers concluded that the mental health of pupils is ‘at crisis point’. 80 per cent of the teachers claimed that mental health among pupils in England had deteriorated during in the previous two years’. These surveys and reports are typically impressionistic and subjective but their cumulative effect is to encourage the adult world to perceive childhood through the prism of medicalisation.
Since the 1980s the manufacture of child-related mental health pathologies has been a growth industry. Report after report claims that mental illness among children is on the rise. Such reports insist that children are more anxious, stressed and depressed than in the past. Children’s behaviour is constantly diagnosed through a psychological label. This pattern is evident in all Anglo-American societies.
As far as sections of the mental health industry is concerned you can never drug children early enough. I remember when the American Academy of Pediatrics published guidelines recommending that children as young as 4 years old can be treated with the psycho-stimulant drug, Ritalin. These guidelines issued by the AAP proposed that pre-school children, who show symptoms of inattention and hyperactivity should be evaluated for pharmacological intervention. ‘Treating children at a young age is important, because when we can identify them earlier and provide appropriate treatment, we can increase their chances of succeeding in school’ was how Dr Mark Worlaich, one of the authors of the guidelines justified this proposal[ix].
Is it any surprise that the recent decades have seen what some health professionals have described as a Ritalin Explosion? In the United States, almost 10 per cent of children have an Attention Deficit Disorder diagnosis. Of these around a third are on some kind of medication.
As I explain in my study Therapy Culture: Cultivating Vulnerability In An Anxious Age children are continually subjected to a narrative of illness: ‘The narrative of illness does not simply frame the way people are expected to feel and experience problems – it also constitutes an invitation to infirmity’.
It is important to realise that the medicalisation of children says far more about the inventive powers of the therapeutic imagination than the conditions of childhood. What has happened is that children’s emotional pain and anxieties have been reinterpreted through the language of psychology. When children behave in ways that veer away from the norm we no longer call them unruly or troublesome but given them a medical label. Children who really hate going to school might have ‘school phobia’. Pupils worried about exams are diagnosed as suffering from ‘exam stress’. In other words, emotional responses to everyday experiences are being rebranded in therapeutic language.
Children’s disobedient behaviour is rendered acceptable by the tendency to treat it as a medical condition. Take the discovery of oppositional defiant disorder in 1980 by the American Psychiatric Association! Frequent tantrums, displays of angry behaviour, verbal hostility towards parents and defiance of adult authority by children as young as three are symptoms of this disease. Medical labels such as ADD and oppositional defiant disorder allows the adult world to avoid facing up to the consequence of its inability to exercise discipline through turning misbehaviour into a medical condition.
For some parents the discovery of new childhood disorders provides a welcome explanation for their children’s bad behaviour or poor performance in school: ‘she isn’t naughty, she is ill’. Given the predicament they face, many parents are all too easily reconciled to accept the diagnosis of ADD as the cause of poor behaviour and school performance. It is also evident that numerous teachers are promoting the diagnosis of ADD as an alternative to managing bad behaviour in the classroom through exercising discipline and authority. Failure to finish homework, inability to focus on class discussion, and boredom in school are regularly blamed on ADD.
Unsurprisingly, over the past 30 or so years children have internalised elements of this narrative. Today’s young people readily communicate their problems in a psychological vocabulary. They describe their feelings in terms of stress, trauma and depression. Writing in the 1940s, sociologist Robert Merton characterised this kind of development as a ‘self-fulfilling prophecy’ 1. That is, the assumptions and beliefs about people lead to them to behave in ways that confirm those assumptions and beliefs. Tell children that they will suffer stress, trauma and depression when enduring certain experiences, such as exams, and many will start to respond to those experiences in precisely those terms. Stewart Justman describes the way in which this expansion of medical diagnosis invites people to feel ill as the ‘nocebo effect’2 .
Once children are instructed to perceive what was once regarded as an everyday unhappiness through the language of psychology, they are likely to adopt the role assigned to them. The relationship between this medicalised narrative of wellbeing and its impact is dialectical. It not only frames the way people are supposed to feel and behave; it also invites people to be ‘not well’. That is why being ‘not well’ has today become part of many people’s identity.
Something has gone seriously wrong young people are treated as potential patients and are offered drugs to cope with life. It is difficult to disagree with Professor Sami Timimi, Consultant Child and Adolescent Psychiatrist and Director of Medical Education in the NHS in Lincolnshire, who responded to the rise in the number of children prescribed Valium by stating that ‘these statistics are shocking and I don’t think there has been a generation as pathologized as this one which is really worrying.[xv]’
But what is really shocking are the cultural attitudes that have led to the medicalisation of childhood and the tendency to regard children as potential patients. By portraying young people as potential mental-health patients, medical professionals disempower them and undermine their capacity for resilience. Tragically, the medicalisation of childhood has the perverse effect of actually making children feel mentally disturbed. Unwittingly, the medicalisation of childhood has has turned into a threat to he public health of young people.
It seems that adult society finds it easier to medicalise children than to educate them to learn how to deal with difficult circumstances. Experience shows that there is no medical solution to the problems of existence. Shoving down Valium children’s throats will do little to help them deal with the problems of life. On the contrary it renders them passive and undermines their capacity to deal with the problems that confront them. That’s why we must not let them turn our young into permanent patients.
Psychology’s corruption of socialisation
The medicalisation of childhood should be understood as an irresponsible evasion of the challenge posed by the need to socialise young people.
Socialisation is the process through which children are prepared for the world ahead of them. For sometime now, it has been evident that parents and schools have been struggling with the transmission of values and rules of behaviour to young people. In part this problem was caused by the lack confidence of older generations in the values into which it was socialised. More broadly western society have become estranged from the values that used to inspire it in the past and found it difficult to provide its adult members with a compelling narrative for socialisation.
The hesitant and defensive manner with which the task of socialisation is pursued has created a demand for new ways of influencing children. Lack of clarity about the transmission of values has led to a search for alternatives. The adoption of the practices of behaviour management serves as one influential approach towards solving the problem of socialisation. Schools have adopted a form of pedagogy that relies on psychological techniques to make children feel secure and good about themselves. Such techniques direct children to focus on their internal life and to interpret their predicament through the prism of psychology. In effect they are educated to perceive themselves as psychologically vulnerable and in need of mental health support.
Sadly, the complex emotional tensions that are integral to the process of growing up are now discussed as stressful events with which children and young people cannot be expected to cope. Yet is through dealing with such emotional upheavals that young people learn to manage risks and gain an understanding of their strengths and weaknesses. Instead of being encouraged to acquire an aspiration for independence, children are educated to feel powerless and likely to have mental health problems. The cumulative outcome of their scaremongering about mental health is to unwittingly make the situation worse. Through portraying young people as potential mental health patients, adult society disempowers them and short circuits the process through they can learn to cultivate their capacity for resilience. Those who want to see young people grow and flourish need to stop subjecting them to the narrative of mental health.
History has shown that young people are resilient and can overcome the adversity they face. To ensure that we cultivate children’s capacity for independence we need to provide them with clear moral values rather than with a psychological diagnosis. When children feel unhappy, out of sorts or experience a crisis of their self, adults need to talk to them and listen to their concerns rather than try to solve the problems with any depressants. What young people need from adults is not a diagnosis but inspiration and leadership. And that’s much more difficult to accomplish than sedating them with drugs!
One final point. Mental illness is a serious problem and can have a devastating impact on those of us that it afflicts. We trivialise this condition if the normal problems of existence are treated as mental health issues. And that is of no help to those members of society who are genuinely afflicted with the agony of mental illness.
The Self-Fulfilling Prophecy’, by Robert Merton, in the Antioch Review, Summer, 1948.
Justman, S. (2015) The Nocebo Effect: Overdiagnosis and Its Costs, Palgrave : New York.