‘One-in-10 kids are mentally ill’? That’s madness
Can you spot the three with disorders in your kid's nursery?
Headlines around the world yesterday reported the finding that one in 10 pre-school children are mentally ill.
The study in question was by Adrian Angold, associate professor of psychiatry at the Duke University Medical Centre in North Carolina. In Professor Angold’s view, these children ‘are really sick’ – he suggests the development of tools and skills to assess the psychological health of babies, in order to diagnose and intervene before the onset of conditions (1).
I suppose it is progress of sorts. After all, only six years ago we were informed that one in five children were so afflicted (2). Halving the rate of childhood mental distress in six years is no mean feat, and would, if true, have me praising those campaigners and professionals responsible for such an improvement in children’s wellbeing. But these statistics reflect, not changes in the psychological health of children, but changes in how we categorise and view childhood behaviour.
Does this one in 10 statistic chime with your experience? The next time you drop your child off at nursery or school, look around. From a class of 30, this claim suggests that three of those children are mentally ill. They may be noisy, upset, disobedient or anxious, but would you really categorise them as mentally ill? Of course not – but then, this debate tends to see parents not as protective guardians but more as a contributor to children’s psychological distress. It also conflates severe but rare mental distress with the more mundane, if unpleasant aspects of negotiating childhood.
In some respects, the classifying of children, even infants, as mentally disturbed is nothing new, having its roots in the psychoanalytic theories of Melanie Klein and her followers. For Klein, each infant’s development proceeds through ‘paranoid-schizoid’ and ‘depressive’ phases. However, these phases are seen as crucial in allowing the child to negotiate the anxiety and fear experienced during development. They are transitory phases, which normally resolve themselves satisfactorily and help the developing maturity of the child (3).
While the ‘psychoanalytic/psychiatric deluge’ of the first half of the twentieth century was rightly criticised for downplaying the social and political aspects of mental distress, it presented a more optimistic view of humanity than that espoused by psychiatry today. Theories of the importance of the unconscious in human behaviour may have undermined notions of rationality, and in this sense can be construed as labelling us all mad. However, Kleinians also saw the aggressive and destructive aspects of the unconscious as a source of strength. In contemporary psychotherapeutic discourse, by contrast, it is the fragility of human nature that is emphasised. The assumption that we are all mad merges with a belief that we are all fragile and in need of professional help.
Mental health professionals now categorise a plethora of childhood – and adult – behaviour as indicators of mental disorder. Whereas a diagnosis of a serious mental illness such as schizophrenia (a concept which is itself open to question (4)) is rare, figures of 10 to 20 per cent prevalence of mental disorder in children are found by reclassifying the hitherto mundane, if unpleasant, aspects of childhood and growing up under a psychiatric umbrella.
Bedwetting and truancy are seen as indicators of childhood mental health problems; refusing to obey parents becomes ‘oppositional defiant disorder’; fighting or ‘anti-social’ behaviour becomes ‘conduct disorder’. While bullying is frequently seen as a source of high mental anguish for children, on closer inspection the definition of what constitutes bullying has expanded to include ‘being mean to someone’ and ‘teasing or calling names’ (5).
The tendency is to view problems as unresolved, not only throughout childhood but also into adult life. Mental health charities such as MIND and the Mental Health Foundation routinely claim that one in four of us will suffer from a mental health problem. At times it appears that we are all ill. For example, a review of some North American studies found that 80million people have eating disorders, 50million suffer from depression and anxiety, 25million are sex addicts, 10million suffer from borderline personality disorder and 66million have experienced incest or sexual trauma, to name but a few. The total number of sufferers of all disorders adds up to several times the population of North America (6). Perhaps everybody has multiple pathologies! (7).
Some children and their parents may well feel anxious and unhappy, and may interpret their experiences through a psycho-medical framework. However, it could be argued that this is more to do with a rise in mental health professionals and campaign groups than to a rise in mental illness. If people are encouraged to view themselves as fragile, ill and in need of professional help, it is perhaps no surprise that some individuals internalise such views.
Ken McLaughlin is a senior lecturer in social work at Manchester Metropolitan University.
(1) ‘One in ten pre-schoolers may be suffering from mental illness’, Guardian, 29 November 2005
(2) ‘The Big Picture’, Mental Health Foundation, 1999
(3) See Melanie Klein and Critical Social Theory, Fred Alford, 1989, for example
(4) See Schizophrenia Re-evaluated (1990) by Mary Boyle or The Dialectics of Schizophrenia (1997) by Phil Thomas for good critiques of the concept of schizophrenia as a useful diagnostic category
(5) See Childline’s website
(6) See Manufacturing Victims by Tana Dineen, 1996.
(7) At a mental health social work conference I attended in 1998 this was the response given by one of the speakers when I questioned the uncritical acceptance of some of these studies
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